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by Safer D

Surgery for Metabolic Syndrome

Weight loss is very important in preventing or managing metabolic syndrome. Before surgery is considered, lifestyle changes, dietary changes, and medicines are often recommended.
Bariatric surgery is considered if a person:
  • Is severely obese ( BMI greater than 40) and diet and exercise treatment has been ineffective
  • Is obese (BMI 35-40) with cardiovascular disease, uncontrolled type 2 diabetes, lipid disorders, sleep apnea, or other physical problems related to increased weight, such as osteoarthritis, that interferes with daily activities.
There are several types of bariatric surgery options that can help you lose weight if you are obese and meet the other criteria:
  • Roux-en-Y gastric bypass —Roux-en-Y gastric bypass involves cutting the stomach to make it smaller. A major part of the intestines that absorb food are bypassed. This allows you to eat only small portions of food and prevents some of the calories from being absorbed by bypassing some of the intestines.
  • Laparoscopic adjustable gastric band (LapBand)—With the aid of a laparoscope, an adjustable band is placed around the stomach. The surgery causes weight loss by decreasing the size of the stomach and amount of food you can eat. But, there is no interruption with the absorption of nutrients. The band is adjustable, so the doctor can change the size of the stomach.
  • Laparoscopic vertical banded gastroplasty—With this surgery, several keyhole incisions are made in the abdomen. The doctor uses a thin, lighted tube with a tiny camera and other tools to operate. Both staples and a band are placed around the stomach, making it a smaller pouch. This allows you to only eat small portions of food.
  • Biliopancreatic diversion with duodenal switch—This procedure makes the small intestine shorter. This decreases the absorption of calories and nutrients.
Outcomes have been favorable for all of these surgery options in the majority of patients. The surgery can result in:
  • Weight loss—To get the most benefits, it is very important that the weight loss be maintained
  • Decrease or elimination of insulin resistance and diabetes
  • Lower blood pressure
  • Improve lipids
Talk to your doctor about the risks and benefits of bariatric surgery. The most important risk is vitamin and mineral deficiency and should be carefully monitored. Most patients should be taking a vitamin and mineral supplement.

References

Bariatric surgery. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated January 12, 2013. Accessed February 22, 2013.

Cornier MA, Dabelea D, Hernandez TL, et al. The metabolic syndrome. Endocr Rev. 2008;29:777-822.

Gastrointestinal surgery for severe obesity.National Institutes of Health website. Available at: http://win.niddk.nih.gov/publications/gastric.htm. Updated June 2011. Accessed February 22, 2013.

Li Z, Maglione M, Tu W, et al. Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med. 2005;142:532-546.

Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547-559

Morinigo R, Casamitjana R, Delgado S, et al. Insulin resistance, inflammation, and the metabolic syndrome following Roux-en-Y gastric bypass surgery in severely obese subjects. Diabetes Care. 2007;30:1906-1908.

Robles-Cervantes JA, Yanez-Diaz S, Cardenas-Camarena L. Modification of insulin, glucose and cholesterol levels in non-obese women undergoing liposuction: Is liposuction metabolically safe? Annals of Plastic Surgery. 2004;52:64-67.

Shikora SA, Kim JJ, Tarnoff ME. Nutrition and gastrointestinal complications of bariatric surgery. Nutr Clin Pract. 2007;22:29-40.

Vásquez LA, Pazos F, Berrazueta JR, et al. Effects of changes in body weight and insulin resistance on inflammation and endothelial function in morbid obesity after bariatric surgery.  J Clin Endocrinol Metab. 2005;90:316-322.

Wei-Jei L, Huang MT, Wang W, Lin CM, Chen TC, Lai IR. Effects of obesity surgery on the metabolic syndrome. Arch Surg. 2004;139:1088-1092.

Vetter ML, Cardillo S, Rickels MR, et al. Narrative review: effect of bariatric surgery on type 2 diabetes mellitus. Ann Intern Med. 2009;150(2):94-103.

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