Laparoscopic Metabolic Surgeries

Abstract

It has been estimated that 190 million people worldwide have diabetes mellitus (DM) and it is likely that this will increase to 324 million by 2025. This epidemic is taking place both in developed and developing countries and the combination of DM, obesity, and metabolic syndrome is now recognized as one of the major threats to human health in the 21st century. Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric operation, ameliorates virtually all obesity-related comorbid conditions, the most impressive being a dramatic resolution of type 2 DM (T2DM). After RYGB, 84% of patients with T2DM experience complete resolution, and virtually all have improved glycemic control. Increasing evidence indicates that the impact of RYGB on T2DM cannot be explained by the effects of weight loss and reduced energy intake alone. Potential mechanisms underlying that direct antidiabetic impact of RYGB include increased lower intestinal hormones as glucagonlike peptide-1 (GLP-1), altered physiology from excluding ingested nutrients from the upper intestine, and other changes yet to be fully characterized. Research aimed at determining the relative importance of these effects and identifying additional mechanisms promises not only to improve surgical design but also to identify novel targets for antidiabetic medications. ___________________________ Key words: diabetes mellitus, metabolic syndrome, Roux-en-Y gastric bypass, glucagon-like peptide-1, Obesity, Bariatric surgry