Metabolik cerrahi nedir? Kime ve ne zaman yapılmalıdır?

Abstract

Metabolik sendrom bazı komplikasyonlara neden olan kardiyometabolik risk faktörleri demetidir.Sendromu oluşturan her bileşen tedavi edilmelidir. Bunun için antilipidemik,antidiyabetik, antihipertansif, ilaçlar kullanılır fakat tedavideki kilit rolde kilo kontrolü oynar.Vücut ağırlığının kontrolünde egzersiz, diyetle günlük alınan kalorinin azaltılması ve fiziksel faaliyetlerin artırılması rol oynar.Değişik tıbbi tedavilerlede deneme yapılmış olup çok başarılı olunamamıştır.Hala en etkin yol cerrahi seçenektir. Kesinkabul edilen tanımı olmamakla berabermetabolik cerrahi, metabolik sendromu tedavi etmek için yapılan cerrahi müdahaleler olarak tarif edilebilir. Genel algı bariatrik cerrahi geçiren hasta kişilerin kilo vermeyle ilişkili tip 2 diyabet hastalığının remisyona girmesidir. Ameliyat sonrası bu hastalar hastanede yatarken kan şeker değerlerinin düzelmeye başladığı görülmüştür. Kan glukozu dengelenmesinde gastrointestinal sistemin önemli rol aldığı anlaşılınca,mekanizmasının ortaya çıkması için çalışmalar yapılmıştır.Ön ve arka barsak hipotezleri ortaya atılmıştır. Arka barsak ameliyatı olan Duodenalswitch’in ön barsak ameliyatı olan gastrikby-pass’a göre hiperinsülinemik cevaba neden olmadan glukoz dengesini ve insülin duyarlılığında iyileşme sağladığı ortaya konmuştur.Arka barsak modulasyonu yapılan ameliyatlar, ön barsak modülasyonu yapılan ameliyatlara göre mineral-vitamin dengesini daha çok bozma eğilimindedir. Son zamanlarda bunu önlemek için transit bipartisyon ameliyatı geliştirilmiştir. Sonuçta metabolik cerrahi ameliyatlarında değişik teknikler tercih edilmektedir. Yapılacak ameliyat yönteminin kişiye özel olması gerektir.

Keywords

• Metabolik cerrahi
• zamanlama
• tip 2 diyabet.

What is Metabolic Surgery? To whom and when should it be applied?

Abstract

Metabolic syndrome is a cluster of cardiometabolic risk factors that cause some complications. Each component of the syndrome needs to be treated. For this purpose, anti-hypertensive, anti-diabetic, and anti-lipidemic agents are used, but weight control plays a key role in treatment. Exercise, reduction of daily calories with diet and increasing physical activity play a role in the control of body weight. Various medical treatments have been tried, but they have not been very effective. The most effective way is still surgery. Although there is no definite accepted definition of metabolic surgery, it can be defined as surgical interventions to treat metabolic syndrome. The general perception in bariatric surgery is that type 2 diabetes enters remission due to patients' weight loss. After the operation in these patients, blood sugar control has been shown to be achieved while patients are still in the hospital. It has been understood that the gastrointestinal system plays an essential role in glucose homeostasis, and its mechanisms have been tried to be revealed. The foregut hypothesis and the hindgut hypothesis have been suggested. A hindgut surgery like a duodenal switch has been shown to improve insulin sensitivity and glucose homeostasis without causing a hyperinsulinemic response compared to a foregut surgery like a gastric bypass. Surgeries that modulate the hindgut have more potential to disrupt the absorption of vitamins and minerals than foregut surgeries. To prevent this, the transit bipartition technique has been developed in recent years.As a result, various methods have been used in metabolic surgery. The choice of a surgical technique should be specific to the patient.

Keywords

• Metabolic Surgery
• timing
• type 2 diabetes mellitus.

