Bariatric and diabetic surgery first began in the United States in the 1960s, and after half a century of development, the most mature and classic procedures are laparoscopic gastric bypass diversion, laparoscopic sleeve gastrectomy, etc.
Laparoscopic gastric bypass diversion.
This procedure is performed by reducing intake and absorption, leading to weight loss, and after the surgery, insulin resistance is relieved after weight loss, and endocrine hormones in the body are changed, leading to the remission or cure of diabetes by various factors. It is currently the gold standard procedure for weight loss and type 2 diabetes in the United States.
Indications: Patients with BMI over 35 kg/m2; BMI 27, 5~35 kg/m2 combined with difficult to control diabetes and other metabolic comorbidities or with previous poor results of other surgeries. Effectiveness: 1 year after surgery, the weight loss is usually 60% to 70%, and the efficiency of diabetes treatment can reach 80% to 85%. It is also the gold standard procedure for bariatric and metabolic surgery in Europe and the United States because of its long-lasting effect and low chance of weight regain.
Advantages.
Good weight loss effect and good treatment for type 2 diabetes. Among current bariatric surgeries, gastric bypass bariatric surgery has the best weight loss effect, control of type 2 diabetes, and the highest efficiency.
Disadvantages.
1, the surgery is relatively complex, difficult to operate, and the risk is relatively high.
2. After surgery, part of the small intestine is not absorbing, so if no intervention is made, the patient is prone to vitamin deficiency and micronutrient deficiency, so the patient needs oral supplementation of vitamins and micronutrients after surgery.
Laparoscopic sleeve gastrectomy
As an intake limiting weight loss surgery, it significantly reduces the volume of the stomach without altering the normal physiological state of the gastrointestinal tract, while removing most of the secretion and digestive functions of the stomach, reducing the digestion of nutrients and making the surgery relatively simple.
Indications: BMI 27,5~35 kg/m2 can be used as a stand-alone weight loss surgery; for those with BMI over 60 kg/m2 who cannot tolerate longer anesthesia and surgery, it can be used as the first step of a step-by-step bariatric surgery, and then gastric bypass can be performed after the weight loss situation improves.
Sleeve gastrectomy (also known as tubular gastric surgery, gastric reduction surgery)
Advantages.
1, the surgery is simple, as long as a part of the stomach is removed
2, weight loss effect is also good, slightly worse than gastric bypass bariatric surgery
3. Slightly cheaper than gastric bypass surgery
Disadvantages.
The weight loss effect of sleeve gastrectomy surgery is limited and is not suitable for patients with severe obesity. Sleeve gastrectomy is suitable for patients with a BMI of 28-35 and no diabetes. However, for obese patients with BMI > 40, the weight loss effect is limited. The complete remission rate of sleeve gastrectomy for the treatment of type 2 diabetes is lower than that of gastric bypass surgery.
1, Sleeve gastrectomy only restricts the patient’s intake and does not control absorption
2, The stomach left behind is larger than the stomach left behind by gastric bypass surgery, and the effect of weight control is limited
3, Some patients, after surgery, will have symptoms of reflux esophagitis, the probability of appearing is 10%, which is an inherent symptom of the surgery itself.
4. The stomach left after the surgery is long, and the weight loss effect is not bad within two years after the surgery, after three or four years, due to the expansion of the stomach muscle, it may rebound if the eating habit is not good.