METABOLIC SURGERY

       Metabolic surgery is scientifically proven, very safe method for long term remission from type 2 diabetes. Sleeve gastrectomy and diversion procedures alter several hormones and genes controlling insulin production and sensitivity. These alterations result in sufficient insulin production and reduced insulin resistance leading to long term control of blood sugars without the need for tablets or insulin.

       These are performed on stomach and intestine by laparoscopic method (by putting small holes on tummy). Metabolic and bariatric surgeries are essentially same. If the purpose of surgery is remission from diabetes and other co-morbid medical conditions, it is called metabolic surgery. If the purpose of surgery is weight loss, then it is called bariatric surgery.

Metabolic surgery is scientifically proven, very safe method for long term remission from type 2 diabetes. Sleeve gastrectomy and diversion procedures alter several hormones and genes controlling insulin production and sensitivity. These alterations result in sufficient insulin production and reduced insulin resistance leading to long term control of blood sugars without the need for tablets or insulin.

These are performed on stomach and intestine by laparoscopic method (by putting small holes on tummy). Metabolic and bariatric surgeries are essentially same. If the purpose of surgery is remission from diabetes and other co-morbid medical conditions, it is called metabolic surgery. If the purpose of surgery is weight loss, then it is called bariatric surgery.

Individuals suffering from type 2 diabetes with excess weight benefit from metabolic surgery. Metabolic surgery helps individuals with uncontrolled type 2 diabetes regardless of their weight.<

 

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Metabolic surgeries alter several gut hormones, that control insulin production and insulin sensitivity. These hormonal changes include increased incretins (GLP 1, peptide YY) and reduced anti-incretins & ghrelin.

Incretins are gut hormones, which increase insulin release in the presence of glucose. In these surgeries, food reaches end of small bowel (distal ileum) rapidly, resulting in increased GLP 1 production. GLP 1 increases size & number of insulin producing beta cells of pancreas. This hormone also reduces insulin resistance. Anti-incretins are produced in first part of small bowel (duodenum) and increase insulin resistance. In most bariatric/metabolic surgeries since duodenum is bypassed, anti-incretins are reduced. Ghrelin hormone, produced in the stomach fundus, increases insulin resistance. As fundus of stomach is removed in most of metabolic surgeries, Ghrelin production is reduced. These hormonal alterations result in increased insulin production and increased Insulin sensitivity leading to durable diabetes remission.

 

ARE YOU SUFFERING FROM TYPE 2 DIABETES WITH OBESITY?

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Metabolic surgery results in long term remission from type 2 diabetes. Blood sugars become normal even without using medications. And this control is long lasting. Metabolic surgeries help individuals with uncontrolled diabetes despite optimum medical treatment.

Mr. Akiri Balaji used to suffer from obesity with 149 kg weight and uncontrolled type 2 diabetes with HbA1C of 11.7%. Dr. Amar performed ‘Sleeve gastrectomy with loop gastroileal bypass’ on him in Oct 2016. He lost 63 kg. His present weight is 86 kg and HbA1C of 3.9%. He is leading diabetes free life.

ARE YOU SUFFERING FROM UNCONTROLLED TYPE 2 DIABETES?

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Metabolic surgeries improve other medical problems like high blood pressure, high blood fats (hyperlipidemia), snoring (obstructive sleep apnea), joint pains (osteoarthritis) in significant number of individuals. These surgeries halt progression of obesity and diabetes induced complications and in certain percentage of patients, these problems also resolve.

ARE YOU SUFFERING FROM HIGH BLOOD CHOLESTEROL WITH OBESITY?

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If your blood sugars are uncontrolled despite changing lifestyle, using tablets and insulin, then you need metabolic surgery to control blood sugars. If you have excess weight, you can undergo metabolic surgery for diabetes remission even if your blood sugars are under control.

METABOLIC SURGERY RESULTS IN LONG TERM REMISSION FROM TYPE 2 DIABETES

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Several studies demonstrated superior results with metabolic surgery compared to medical management in patients suffering from type 2 diabetes and obesity. International Diabetes Organizations included metabolic surgery in the treatment algorithm of type 2 diabetes.

