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Outcomes of Metabolic Surgery

  • Rene Aleman
  • Francesco Rubino
  • Emanuele Lo Menzo
  • Raul J. Rosenthal
Chapter

Abstract

The concept of “metabolic surgery” has evolved to indicate a surgical approach aimed at controlling metabolic illnesses and not just excess weight. Demographic characteristics, prevalence, and severity of diabetes and cardiovascular disease differ substantially in patients who present for metabolic surgery compared to those who seek conventional bariatric surgery for weight loss. Such differences have important ramifications for preoperative and postoperative patient management as well as outcomes of metabolic surgery. While for decades excess weight loss (EWL) has been a traditional measure of the efficacy of bariatric surgery, remission/improvement of metabolic disease (type 2 diabetes mellitus (T2DM), hypertension, obstructive sleep apnea, dyslipidemia) and cardiovascular risk reduction are more rational measures of outcomes in metabolic surgery. This chapter aims to define the role of metabolic surgery, review the effects of gastrointestinal surgery on metabolic outcomes from retrospective and observational studies, and review the outcomes of metabolic surgery from prospective randomized controlled trial data.

Keywords

Cholesterol Obesity Attenuation Androgen Triglyceride 

References

  1. 1.
    Rubino F, Schauer PR, Kaplan LM, Cummings DE. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med. 2010;61(1):393–411.  https://doi.org/10.1146/annurev.med.051308.105148.CrossRefPubMedGoogle Scholar
  2. 2.
    Rubino F, Kaplan LM, Schauer PR, Cummings DE, Diabetes Surgery Summit Delegates. The diabetes surgery summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg. 2010;251(3):399–405.  https://doi.org/10.1097/SLA.0b013e3181be34e7.CrossRefPubMedGoogle Scholar
  3. 3.
    Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of weight loss on predicted cardiovascular risk: change in cardiac risk after bariatric surgery. Obesity. 2007;15(3):772–84.  https://doi.org/10.1038/oby.2007.589.CrossRefPubMedGoogle Scholar
  4. 4.
    Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–24.  https://doi.org/10.1097/01.sla.0000137343.63376.19.CrossRefPubMedGoogle Scholar
  5. 5.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.  https://doi.org/10.1056/NEJMoa066603.CrossRefPubMedGoogle Scholar
  6. 6.
    Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.  https://doi.org/10.1056/NEJMoa066254.CrossRefGoogle Scholar
  7. 7.
    Marrugat J. An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas. J Epidemiol Community Health. 2003;57(8):634–8.  https://doi.org/10.1136/jech.57.8.634.CrossRefPubMedGoogle Scholar
  8. 8.
    Morgan CLL, Currie CJ, Stott NCH, Smithers M, Butler CC, Peters JR. Estimating the prevalence of diagnosed diabetes in a health district of Wales: the importance of using primary and secondary care sources of ascertainment with adjustment for death and migration. Diabet Med. 2000;17(2):141–5.  https://doi.org/10.1046/j.1464-5491.2000.00221.x.CrossRefPubMedGoogle Scholar
  9. 9.
    Dixon JB, Zimmet P, Alberti KG, Rubino F. International diabetes federation taskforce on epidemiology and prevention. Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med. 2011;28(6):628–42.  https://doi.org/10.1111/j.1464-5491.2011.03306.x.CrossRefPubMedGoogle Scholar
  10. 10.
    Nguyen NT, Blackstone RP, Morton JM, Ponce J, Rosenthal RJ. The ASMBS textbook of bariatric surgery: volume 1: bariatric surgery. New York: Springer; 2014.. https://market.android.com/details?id=book-K7ONBAAAQBAJ Google Scholar
  11. 11.
    Sjöström L, Lindroos A-K, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.  https://doi.org/10.1056/NEJMoa035622.CrossRefPubMedGoogle Scholar
