The Comprehensive Care of the Bariatric Patient: Learning the Essentials of a Successful Bariatric Program (original) (raw)

Management of the Metabolic/Bariatric Surgery Patient

The American Journal of Medicine, 2011

There is currently a global pandemic of obesity and obesity-engendered comorbidities; in particular, certain major chronic metabolic diseases (eg, type 2 diabetes) which markedly reduce life expectancy and quality of life. This review is predicated on the fact that management of the obese patient is a primary concern of all physicians and health care providers, and that metabolic/bariatric surgery is a highly successful therapeutic option for this disease.

Bariatric Surgery - Effects on Obesity and Related co-Morbidities

Current Diabetes Reviews, 2014

Laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG) are the three most commonly performed bariatric procedures. Obesity responds well to bariatric surgery, with major long-lasting weight loss that is most pronounced after RYGB and SG, where the mean weight loss is about 40 kg or 15 body mass index (BMI) units. Some of the benefits after RYGB and SG are independent of weight loss, and the remission of type 2 diabetes is observed a few days after the operation; this depends on changes in insulin sensitivity and gut hormone responses, especially a 10-fold increase in glucagon-like peptide-1 (GLP-1), which improves insulin secretion. After gastric banding, the remission of diabetes depends more on weight loss. Bariatric surgery reduces cardiovascular risk factors including hypertension, lipid disturbances, non-alcoholic fatty liver, musculoskeletal pain and reduces mortality of diabetes, cardiovascular diseases and cancers. Bariatric surgery also improves quality of life. The acute complications of surgery are infection, bleeding and anastomotic leak. Long-term complications are nutritional deficiencies, including vitamins and minerals, and anemia. Some patients have dumping after meals, and a few patients will develop postprandial hypoglycemia after RYGB. About 25% of patients require plastic surgery to provide relief from excessive skin tissue.

Bariatric surgery versus non-surgical treatment for obesity: a

Objective To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity. Design Systematic review and meta-analysis based on a random effects model. Data sources Searches of Medline, Embase, and the Cochrane Library from their inception to December 2012 regardless of language or publication status. Eligibility criteria Eligible studies were randomised controlled trials with ≥6 months of follow-up that included individuals with a body mass index ≥30, compared current bariatric surgery techniques with non-surgical treatment, and reported on body weight, cardiovascular risk factors, quality of life, or adverse events. Results The meta-analysis included 11 studies with 796 individuals (range of mean body mass index at baseline 30-52). Individuals allocated to bariatric surgery lost more body weight (mean difference −26 kg (95% confidence interval −31 to −21)) compared with non-surgical treatment, had a higher remission rate of type 2 diabetes (relative risk 22.1 (3.2 to 154.3) in a complete case analysis; 5.3 (1.8 to 15.8) in a conservative analysis assuming diabetes remission in all non-surgically treated individuals with missing data) and metabolic syndrome (relative risk 2.4 (1.6 to 3.6) in complete case analysis; 1.5 (0.9 to 2.3) in conservative analysis), greater improvements in quality of life and reductions in medicine use (no pooled data). Plasma triglyceride concentrations decreased more (mean difference −0.7 mmol/L (−1.0 to −0.4) and high density lipoprotein cholesterol concentrations increased more (mean difference 0.21 mmol/L (0.1 to 0.3)). Changes in blood pressure and total or low density lipoprotein cholesterol concentrations were not significantly different. There were no cardiovascular events or deaths reported after bariatric surgery. The most common adverse events after bariatric surgery were iron deficiency anaemia (15% of individuals undergoing malabsorptive bariatric surgery) and reoperations (8%). Conclusions Compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome. However, results are limited to two years of follow-up and based on a small number of studies and individuals. Systematic review registration PROSPERO CRD42012003317 (www. crd.york.ac.uk/PROSPERO).

Bariatric surgery in managing diabetes mellitus

Current Opinion in Gastroenterology, 2016

Purpose of review Obesity is a worldwide epidemic, having profound effects on Western populations. Bariatric surgery has long been employed to treat obesity and its related comorbidities. Over time, researchers have amassed significant data to support bariatric surgery in the pursuit of treating diabetes mellitus. This review serves to introduce the most recent findings and their relation to the various bariatric surgical options as bariatric surgery will continue to cement itself in the treatment paradigm of diabetes mellitus. Recent findings Numerous studies performed in the past 10 years have demonstrated the improvement or cessation of diabetes with bariatric surgical intervention. In comparing the vertical sleeve gastrectomy and Roux-en-Y gastric bypass, data demonstrate a more beneficial response of diabetes to the Roux-en-Y gastric bypass, and an even further exaggerated response with the biliopancreatic diversion/duodenal switch. The benefit has long been established, but what causes the improvement in diabetes mellitus after bariatric surgery? Recent data suggest a decrease in circulating bile salts as well as changes to inflammatory markers and circulating cytokines. Furthermore, tailoring of existing surgical procedures has led to the development of the SIPS procedure, and its benefit is demonstrated in bypassing a large portion of intestine while eliminating an enteroenterostomy, helping to reduce short gut syndrome and resultant diarrhea. Summary The surgical climate within the bariatric field is changing and will continue to do so in the future. As the understanding of the causes or mechanisms in which bariatric surgery improves metabolic disorders becomes more evident, the process of individualizing care for specific patients will become more prevalent.

Treatment of obesity and diabetes with bariatric surgery

Abstract Obesity rates are on the rise worldwide. Nearly 1 in every 4 Canadians is classified as being overweight. With an increase in obesity, there is also a correlated rise in its comorbidities, most notably Type-2 Diabetes Mellitus (T2DM). Bariatric surgery is superior to diet and lifestyle management in managing the severe obese. These bariatric procedures are traditionally classified as either being restrictive(reducing caloric intake), or malabsorptive (re-routing the gastrointestinal tract). The roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric surgery. Studies have shown that post-RYGB, there is a significant improvement or even complete resolution in patients’ type-2 diabetes mellitus (T2DM), with significantly more patients achieving euglycemia compared to the control population. RYGB has also been shown to prevent the development of T2DM. When RYGB was compared to more restrictive procedures, it achieved superior results in both weight-loss and T2DM resolution and the maintenance of these results long-term. The superiority of procedures, such as RYGB, is potentially explained through alterations in gut hormones, ghrelin and GLP-1. In this review, we explore the role of bariatric surgery in the prevention and treatment of T2DM, with a specific focus on the recent evidence surrounding surgical treatment via RYGB. Keywords: Bariatric surgery, obesity, diabetes

Bariatric surgery as metabolic surgery for diabetic patients.

The recent increase in the prevalence of obesity seems to be responsible for the increase in T2 Diabetes Mellitus (T2DM). At present around 50 % of T2DM patients are obese and this percentage appears set to increase in the near future. Successful management of T2DM in obese patients is a complicated task, as many parameters such as blood pressure, LDL-cholesterol levels have to be adequately controlled along with HbA1c levels. There is a substantial amount of evidence showing that bariatric surgery achieves long term remission of diabetes in the majority of obese patients and improves significantly comorbidities associated with DM such as dyslipidemia, hypertension, and obstructive sleep apnea. It seems that early surgical intervention before irreversible b-cell damage has occurred, increases the chances of long term T2DM resolution. However, at present a very small percentage (< 2%) of obese patients with T2DM is treated surgically. The present review focuses on the efficacy and safety of the main bariatric procedures. It also emphasizes the mechanism with which bariatric surgery exerts its therapeutic effect and on the long term results on T2DM remission.