According to this algorithm, in Indians/ Asians, metabolic surgery is 

 

  • considered if BMI is ≥ 27.5 kg/m2 with inadequately controlled type 2 diabetes 
  • recommended if BMI is ≥ 32.5 kg/m2 with inadequately controlled type 2 diabetes 
  • recommended if BMI is ≥ 37.5 kg/m2 with mere presence of type 2 diabetes. 

 

 

And in individuals from Western countries, metabolic surgery is 

 

  • considered if BMI is ≥ 30 kg/m2 with inadequately controlled type 2 diabetes 
  • recommended if BMI is ≥ 35 kg/m2 with inadequately controlled type 2 diabetes 
  • recommended if BMI is ≥ 40 kg/m2 with mere presence of type 2 diabetes.

 

ARE YOU SUFFERING FROM TYPE 2 DIABETES AND OBESITY?

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If your weight is normal or your BMI is < 27.5 kg/m2 and if you have uncontrolled Type 2 diabetes leading to health risks despite optimum medical treatment, then you can be considered for metabolic surgery to control diabetes, after discussing with your endocrinologist.

ARE YOU SUFFERING FROM UNCONTROLLED TYPE 2 DIABETES?

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Metabolic surgery acts by enhancing insulin production and sensitivity. In type 1 diabetes, there is reduced or absent production of insulin, mostly due to autoimmune destruction of beta cells of pancreas (body defense senses its own cells as enemies and destroy them). So metabolic surgery won’t help individuals with type 1 diabetes. It is contraindicated.

METABOLIC SURGERY RESULTS IN LONG TERM REMISSION FROM TYPE 2 DIABETES

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Sleeve gastrectomy (SG), Roux-en-y gastric bypass (RYGB) and Mini gastric bypass – One anastomosis gastric bypass  (MGB – OAGB) are the most popular metabolic surgeries. But they have certain limitations. Remission is more with diversion surgeries since hormonal changes are high. Biliopancreatic diversion with duodenal switch (BPD DS) is the most effective metabolic Surgery since hormonal changes are very high, but malabsorption risk is also very high since most of the small intestine is bypassed. There are several modifications of BPD DS to reduce mal-absorption without compromising on efficacy. These include ‘Single anastomosis duodenoileal bypass with sleeve (SADI S)’, ‘Sleeve gastrectomy with loop gastroileal bypass (SG LGIB)’, ‘Sleeve gastrectomy with duodeno-ileal interposition (SG DII)’, Sleeve gastrectomy with jejunoileal anastomosis (SG JIA)’ and ‘Sleeve gastrectomy with loop duodeno-jejunal bypass (SG LDJB)’. These sleeve + bypass combination surgeries achieve durable control of type 2 diabetes.

KNOW MORE ABOUT DIFFERENT TYPES OF METABOLIC SURGERIES –

SLEEVE GASTRECTOMY (SG)

SINGLE ANASTOMOSIS DUODENOILEAL BYPASS WITH SLEEVE (SADI S)

SLEEVE GASTRECTOMY WITH LOOP GASTROILEAL BYPASS (SG LGIB)

SLEEVE GASTRECTOMY WITH LOOP DUODENOJEJUNAL BYPASS (SG LDJB)

SLEEVE GASTRECTOMY WITH JEJUNOILEAL ANASTOMOSIS (SG JIA)

ROUX EN Y GASTRIC BYPASS (RYGB)

MINI GASTRIC BYPASS or ONE ANASTOMOSIS GASTRIC BYPASS (MGB – OAGB)

BILIOPANCREATIC DIVERSION WITH DUODENAL SWITCH (BPD DS)

SLEEVE GASTRECTOMY WITH DUODENOJEJUNAL BYPASS (SG DJB)

SLEEVE GASTRECTOMY WITH DUODENOILEAL INTERPOSITION (SG DII)

SLEEVE GASTRECTOMY WITH JEJUNOILEAL INTERPOSITION (SG JII)

SLEEVE GASTRECTOMY WITH TRANSIT BIPARTITION (SG TB)

BANDED SLEEVE GASTRECTOMY (BSG)

BANDED ROUX EN Y GASTRIC BYPASS (BRYGB)

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