Via practica 6/2020

Bariatric/metabolic surgery of diabesity

Surgery for severe obesity has been known for many years as bariatric surgery. Its origins date back to the 1960s. From the very beginning, the primary goal of the surgical intervention was a dramatical and long-term reduction of obesity. In the new millennium, bariatric surgeons and obesitologists have begun to pay more attention to the positive effect on the associated diseases that accompany obesity, or worsen or even cause it. It has been shown that with severe weight reduction, there is also an improvement or even cure of comorbidities associated with obesity, but especially with type 2 diabetes mellitus (T2DM). Currently this surgery is called surgery for obesity and related diseases. Indications for surgical treatment have been expanded, BMI (body mass index) has been reduced in the presence of comorbidities, for which surgery is already indicated, and the spectrum of concomitant diseases that can be positively influenced surgically has also been expanded. Standard procedures have been established, of which the most frequently performed is sleeve resection of the stomach (sleeve gastrectomy – SG), followed by gastric bypass in the modification Roux-Y (RYGB), or bypass with one anastomosis (OAGB). Less frequently, a duodeno-ileal anastomosis with sleeve gastric resection (single anastomosis duodeno-ileal with sleeve gastrectomy – SADI-S) is performed. Gastric bandages have been abandoned and other procedures are considered investigative. In Slovakia, payments for bariatric/metabolic operations are included in lump sum payments for individual hospitals.

Keywords: bariatric/metabolic surgery, obesity, type 2 diabetes mellitus, comorbidities, sleeve resection, gastric bypass