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WJOLS

Sleeve Gastrectomy in Metabolic Syndrome for Nonmorbid Obese Patients: Is this the Future for Diabetes Treatment?
with diabetes, and quoting the lack of long-term data to insulin sensitivity and reversing MS, even in patients
stablish complete and long-term resolution. 9 with BMI < 30%.
The importance of metabolic changes with bariatric The procedures described in different studies
procedures have being reported in some studies, such as includes RYGB, sleeve gastrectomy, bilio-pancreatic
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De Paula et al that have demonstrated an 82% of diabetes diversion with duodenal switch, and Ileal interposi-
resolution, even in normal and overweight patients, with tion with sleeve gastrectomy. In Table 1 shows an
a mean BMI of 23.1 and 28.3 respectively. overall percentage of glycemic control at 12 months
There are two main anatomical mechanisms in which period after the procedure have being performed. And
bariatric surgery takes its effects. The first it is creating some of them describe that patients had achieved gly-
anatomical change to minimize the space of food intake, cemic control without medication even before the hospital
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and creating a hormonal effect, directly changing hunger discharge and 72 hours after surgery. The main percent-
stimulation by hormones that are produced in specific age of patients that acquire glycemic control, after the
cells in gastric fundus, such as GH. And the second, it is procedures, varies from 60 to 100%, with a mean 85%.
creating secreting limbs for the gastric and biliopancre- And the studies vary in the description of DM remission
atic digestive juices, to bypass a specific gastrointestinal as some authors describe partial remission as main HbA1
segment that it is responsible of absorptive mechanisms. < 6.5% without diabetes medication, and others < 7.0%,
There are procedures that are created to stablish this and complete remission if HbA1 < 5.6%. But the findings
two anatomophysiological effects at the same time, like in each study have showed, overall, that bariatric pro-
duodenal switch with pancreatobiliary diversion. And cedures are better treatment of long-term patients with
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all of this mechanisms have proved to produce adequate DM that medical therapy alone, and surgical treatment
glycemic control, with weight loss effects, depending will have a direct effect on other comorbidities, resolving
on each procedure, in nonmorbid obese patients and in hypertension in 58%, sleep apnea in 80%, hypertriglyceri-
patients only with overweight patients. 12,14 demia resolved in 58%, hypercholesterolemia resolved in
3
Based on this findings the medical-surgical field has 64%, and a prediction of 10 years risk of cardiovascular
encountered a new perspective of clinical outcome. The disease for each patient, calculated using the United
treatment of metabolic disorders, without obese morbi dity. Kingdom Prospective Diabetes Study (UKPDS) risk
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3
Several studies have evaluated different types of engine, fell substantially after surgery 71%. This are
comorbidities of mild obesity that medical therapy for
bariatric procedures. Performed in patients under 35 BMI, DM itself will not cure.
even in patients with normal weight, all of them have
achieved glycemic control, regardless of weight control METHODOLOGY
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mechanisms (Table 1). In some of them, the role of gastric
hormones and the relation between gastric anatomy and Source of Data
insulin resistance have been analyzed and described. 3,6,14 This study was carried out in Guatemala city in a nutri-
Results in insulin resistance and b-cell dysfunction tion, bariatric and metabolic clinic, Metabolik, and the
tests, showed different type of improvements with dif- patients that were selected for surgery where operated
ferent procedures. Not all studies have evaluated this with minimal access approach in an advanced laparos-
variables. But, it described that the nonweight loss effect copy center. Patients were selected from a multispecialty
of bariatric surgery in nonobese patients has an direct clinic specialized in diabetes and diabetes complications
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impact on the incretin pancreatic-stimulation. There- and over 125 patients charts, 32 where selected as candi-
fore, weight loss has a very important effect on improving dates for preoperative evaluation, and 10 patients were
selected for surgery.
Table 1: Glycemic control in patients that overcome
bariatric procedures Study Period
Mean % Glycemic
Case study Cases Female Male BMI control Patients were preselected in a retrospective manner,
M Frenken 15 16 8 8 32 100 collecting information in medical records from January
Kwang Yeol Paik 16 12 4 8 27.9 66 2010 to May 2014. Evaluation of patients preselected was
Wu Q, Xiao Z, 8 5 3 31.5 83 performed during July 2014, and procedures where per-
Cheng Z, Tian H 6 formed during August to September 2014.
M Cerci, MI Bellini, 25 15 10 33.2 86
F Russo 7 Method of Collection of Data
Ricardo V Cohen 3 66 40 26 32.5 88
Aureo L DePaula 17 202 59 143 29.7 86.40 Information of patients admitted and evaluated with diag-
Total 358 131 198 31.13 85 nostic and treatment of DM where collected from files.
World Journal of Laparoscopic Surgery, September-December 2015;8(3):75-80 77