Definition of obesity
Obesity is a group of common and ancient metabolic syndrome. When the body eats more calories than calories consumed, excess calories are stored in the body in the form of fat, and the amount exceeds the normal physiological needs and reaches a certain value, then it evolves into obesity. Normal male adult adipose tissue weight accounts for about 15% to 18% of body weight, women account for about 20% to 25%.
With the growth of age, the proportion of body fat increases accordingly. Because of the increase of body fat, the weight exceeds the standard weight 20% or the body mass index [BMI = weight (Kg) / (height) 2 (m2)] is greater than 24 is called obesity. If no obvious cause can be found is called simple obesity; with a clear cause is called secondary obesity.
Many obese patients have been accompanied by type 2 diabetes metabolic syndrome due to obesity; type 2 diabetes has become a worldwide epidemic, the International Diabetes Federation (IDF) statistics in 2010 the global incidence of about 239 million.
In China, the overall prevalence of people over 20 years of age reached 9.7%, and the prevalence of pre-diabetes was 15.5% higher. According to this projection, the total number of people with diabetes in China has reached 148 million. Nearly 90% are type 2 diabetics, and most patients are overweight and obese to varying degrees.
The dangers of diabetes
1. eye damage: retinal microangiopathy, leading to vision loss or even blindness.
⒉ Kidney damage: leading to renal insufficiency, requiring dialysis or kidney transplantation.
3. lower limb damage: vascular lesions of the lower limbs leading to skin ulcers and eventually gangrene or even amputation
4. heart damage: the formation of coronary atherosclerotic plaques in the heart can lead to angina and heart disease
5. hypertension: large platelet blockages in the arteries leading to high blood pressure.
6. Stroke: blockage of the cerebral arteries makes the blood in the brain not to flow, leading to stroke.
Current status of diabetes treatment
The treatment of diabetes is mainly based on the “classic five steps”, namely: education, diet control, dynamic therapy, oral medication or insulin injection, and self-monitoring of blood glucose.
However, according to a 10-year prospective diabetes study in the United Kingdom, only 1/3 of diabetic patients are well controlled in specialized diabetes medical treatment centers combined with various new treatments, and most patients continue to develop microvascular and macrovascular complications. The chance of complications increases with the number of years, and the chance of complications can be as high as 98%.
New concepts in diabetes treatment
In 1982, Pories, an American surgeon, stumbled upon bariatric surgery and reported the results of a 14-year study: bariatric surgery had a cure rate of 83% for obese type 2 diabetes. This opened up a new avenue of surgical treatment for type 2 diabetes.
In 2009, experts at the first global meeting on minimally invasive surgery for type 2 diabetes in the United States recommended that gastric bypass surgery be promoted worldwide, and the U.S. Diabetes Prevention and Control Guidelines Center 2009 included gastric bypass surgery as a standard procedure for the treatment of type 2 diabetes.
In November 2011, the IDF held a meeting in Belgium, in which the indications for surgery for type 2 diabetes were defined: for Asians, if the patient has a BMI > 32.5 kg/m² and combined with diabetes, surgery should be the preferred treatment; if the patient has a BMI > 32.5 kg/m² ≥ BMI ≥ 27.5 kg/m² and combined with diabetes, after conventional medical If the patient has a BMI>32kg/m²≥BMI≥27.5kg/m² and the combined diabetes is ineffective after conventional medical treatment, surgery should be an important treatment option.
Surgical procedure: gastric bypass (gastric bypass, gastric diversion)
Treatment mechanism
1. Endocrine change, improvement and restoration of islet cell function.
2. Weight loss and increase of insulin sensitivity.
3. Decrease in dietary intake and absorption, and decrease in glycemic load.
Indications for surgery.
1. Meet the diagnostic criteria of type 2 diabetes.
2. Good islet cell compensatory function (normal fasting C-peptide level, reflecting more than 2 times two hours after meal).
3. History of diabetes mellitus.
4. Body mass index BMI>27.5kg/m.
(BMI is calculated as: BMI = weight(kg) ÷ height2(m2), for example, if someone is 70kg and 1.70m tall, then: BMI = 70/1.702 = 24.2.)
Postoperative efficacy
It has been clinically observed that the overall efficiency of type 2 diabetes after gastric bypass is 95% and the cure rate is about 80%. Meanwhile, a large number of clinical observations showed that the surgical efficiency was 100% for type 2 diabetes with a history of less than 5 years and 70% for a history of more than 10 years, and the long-term postoperative maintenance of blood glucose at normal levels could effectively reduce the incidence of diabetic complications.
Comparison of medical and surgical treatment
Compared with medical treatment, the clinical effect of surgery for type 2 diabetes is significantly better than that of medical treatment, and patients can solve the problem at once; allowing patients to get rid of drugs and significantly improve their quality of life.
Advantages of laparoscopic gastric bypass
Laparoscopic surgery technology has been developing in the past 10 years, and in the late 1980s laparoscopy began to be introduced into obesity surgery Lee and David’s study showed that laparoscopic bariatric surgery can not only achieve the weight loss effect of traditional open surgery, but also has the advantages of small trauma, less bleeding, light pain, short hospital stay and fast recovery, etc. After surgery, it can increase the cosmetic effect of the abdominal wall and can avoid postoperative intestinal adhesions, incision hematoma, infection, incisional hernia and other complications.