Endocrine Abstracts

Bariatric surgery has become the most effective therapeutic option for morbid obesity (BMI > 40 or >35 with major complications). All established surgical techniques are followed by significant body weight reduction as well as clear improvement /remission of main obesity-associated comorbidities such as type 2 diabetes (DM2), dyslipidaemia, hypertension, sleep apnoea and cardiac dysfunction. Mixed restrictive-malabsorptive techniques, such as Roux-en Y-gastric bypass (RYGB), induce more weight loss, better metabolic improvement and make postoperative weight regain (WR) less likely than restrictive procedures such as vertical gastroplasty or gastric banding (GB). Therefore, individualization and a complete preoperative assessment by a multidisciplinary team are needed in order to tailor bariatric surgery to patient characteristics. More recently, BS has shown to induce DM2 remission in a significant percentage of patients, which vary depending on the technique (GB; RYGB; BPD/DS). Short DM2 duration, low needs of antidiabetic medications and good metabolic control seems to be preoperative predictive factors of success.

Besides acute postoperative complications, malabsorptive BS, especially biliopancreatic diversion but also RYGB, can cause mid and long-term vitamin and nutritional deficiencies, which should be prevented by providing routine iron, vitamin B12, calcium, vitamin D, and folic acid supplementation.

Patients operated of BS should be strictly followed in order to prevent nutritional complications, but also to avoid WR, which can start as soon as two years following surgery leading to metabolic deterioration and partial reversal of achieved benefits. Nutritional as well as lifestyle and perhaps hormonal factors may contribute to WR.

The effect of BS on DM2 remission has set the basis of proposing different surgical techniques in patients with BMI lower than 35, or even without obesity. Although the initial experimental results are encouraging, we need more experience before establishing the involved mechanisms and the possible role of this surgical approach in DM2 management.