Metabolic surgery (surgery for diabetes and other metabolic diseases)
Diabetes surgery or metabolic surgery resolves type 2 diabetes in 80% of cases
WHAT IS TYPE 2 DIABETES SURGERY OR METABOLIC SURGERY?
Diabetes surgery, also called metabolic surgery, involves surgical techniques applied to patients (not necessarily with morbid obesity) with type 2 diabetes who do not manage to achieve adequate control of their disease and blood sugar levels despite appropriate medical treatment. Metabolic surgery has also been shown to be beneficial for resolving obesity-related diseases.
Metabolic surgery is effective against type 2 diabetes and improves quality of life. It is estimated to increase these patients' life expectancy by up to 10 years.
Diabetes surgery in numbers:
99% of patients stop injecting insulin.
83% of patients control their condition and do not need additional medical treatment.
98%of patients solve their hypercholesterolemia.
75% of patients solve their hypertriglyceridemia.
70% of patients remove arterial hypertension.
18% of patients who needed injected insulin are controlled by oral pills.
WHAT DOES IT INVOLVE?
Gastric bypass
The main surgical technique used is gastric bypass. This is performed, barring some exceptional cases, using a minimally invasive approach (laparoscopic surgery). It is performed in two stages:
- Through minimal incisions in the abdomen, a small gastric pouch is created (some 20-50 cc.) that is separated from the rest of the stomach, modifying the anatomy of the digestive system. This ensures that food does not come into contact with the first part of the small intestine. This way, a smaller amount of food is eaten and its absorption is limited to the last portion of the intestine.
- Additionally, a gastrojejunal anastomosis is performed in Roux-en-Y with variable length of the jejunum, which causes the malabsorption component.
This procedure achieves reduced food intake and ensures that it doesn't go through the duodenum or near the pancreas, thereby limiting absorption. The duodenum is the source of the metabolic signaling that causes insulin resistance.
Diabetes remission should occur immediately following the surgical intervention, and in the majority of cases patients are discharged without the need for medication and will never have to inject themselves with insulin again. In addition to reversing type 2 diabetes, its also reduces certain hunger-causing hormones (ghrelin, for example).
What's more, this technique also achieves significant weight loss (70-85% of excess weight) and reduces comorbidities, representing an important advance for all people with this disease. Gastric bypass is one of the most performed surgical procedures around the world.
Technique: Minimally Invasive Laparoscopic Surgery
Anesthesia: General
Stay in the ICU: 12-24h
Hospitalization time: 48-72h
YOUR TREATMENT, STEP BY STEP
APPOINTMENT WITH THE SURGEON
At your first consultation, you will be seen by doctor Salvador Morales Conde, Chief of Surgery and Director of the Center. He will be in charge of evaluating your baseline condition. After examining you, he will order a series of tests to determine whether you have any underlying conditions that must be treated prior to the diabetes surgery. In addition, he will explain which intervention best suits your needs and will answer all your questions or concerns.
MULTIDISCIPLINARY TEAM
While the tests requested during the surgical consultation are being performed, amultidisciplinary team comprised of endocrinologists, nutritionists, psychologists, and exercise and fitness educators will study your case to ensure a thorough assessment and to define the treatments necessary to reduce the risk of experiencing any illnesses related to excess weight or to keep them under control.
PREOPERATIVE EVALUATION
The risk of anesthesia will be evaluated. This typically consists of blood tests, electrocardiogram, chest X-ray and examination by the anesthesiologist.
INTERVENTION
The procedure will be performed after the 3 weeks of treatment with the multidisciplinary team. Patients are typically admitted on the same day and a few hours prior to the procedure. The surgery is performed laparoscopically under general anesthesia. It is not necessary to open up the abdomen.
ICU
The 12-24 hours immediately following the surgery are spent in the Intensive Care Unit to ensure optimal patient safety and monitoring.
HOSPITAL WARD
After a short stay in the hospital ward (approx. 48-72 hours), the drain is removed and the patient its discharged.
RETURN TO HOME
Treatment following obesity surgery does not end with the surgical intervention. It requires continued follow-up to monitor weight loss and nutritional status. This monitoring and follow-up by the multidisciplinary team helps guarantee the success of the procedure. This surgery entails significant changes in eating habits that require an adaptation period. Our specialists will support the patient at all times throughout this process.
