Bariatric vs Metabolik Surgery

 

WHAT IS OBESITY (BARIATRIC) AND DIABETES (METABOLIC) SURGERY?

 

The word “bariatric” comes from Greek word “baros”, which means “weight”, and from beginning has been used to describe gastrointestinal surgeries ensuring weight loss to obese patients. It is known that obesity surgeries besides weight reduce treat diabetes, hypertension, fat disorders and decrease related to these diseases mortality,. Experiments performed on rats and medical studies made on people shows that this type of surgeries, prior to weight loss, induct different metabolic effects and improve diabetes.

In 2007 in Rome, at the Diabetes Surgery Summit Conference diabetes surgery was defined and metabolic surgery concept has been improve. Lately American Bariatric Surgery Association changed its name by adding the metabolic surgery to became American Bariatric and Metabolic Surgery (ASMBS).

Today Bariatric and Metabolic Surgery definitions are intertwined. Which methods of surgery is included in bariatric and which in metabolic surgery definition continues to be a serious debate.

In 1978, Buchwald and Varco proposed the concept of metabolic surgery. Metabolic surgery has been defined as ''Surgical manipulation of the normal organs and organ systems in order to regain health by obtaining biological results" As an examples of metabolic surgery may serve: gastrectomy and vagatomy for the treatment of peptic ulcer disease, diversion portal for glycogen storage disease and partial ileal bypass for hyperlipidemia.

On the other side splenectomy for ITP disease is defined as a functional surgery.

Rubino et al. in the studies published in the Annals of Surgery in 2012 compare data of patients treated in bariatric and metabolic surgical departments of Weil Cornell Medical College. In the results of comparison of 100 patients from each department; metabolic surgery group consist of younger patients with lower body mass index (BMI), and less comorbidities. According to this data Rubino et al have modified metabolic surgery definition. Metabolic surgery should be considered as an extensive surgical specialty performed to treat metabolic diseases; which targets gastrointestinal tract. Depending on the aim of surgery it's counted among the bariatric or metabolic surgery group. If we want to treat patients concomitant diseases performed surgery is metabolic. If aim is weight loss, performed surgery is bariatric. Because of this, for example sleeve gastrectomy is not just bariatric surgery, it can also at the same time be a metabolic surgical procedure.

Duodenojejunal bypass (DJB) (bridging), Duodenoileal bypass (DIB) and ileal interposition (IT) are new experimental metabolic surgical procedures.

The first experimental studies on rats and dogs related to IT were started in the 1980s. The most of the studies indicate that IT, treat diabetes by increasing secretion of GLP-1 and PYY peptide and decreasing B cells hypertrophy and peripheral insulin resistance.

The common problem in all this experimental studies is model unsuitability with a human. There is no prospective randomized study of the IT performed on people. In Brazil metabolic surgery started with IT, but later to IT procedure sleeve gastrectomy has been added. This technique called as ileal break was shown in many studies as incretin and GLP-1 PYY levels increasing method.

Bariatric surgery, that overcomes also diseases related to obesity (diabetes, hypertension, dyslipidemia, etc.) should be considered as a metabolic surgery.

Methods of bariatric and metabolic surgery are divided into three groups.

  1. Restrictive methods: The group of restrictive methods included gastric band, sleeve gastrectomy.

  2. Combined methods reducing volume of stomach and the absorption (Restrictive and malabsorptive) Among the combined methods reducing volume of stomach and absorption (Restrictive and malabsorptive) the most important is gastric bypass surgery. Gastric Bypass techniques include Roux-N-Y, duodenal switch IT or mini-bypass surgeries.

  3. Methods reducing absorption (Malabsorptive) Among the methods reducing absorption (Malabsorptive) the most popular is biliopancreatic diversion, used in patients with super obesity, eating disorders and habits of eating big amongs of food. Further, methods like DJB, DIB are classified as the malabsorptive methods.