What are the procedures for metabolic surgery?
A consequence of the increasing sedentary lifestyle, poor nutritional habits and lack of exercise that has come to characterize the man of the 21st century is weight gain, overweight and obesity. This is due to a disproportionate balance of our energy intake and expenditure with excess calories being stored as body fat. This leads to a disturbance in the metabolic balance of the body with an increased predisposition to hypertension, high levels of lipids in the blood circulation, especially triglycerides (dyslipidemia) and high blood sugar levels. This constellation of symptoms and signs is called the metabolic syndrome and presents an increased risk of cardiovascular disease, stroke, and type 2 diabetes mellitus.
Different methods have been used to address this disorder, especially with the use of medication, lifestyle modifications, and exercise with minimal, and at best, modest results. In the late 20th century, trials and experiments began to be conducted to establish whether surgical procedures could be offered as a treatment option for metabolic disorders. The results obtained were amazing. This gave birth to metabolic surgery. Since then, there has been increasing evidence of the efficacy of metabolic surgery as a treatment option for metabolic conditions such as diabetes mellitus.
Metabolic surgery, known by its other names, bariatric surgery or diabetes surgery, uses bariatric techniques and principles including ileal interposition, transit bipartition, gastric bypass, sleeve gastrectomy, gastric band, etc. The procedures are generally carried out using minimal access incisions (laparoscopic incisions). The results so far have been phenomenal to say the least.
Indications for metabolic surgery or who qualifies for metabolic surgery includes the following criteria
Have a body mass index of 40 or higher or weigh more than 100 pounds.
Have a body mass index of 35 or greater with a minimum of one or more obesity-related comorbidities, including type 2 diabetes mellitus, nonalcoholic fatty liver disease, hypertension, heart disease, to name a few.
· Difficulty or inability to achieve a healthy weight despite conscious efforts to lose weight.
procedures
The basic principle by which metabolic surgery works is to decrease the length of the intestine, thus decreasing the amount of food absorbed and increasing satiety. In addition, there is an alteration in the intestinal hormones that contribute to the known effects.
Some of the procedures include
Ileal interposition: this procedure consists of placing the ileum between the stomach and the proximal part of the small intestine. This works to increase the secretion of certain gut hormones eg GLP-1, GIP, lowering ghrelin levels, regulating glucagon levels.
Advantages
Increased GLP-1 leads to increased insulin secretion in the early phase
Long-term regulation of insulin secretion.
Decreased insulin resistance
Decreased glucose production by the liver.
Control of Type 2 Diabetes Mellitus
Disadvantage
technically difficult
Gastric band surgery: A small portion of Sam’s stomach is divided into the small intestine. The distal segment of the small intestine is attached to the small portion of the stomach. The proximal intestinal portion is then connected to the side of the distal intestinal portion to ensure mixing of gastric secretions and enzymes with food. This creates a smaller stomach pouch and less digestion and absorption of nutrients from food.
Advantages
Achieve rapid weight loss.
Increased satiety with small portions of food
Long-term maintenance of weight loss.
Disadvantages
A complex procedure
May predispose to long-term vitamin and mineral deficiency
It leads to a longer hospital stay than the other techniques.
transit bipartition: this can be combined with sleeve gastrectomy. The small intestine divides at a certain point. The distal portion is attached to the lower portion of the stomach, while the proximal portion of the intestine is attached to the small intestine.
Advantages
Patients can lose up to 70% of the weight
Leads to the achievement of good sugar control
Decreased occurrence of leaks compared to sleeve gastrectomy
Disadvantages
A complex procedure
It can lead to vitamin and mineral deficiency.
Gastric band: here, more than 4/5 of the stomach is removed. The remaining portion looks like a banana. This significantly decreases the capacity of the stomach and alters the production of intestinal hormones.
Advantages
Decreases the capacity of the stomach
It leads to a subsequent and faster weight loss.
The hospital stay is short
It alters the intestinal hormones that lead to a lower feeling of hunger.
Disadvantages
cannot be reversed
It can lead to vitamin and mineral deficiency.
Gastric band: here, an inflatable band is secured around the upper part of the stomach. A small pocket is created above the band, just like below the band. This leads to greater satiety and fullness with smaller food portions.
Advantages
Leads to a weight loss of more than 40%
There is no cutting involved
The functional capacity of the stomach decreases.
Very low postoperative complications
Disadvantages
Weight loss is achieved more slowly compared to other procedures
The band can slip
Higher rate of repeat procedures.