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Bariatric Surgery

Bariatric Surgery

Bariatric surgery is a technique used to treat obesity and its complications. The first bariatric surgery performed was a jejunoileostomy done in 1953 by Varco. From then bariatric surgery changed a lot, being performed nowadays by laparoscopic approach (minimally invasive). The mostly commonly practiced bariatric surgeries worldwide are

1. Sleeve gastrectomy

Involves removing 75-80% of the stomach. This forms part of a restrictive surgery

2. Gastric bypass

This is a malabsorptive-restrictive surgery.  The stomach is divided in 2 parts, with the smaller part being used for digestion. The small intestines are also divided so as only part of it absorbs nutrients.

3. Gastric banding

The band is placed at the stomach level to restrict food intake and slow digestion.

4. Gastric greater curve plication

The stomach is plicated in such a form to limit the quantity of food the person can eat.

As obesity increased during the last decades, the number of surgeries being performed increased drastically, therefore allowing more studies and comparison. When the results were seen it was observed that the surgeries also had a direct effect on one of the most important metabolic diseases, Diabetes Mellitus. With this observation appeared the denomination of Metabolic and Diabetic Surgery.

Dr. Sookha Pravish Rai, took part in the 2nd World Congress on Interventional Therapies for Type 2 Diabetes on 28-30 March 2011 in New York, USA. The direct and indirect complications of Diabetes mellitus are extremely severe. Worldwide, more than 285 million people are affected by DM, 50.8 million only in India, 43.2 million in China and 26.8 million in the USA. The prevalence of diabetes mellitus Nauru is currently leading with 30.9% of its adult population affected. Mauritian population comes in the 4th most prevalent place with 16.2% of Mauritian adults affected by Diabetes Mellitus.

Worldwide every 10 seconds a person dies from diabetes related causes, and every 10 seconds 2 people develop diabetes.  Diabetes is the largest cause of kidney failure in developed countries and is responsible for huge dialysis costs.

Surgeries are being done worldwide in obese and Nonobese diabetics with great results on the glycemic controls. A study by Dr Lee published in obesity surgery journal this July showed that in patients between BMI 23 – 35 operated by laparoscopic gastric bypass, 57% were diabetes free without any medications, and up to 93 % have improvement in their glycemic level. There are many studies published in the obesity surgery journal and SOARD journal showing the beneficial effect of bariatric surgery on Diabetes mellitus, with all results suggesting best results in patients who have been recently diagnosed with DM. Most bariatric surgeons suggest that the DM patients should be operated upon within 5 years of being diagnosed with DM. My research work during my PHD studies showed 85% of patients were drug free 2 years after sleeve gastrectomy.

I would like to conclude by saying that all these surgeries are performed laparoscopically (minim invasive surgery). If the type of surgery and the patient is selected well the results are excellent. This year during the 2nd World Congress on Interventional Therapies for Type 2 Diabetes the International Diabetes Federation (IDF) accepted diabetic surgery as an official treatment for Diabetes Mellitus. The actual possibility of treating diabetes by surgery, or even ameliorating it will decrease diabetes related complications as renal failure requiring dialysis, cataract, heart disease, female hormonal disease, gastroenterological disease, neurological disease, arteriopathy going till gangrene and psychiatric disorders. Treatment of all the complications consumes a great part of the health budget.

Treatment of Diabetes is definitely a better solution than treating the complications later.