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WJOL

10.5005/jp-journals-10033-1252
Sleeve Gastrectomy in Metabolic Syndrome for Nonmorbid Obese Patients: Is this the Future for Diabetes Treatment?
ORIGINAL ARTICLE

Sleeve Gastrectomy in Metabolic Syndrome for Nonmorbid

Obese Patients: Is this the Future for Diabetes Treatment?

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1 Ricardo López Osorio, Pablo Hartedt

ABSTRACT INTRODUCTION
During the development of surgical treatments, there have Obesity and its comorbidities have been the pillars of
been so many improvements and challenging task that have procedures and investigations to reduce the morbidity
lead surgeons to treat patients with new procedures and new
indications. and mortality of this preventable disease. Obesity is the
Gastrectomy surgery initially was performed for cancer sur- second cause of preventable deaths in US after smoking,
gery. Now it is a worldwide performed procedure for complete therefore, this disease is making of bariatric surgery, one
healthy stomachs, but the main indication its weight loss, and
all the physiological improvements that this procedure will bring of the most performed gastrointestinal procedures in US.
to the patients’ health. In obese patients, main indication of consult in bariatric
During the bariatric surgery development, there have been clinics is not the esthetic aspect but a clinical problem due
different choices for different indications and different patients, to morbidity that causes severe weight, like hypertension,
depending on a variety of conditions and data that take evi-
dence based medicine, to approve that this procedures can be diabetes, gout, etc.
accepted in the surgical field. Bariatric surgery was initiated in the 1990, with the
All the studies that have been showing improvement of specific indication of treatment of morbid obese patients,
medical conditions in obese patients, and had compared dif- and the main goal of this procedures is to establish an
ferent type of procedures (Gastric Bypass, Duodenal Switch,
Biliopancreatic Divertion, Sleeve Gastrectomy), led surgeon in anatomical restructure, for restrictive and metabolic
1
different part of the world to take indications of surgery beyond gastrointestinal absorption modification. The main
weight loss. Being proved by previous analysis, that most of objective of this procedures is to reduce weight, but
the patients get remission or cure, of comorbidities before an
statistically significant weight loss, this study was led to perform during the experience of surgeon performing and
vertical sleeve gastrectomy in patients with overweight, non- investigating long-term outcomes of this procedures, it’s
obese, that where diagnosed with metabolic syndrome (MS). been shown that comorbidities are improved even before
Ten patients where operated (f = 6 m = 4), all of them met at least weight loss begins. 2
three criteria for MS (National Cholesterol Education Program
Adult Treatment Panel III Citeria), 100% had diabetes mellitus Therefore, the metabolic changes that this procedures
(DM) as a criteria. After surgery the patients where followed up involves, and the metabolic improvement in patients
to 12 months and the mean body mass index (BMI) achieved with metabolic syndrome (MS), took expert surgeons in
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overall was 22.58 kg/m being the minimum 18.8 kg/m this field to research if it is possible to improve diabetes
(f = 22.28 m = 22.44). The total mean weight loss overall
was 64.95 ± 12.6 kg, and the mean percentage of weightloss mellitus (DM), hypertension, dyslipidemia, which all are
was 35% of initial weight with no clinical significance in the diagnostic criteria of MS. And with several data pub-
patients and 70% had remission of DM. lished of improvement of this criteria with deferent type
Keywords: Bariatric surgery, Diabetes remission, Metabolic of bariatric procedures, in nonmorbid obese patients, 3-6
surgery, Metabolic syndrome, Nonobese, Sleeve gastrectomy. we decided to add more data performing a restrictive
How to cite this article: Osorio RL, Hartedt P. Sleeve Gastrec- gastric procedure that can improve MS and remission
tomy in Metabolic Syndrome for Nonmorbid Obese Patients: of DM in nonobese patients.
Is this the Future for Diabetes Treatment? World J Lap Surg
2015;8(3):75-80.
Source of support: Nil METABOLIC SYNDROME
Metabolic syndrome (MS) was described by The World
Conflict of interest: None
Health Organization (WHO) in 1998. Based that insulin
resistance was the center pillar to the pathophysiology
1,2 Surgeon of MS, the WHO criteria had to determine insulin resis-
1,2 Department of Laparoscopic, Metabolic and Bariatric Surgery tance in patients. Fasting glucose level above 100 mg/dl
MetaboliK Minimal Acces Surgery Center, San Benito, Peten or impaired glucose tolerance (IGT), defined as a glu-
Guatemala, CA cose level above 140 mg/dl, after ingestion of 75 gm
Corresponding Author: Ricardo Lopez Osorio, Surgeon of glucose load during an oral glucose tole rance test.
Department of Laparoscopic, Metabolic and Bariatric Surgery Alternatively, other measures could serve as evidence
MetaboliK Minimal Acces Surgery Center, San Benito, Peten of insulin resistance, such as an elevated homeostatic
Guatemala, CA, e-mail: drlopezri@gmail.com
model assessment of insulin resistance (HOMA-IR)
World Journal of Laparoscopic Surgery, September-December 2015;8(3):75-80 75