WHEN IS METABOLIC SURGERY RECOMMENDED?
- Patients between the ages of 25 and 65 (other ages may be evaluated by the specialists).
- Patients with type 2 diabetes and a BMI of more than 40 kg/m2.
- Patients with a BMI between 30 and 35 kg/m2 who do not manage to adequately control their diabetes with conventional treatment.
- Greater efficacy has been shown in patients with type 2 diabetes.
HOW EFFECTIVE IS IT?
- Some 83% with type 2 diabetes experience remission.
- Over 90% of patients experience improved blood sugar control and therefore treatment.
- Some 99% stop insulin injections.
- After the procedure, patients tend to lose between 70% and 85% of their excess weight.
- It guarantees better quality of life for the patient.
- Significant reduction in obesity-related cardiac, vascular, renal, and ophthalmological complications.
FAQs
WHAT RESULTS CAN I EXPECT IN TERMS OF MY DIABETES?
About 80% of patients experience remission of their diabetes, meaning their blood sugar levels return to normal levels without the need to take medication or inject insulin. For the remaining cases, they experience improved blood sugar control and improved treatment (oral medication instead of insulin, for example). Additionally, recent studies have proven that diabetes management achieved through surgery is able to stabilize or even reverse typical T2DM complications such as nephropathy or retinopathy.
CAN I LOSE AN EXCESSIVE AMOUNT OF WEIGHT?
Patients with more severe obesity will lose more weight. However, the data also show that patients with more moderate obesity, BMI between 30 and 35 kg/m2, will not lose excessive amounts of weight, but they will get closer to what would be considered their normal BMI (20 to 25 kg/m2). As with any other type of surgery, there may be some health issues that get in the way of a surgical treatment option for your diabetes. The surgeon and their medical team assess each and every medical record and suitably advise the patient in that respect.
WHAT ARE THE INDICATIONS FOR METABOLIC SURGERY?
It is possible to consider this type of treatment in patients with poorly managed T2DM despite use of appropriate medical treatment and less severe obesity class (BMI between 30 and 35 kg/m2). More than 12 recent clinical trials state that, in properly selected patients, the results from surgery are better at 5 years post-procedure than those from conventional medical treatment. Indication for this kind of treatment must be made collectively and following a thorough multidisciplinary assessment of each case.
WHAT HEALTH COMPLICATIONS CAN OBESITY CAUSE?
Some of the complications associated with obesity include:
- Metabolic: Type 2 diabetes, high blood pressure, dyslipidemia (hypercholesterolemia and hypertriglyceridemia), hyperuricemia.
- Respiratory: Respiratory failure, sleep apnea syndrome (Pickwick Syndrome).
- Cardiovascular: Myocardial infarction, heart failure, peripheral artery disease/varicose veins.
- Nephro-urinary: Nephrotic syndrome, urinary incontinence.
- Digestive: Gastroesophageal reflux, cholelithiasis.
- Sexual: Amenorrhea, hypermenorrhea, infertility, preeclampsia, infertility and erectile dysfunction.
- Infectious: Necrotizing pancreatitis, necrotizing skin infections.
- Joint: Generalized osteoarthritis.
- Neurological: "Pseudotumor Cerebri."
- Oncological: High risk of experiencing colon, kidney, prostate, endometrial, or breast cancer.
- Psycho-social: Depression, social exclusion, reduced employment, labor discrimination, psychosis, anxiety disorders.
HOW DOES THIS SURGERY IMPROVE THESE HEALTH PROBLEMS?
High blood pressure, diabetes, and high cholesterol are cured in about 90% cases with the loss of the first 15-25 kg. In the remaining 10%, it improves disease control (fewer medications or lower doses).
MEDICAL TEAM
Prestigious experts in the treatment of obesity and overweight
We have a comprehensive clinic and multidisciplinary team comprised of multiple specialists: expert surgeons in metabolic and bariatric surgery techniques, endocrinologists, nutritionists, psychologists, specialists in exercise and fitness education, and more.
In addition, our patients can choose from a wide range of services at the Quirónsalud Sagrado Corazón Hospital, and the experts they may need from any specialized units: Intensive Care, Anesthesiology, Internal Medicine, Radiology, etc.
