[Contemporary overview of the bariatric-metabolic surgery]

Abstract

Introduction: The increasing prevalence of obesity and type 2 diabetes mellitus (T2DM) worldwide may nowadays be regarded as a "twin" metabolic pandemic, causing the number of patients with the metabolic syndrome (MS) to rise rapidly. MS is a combination of several interrelated medical disorders such as obesity, T2DM, hypertension, dyslipidaemia etc. These conditions very frequently result in atherosclerosis, ischaemic heart disease, liver steatosis or even steatofibrosis. MS usually causes a significant worsening of the quality of life, often also leading to shortened life span. Bariatric, also referred to as metabolic (B-M), surgery currently represents a very powerful method for the treatment of morbid obesity and the metabolic syndrome.

Methods: Contemporary bariatric-metabolic surgery uses either restrictive or malabsorptive methods, or a combination thereof. The purely restrictive procedures may include for instance adjustable gastric banding (AGB), and more recently also vertical gastric greater curvature plication. According to some authors, the purely restrictive methods include sleeve gastrectomy (SG); this procedure, besides restriction and a faster emptying of the residual stomach, has been proven to involve a hormonal effect (decreased plasma ghrelin level). Methods such as biliopancreatic diversion by Scopinaro (BPD/S) or its duodenal switch modification (BPD/DS), are regarded as purely malabsorptive. The Roux-en-Y gastric bypass (RYGBP), the most commonly used type of bypass surgery, represents a combination (restrictive-malabsorptive) method.

Results: According to Buchwald's meta-analysis, the total average weight loss after a B-M surgery was 38.5 kg, or 55.9% EBWL (Excess Body Weight Loss), regardless of the method and timing of the operation. Up to 2 years after the procedure, the average weight loss was 36.6 kg, or 53.8% EBWL, and more than 2 years after the procedure, the average weight loss was 41.2 kg, or 59% EBWL. T2DM was improved or resolved after the operation in 86.6% of cases. The best results of T2DM treatment were achieved after BPD/DS (95.1%). T2DM resolved after GBP in 80.3%, after SG in 75.8% and after AGB in 56.7% of obese diabetics.

Conclusion: Treatment options for the metabolic syndrome include bariatric-metabolic surgery, preferably using the mini-invasive laparoscopic method. These procedures are indicated primarily in morbidly obese patients with BMI > 40 kg/m2 after conservative therapy failure, or patients with severe obesity (BMI > 35 kg/m2) associated with serious circulatory, metabolic or mobility complications. Moreover, surgical treatment of T2DM has been proven to be possible in the last decade.