Experiments were done in the last half of the 20th century to see if diseases like high lipids and cholesterol could be treated with surgical procedures such as intestinal bypass.
In 1995, Dr. Walter Pories and his research team published an article titled “Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus”. Since that landmark paper, much evidence has been accumulated showing that surgery can cure/improve several metabolic diseases, especially adult onset or Type 2 diabetes mellitus.
Today, the term Metabolic Surgery is used to describe surgical procedures to treat metabolic diseases, especially, type 2 diabetes. The best-known metabolic surgery is the Gastric Bypass with over 20 years of experience with this procedure. Other established procedures are the Gastric Band and the Biliopancreatic Diversion with or without Duodenal Switch. Experimental procedures under study include the Vertical Sleeve Gastrectomy, Ilial Interposition, and Duodenojejunal Bypass. Other minimally invasive devices, such as the Intraluminal Duodenal Sleeve are also being investigated.
The term Metabolic Surgery is used to describe weight loss treatments and procedures to treat metabolic diseases, especially, type 2 diabetes.Gastric Bypass and Bilio-pancreatic diversion have resulted in control/ cure for diabetes. This surgery can only be performed in obese patients with BMI greater than 35.
However, the need for control of diabetes in non-obese patients led to the development of Ileal Interposition surgery or Duodenojejunal bypass surgery for diabetics who do not require gastric bypass. This can be performed in this type 2 diabetics with BMI as low as 30 or with sleeve Gastrectomy in overweight/obese diabetics.
Ileal interposition is a procedure where a segment of last part of small intestine (ileum) is interposed between 2 parts of the small intestine (jejunum) just beyond the stomach. No part of small intestine is removed or bypassed. The duodenojejunal bypass is similar to gastric bypass except that the small bowel anastomosis is done to the duodenum instead of the stomach. These two procedures give patients good stomach volume to eat.
This surgery can only be performed in obese patients with BMI greater than 35. This can be performed in this type 2 diabetics with BMI as low as 30 or with sleeve Gastrectomy in overweight/obese diabetics. Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.
BMI more than 40, or more than 45 kgs overweight.
Benefits of Metabolic Surgery
Long-Term Weight Loss Success
Bariatric surgeries result in long-term weight-loss success. Most studies demonstrate that more than 90 percent of individuals previously affected by severe obesity are successful in maintaining 50 percent or more of their excess weight loss following bariatric surgery.
Several large population studies find that individuals affected by severe obesity who have had bariatric surgery have a lower risk of death than individuals affected by obesity who do not have surgery. One of these studies found up to an 89 percent greater reduction in mortality throughout a 5-year observation period for individuals who had bariatric surgery when compared to those who did not.
Improvement in Coexisting Diseases
The exceptionally high reduction in mortality rates with bariatric surgery is due to the highly significant improvement in those diseases that are caused or worsened by obesity.
Risks & Complications
Intra-abdominal complications including disruption of a bowel, intra-abdominal infections, small bowel obstructions, and death may result from bariatric surgery in less than 0.5% of patients. There may be other complications related to a specific type of surgery such as band slippage and /or erosion after gastric banding. Gastric bypass-specific side effects include clinical manifestations of vitamin malabsorption. There is also the potential for dumping syndrome (feeling bloated, dizzy).In rare cases, might require reoperation.