|| Obesity and Endoscopic Surgery
Metabolic surgery is one that allows healing and prevents diabetes complications. It is performed in non-obese patients with BMI between 23 and 34 kg/m2 and associated metabolic syndrome.
It has been shown that this procedure is achieved by almost 100% abate the need for drugs in these patients and remission achieved over 90% of people with Type 2 (diabetes that is acquired in adulthood is not associated with obesity).
The best results were seen in patients with less than 8 years of diabetes evolution.
The goal of surgery is to improve the quality of life of patients, reaching normal values of blood glucose without additional medication, resolving and preventing diabetes complications because of this, increasing life expectancy with quality.
Improves the psychological, familial and personal aspect
Who are the candidates for metabolic surgery
Patients younger than 10 years diagnosed with type 2 diabetes
Glycosylated hemoglobin greater than 7.5%.
BMI: 23 - 34.
Age: 18 - 65.
Treatment stable for at least 6 months.
C-peptide levels between 1 - 4.5.
Who are not candidates for metabolic surgery
Patients with type 2 diabetes already have complications: retinopathy, neuropathy or microangiopathy.
Patients on hemodialysis or peritoneal dialysis.
Blood insulin levels well below normal or not found.
Mental health disorders (not possible to follow medical advice)
Patients who are pregnant.
History of an operation on the stomach or small intestine (relative).
Glycemic control (regardless of weight loss) is based on:
The theory of the foregut (excluding intestinal transit) .- inhibits the secretion of hormones related to insulin resistance, promotes and cancels incretins antincretinas, potentiates insulin.
Another mediator effects is the GLP-1 (glucagon - like peptide - 1) peptide that occurs in the distal intestine (hindgut theory) in response to a mixed meal, inhibits glycogenolysis, inhibits glucagon, prolonged gastric emptying and intestinal motility, is the most potent incretin promoting insulin secretion, as well as B cells potentiates the proliferative and anti-apoptotic activity, thereby improving insulin sensitivity.
Peptide YY3 - 36 (PYY) reduces appetite. It is produced in enteroendocrine cells of the ileum and colon, with similar function as the ghrelin (hormone that regulates appetite).
In summary, preventing the passage of food through the duodenum and nearing the end of the small intestine in less time causes increased insulin production, decrease resistance to insulin receptors and absorb less food.
With surgical procedures resolutions have been reported with rates of diabetes as well: 83 - 92% for gastric bypass 95 to 100% for duodenal jejum bypass.
Pedro Gutiérrez Contreras MD. Phone: 00 52 (933) 3 160 744 / 3 50 0476 – Movile: 00 52 1 (993) 2 190 444
Hospital Ángeles Villahermosa - Prolongación Paseo Usumacinta No 2085, Colonia el Espejo.
Third Floor, Office no. 333 - Villahermosa, Tabasco, México