References

1. 1-Janković D, Wolf P, Anderwald CH, Winhofer Y, Promintzer-Schifferl M, Hofer A, et al. Prevalence of endocrine disorders in morbidly obese patients and the effects of bariatric surgery on endocrine and metabolic parameters. Obes Surg. 2012;22(1):62-9.
2. 2-Elshaer M, Hamaoui K, Rezai P, Ahmed K, Mothojakan N, Al-Taan O. Secondary Bariatric Procedures in a High-Volume Centre:Prevalence, Indications and Outcomes. Obes Surg. 2019 ;29(7):2255-2262.
3. 3-Cottam S, Cottam D, Cottam A. Sleeve Gastrectomy Weight Lossand the preoperative and postoperative predictors:A systematic Review.Obes Surg. 2019;29(4):1388-1396.
4. 4- Worm D, Madsbad S, Hansen DL. Metabolic Healthy in severely obese subjects:A Descriptive study. Metab Syndr Relat Disord. 2019;17(2):115-119.
5. 5- Wang L, Wang J, Jiang T. Effect of Laparoscopic Sleeve Gastrectomy on Type 2 Diabetes Mellitus in patients with Body Mass Index less than 30 kg/m2.ObesSurg. 2019;29(3):835-842.
6. 6-Rubino F, Shukla A, Pomp A, Moreira M, Ahn S.M, Dakin G, et al. Bariatric, metabolic, and diabetes surgery:what’s in a name? Ann Surg 2014;259:117-22.
7. 7-Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. AnnSurg 2006;244:741-9.
8. 8-Nora M, Guimarães M, Almeida R, Martins P, Gonçalves G, Santos M, et al. Excess Body Mass Index Loss Predicts Metabolic Syndrome Remission After Gastric Bypass Diabetol Metab Syndr. 2014 2;6(1):1.

9. 9- Cazzo E, Gestic MA, Utrini MP, Machado RR, Geloneze B, Pareja JC, et al. Impact of Roux-en-Y-Gastric Bypass on Metabolic Syndrome and Insulin Resistance Parameters. Diabetes Technol Ther. 2014;16(4):262-5.
10. 10- Li JF, Lai DD, Ni B, Sun KX.Comparison of LaparoscopicRoux-en-Y Gastric Bypass WithLaparoscopicSleeveGastrectomyforMorbidObesityorType 2 DiabetesMellitus:A Meta-Analysis of RandomisedControlledTrials.Can J Surg. 2013;56(6):158-64.
11. 11- Aftab H, Risstad H, Søvik TT, Bernklev T, Hewitt S, Kristinsson JA, et al. Five-year Outcome After Gastric Bypass forMorbid Obesity in a Norwegian Cohort. Surg Obes Relat Dis. 2014 J;10(1):71-8.
12. 12- Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, MingroneG,etal.Bariatricsurgeryversusnon-surgicaltreatmentforobesity:a systematicreviewand meta-analysis of randomisedcontrolledtrials. BMJ. 2013 22;347:f5934.
13. 13- Desiderio J, Trastulli S, Scalercio V, Mirri E, Grandone I, Cirocchi R, et al.Effects of laparoscopic sleeve gastrectomy in patients with morbid obesity and metabolic disorders. DiabetesTechnolTher. 2013;15(12):1004-9.
14. 14- Neff KJ, le Roux CW. Bariatric Surgery:The indications in Metabolic Disease. Neff KJ, le Roux CW. DigSurg. 2014;31(1):6-12.
15. 15- Williams S, Cunningham E, Pories WJ. Surgical Treatment of metabolic syndrome Med Princ Pract. 2012;21(4):301-9.
16. 16- Gass M, Beglinger C, PeterliR. Metabolic Surgery-Principles and Current concepts Langenbecks Arch Surg. 2011;396(7):949-72.
17. 17- Sabench Pereferrer F, Hernàndez Gonzàlez M, Del CastilloDéjardin D. Experimental Metabolic Surgery:Justification and Technical Aspects Obes Surg. 2011;21(10):1617-28.