Obesity has become a widespread global health problem. In China, with the improvement of living standards, the proportion of obesity is increasing year by year. According to China’s nutrition and health status survey report, more than 280 million people are overweight and obese. And with the rise of the severity of obesity, the incidence of diabetes, hypertension, hyperlipidemia, coronary heart disease, myocardial infarction, stroke, amenorrhea and breast cancer has increased significantly, and the mortality rate has increased significantly. Obesity has been recognized by the World Health Organization as the fifth most important risk factor affecting human health.
Non-surgical treatment has been the main means of treatment for obesity and metabolic diseases such as type 2 diabetes. However, non-surgical treatments such as diet control, physical exercise, lifestyle changes, and medications are difficult to achieve long-term effectiveness and cure. Weight loss from a low-calorie diet will generally rebound within a short period of time; exercise with diet control can theoretically achieve lasting weight loss, but it is often difficult for patients to adhere to it for a long time; lifestyle changes have poor long-term effects; and medication is even less effective in the treatment of severe obesity. Once diabetes is diagnosed, serious complications follow 20 years later.
Due to the rapid development of minimally invasive surgery, existing clinical practice shows that minimally invasive surgery is the only long-term effective modality for obese and obese diabetic patients, and that most obese patients with complications such as diabetes, hyperlipidemia, hypertension, and amenorrhea can be completely or partially relieved after surgery. It is the ability to not only lose weight, but also effectively control metabolic conditions such as type 2 diabetes that made this procedure the best medical innovation of 2013 by the Cleveland Medical Center.
At our Bariatric and Metabolic Surgery Center at Huashan Hospital, we judge whether the procedure is necessary based on the patient’s body mass index (BMI = weight (kg)/height2(m)). The presence of one or more obesity-related diseases such as diabetes, hypertension, hyperlipidemia, polycystic ovary syndrome, and waist size (>85cm for women and >90cm for men) are also indicators for our evaluation. And we also need to exclude the presence of secondary obesity due to medications, endocrine disorders, and other causes, as well as serious psycho-behavioral disorders.
Unlike the original concept of treating diabetes, our surgery is a certain degree of reduction in the stomach (the surgery is simpler and less invasive than radical gastric cancer surgery), which affects the patient’s appetite and food intake, bringing about changes in gastrointestinal hormones, flora balance and gastrointestinal dynamics, producing the effect of reducing body weight and enabling remission of metabolic diseases such as diabetes. The exact mechanism is being studied worldwide and by us.
We perform these procedures using minimally invasive laparoscopic techniques, resulting in less surgical trauma, postoperative pain, and hospitalization time, as well as faster postoperative recovery. With nearly a decade of experience in laparoscopic radical gastrointestinal tumor surgery, we will technically ensure maximum surgical safety and minimal trauma.
Since the BMI of Asian population is not as high as that of Europeans and Americans, but mainly centripetal obesity with larger waist circumference and obesity-related diseases such as diabetes, hypertension and hyperlipidemia are more prominent, our center has different views on the choice of surgical methods. Compared with Europe and the United States, domestic weight reduction and metabolic surgery is relatively late, and it is mainly inherited from the past experience of Europe and the United States that gastrointestinal diversion surgery is the main procedure for treating obese people with type 2 diabetes. In addition, Asia is a region with a high prevalence of gastric cancer, and the problem of cancer in the remnant stomach and the difficulty of tumor detection are more prominent, and with the increase of sleeve gastrectomy, more data show that sleeve gastrectomy has similar results as gastrointestinal diversion. Studies have shown that sleeve gastrectomy is no longer just a procedure to limit gastric volume, but it is found to involve more gastrointestinal hormonal changes and changes in flora balance, as well as significantly accelerated gastrointestinal dynamics, all of which together participate in the regulation of human endocrine metabolism and achieve similar therapeutic effects as gastrointestinal diversion. In addition, its biggest advantage is that sleeve gastrectomy has a greater safety profile than gastrointestinal diversion, with fewer long-term adverse outcomes such as nutritional disorders and residual gastric cancer, making it more acceptable to physicians and patients. Nowadays, even in Europe and the United States, where the population has a relatively high BMI, the proportion of people choosing to undergo sleeve gastrectomy is rapidly increasing. This is illustrated by the fact that the proportion of sleeve gastrectomies in Japan reached 54% in 2011. We have advocated the sleeve gastrectomy as the first choice for the treatment of obese type 2 diabetes, and our clinical experience in bariatric surgery shows that the results of sleeve gastrectomy are quite satisfactory and the satisfaction rate of patients is high. In addition, we at Huashan Hospital have created a new procedure for the treatment of obesity and type 2 diabetes mellitus – fundoplication with lateral folding of the greater curvature of the stomach. We have created this procedure based on our research on the limitations of the international technique of using the greater curvature of the stomach to treat obesity and metabolic diseases despite its effectiveness. It offers an option for those who are apprehensive about gastrectomy, with improved safety, cost savings, and reversibility, especially in obese patients with esophageal reflux and hiatal hernia. Clinical results similar to those of sleeve gastrectomy can be achieved.
Since 2009 we have been forming a bariatric and metabolic surgery team to carry out the corresponding clinical and research work. Now, there is a Bariatric and Metabolic Surgery team composed of minimally invasive surgery, anesthesiology, nutrition, sports rehabilitation, critical care medicine, sleep monitoring, endocrinology, cardiovascular medicine, respiratory medicine, gastroenterology, psychological medicine, plastic surgery, male medicine, case managers and professional nursing team to serve you and escort your weight loss journey.