  12. 12.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279–89.  https://doi.org/10.1007/s11695-017-2666-x.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Khorgami Z, Shoar S, Saber AA, Howard CA, Danaei G, Sclabas GM. Outcomes of bariatric surgery versus medical management for Type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Obes Surg. 2019;29(3):964–74.  https://doi.org/10.1007/s11695-018-3552-x.CrossRefPubMedGoogle Scholar
  14. 14.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50.. discussion 350-352. https://www.ncbi.nlm.nih.gov/pubmed/7677463 CrossRefGoogle Scholar
  15. 15.
    Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84; discussion 84-85.  https://doi.org/10.1097/01.sla.0000089851.41115.1b.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Gill RS, Birch DW, Shi X, Sharma AM, Karmali S. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis. 2010;6(6):707–13.  https://doi.org/10.1016/j.soard.2010.07.011.CrossRefPubMedGoogle Scholar
  17. 17.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.  https://doi.org/10.1001/jama.292.14.1724.CrossRefPubMedGoogle Scholar
  18. 18.
    Pournaras DJ, Aasheim ET, Søvik TT, et al. Effect of the definition of type II diabetes remission in the evaluation of bariatric surgery for metabolic disorders. Br J Surg. 2012;99(1):100–3.  https://doi.org/10.1002/bjs.7704.CrossRefPubMedGoogle Scholar
  19. 19.
    Miras AD, Risstad H, Baqai N, et al. Application of the International Diabetes Federation and American Diabetes Association criteria in the assessment of metabolic control after bariatric surgery. Diabetes Obes Metab. 2014;16(1):86–9.  https://doi.org/10.1111/dom.12177.CrossRefPubMedGoogle Scholar
  20. 20.
    Nguyen NT, Varela E, Sabio A, Tran C-L, Stamos M, Wilson SE. Resolution of hyperlipidemia after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg. 2006;203(1):24–9.  https://doi.org/10.1016/j.jamcollsurg.2006.03.019.CrossRefPubMedGoogle Scholar
  21. 21.
    Vest AR, Heneghan HM, Agarwal S, Schauer PR, Young JB. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98(24):1763–77.  https://doi.org/10.1136/heartjnl-2012-301778.CrossRefPubMedGoogle Scholar
  22. 22.
    Puzziferri N, Roshek TB 3rd, Mayo HG, Gallagher R, Belle SH, Livingston EH. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014;312(9):934–42.  https://doi.org/10.1001/jama.2014.10706.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Vila M, Ruíz O, Belmonte M, et al. Changes in lipid profile and insulin resistance in obese patients after Scopinaro biliopancreatic diversion. Obes Surg. 2009;19(3):299–306.  https://doi.org/10.1007/s11695-008-9790-6.CrossRefPubMedGoogle Scholar
  24. 24.
    Jamal M, Wegner R, Heitshusen D, Liao J, Samuel I. Resolution of hyperlipidemia follows surgical weight loss in patients undergoing Roux-en-Y gastric bypass surgery: a 6-year analysis of data. Surg Obes Relat Dis. 2011;7(4):473–9.  https://doi.org/10.1016/j.soard.2010.08.009.CrossRefPubMedGoogle Scholar
  25. 25.
    Patel VJ, Joharapurkar AA, Shah GB, Jain MR. Effect of GLP-1 based therapies on diabetic dyslipidemia. Curr Diabetes Rev. 2014;10(4):238–50.. https://www.ncbi.nlm.nih.gov/pubmed/24998439 CrossRefGoogle Scholar
  26. 26.
    Mokadem M, Zechner JF, Margolskee RF, Drucker DJ, Aguirre V. Effects of Roux-en-Y gastric bypass on energy and glucose homeostasis are preserved in two mouse models of functional glucagon-like peptide-1 deficiency. Mol Metab. 2014;3(2):191–201.  https://doi.org/10.1016/j.molmet.2013.11.010.CrossRefPubMedGoogle Scholar
  27. 27.
    Brolin RE, Kenler HA, Wilson AC, Kuo PT, Cody RP. Serum lipids after gastric bypass surgery for morbid obesity. Int J Obes. 1990;14(11):939–50.. https://www.ncbi.nlm.nih.gov/pubmed/2276855 PubMedGoogle Scholar
  28. 28.
    Scopinaro N, Marinari GM, Camerini GB, Papadia FS, Adami GF. Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: a long-term follow-up study. Diabetes Care. 2005;28(10):2406–11.. https://www.ncbi.nlm.nih.gov/pubmed/16186271 CrossRefGoogle Scholar
  29. 29.
    Hinojosa MW, Varela JE, Smith BR, Che F, Nguyen NT. Resolution of systemic hypertension after laparoscopic gastric bypass. J Gastrointest Surg. 2009;13(4):793–7.  https://doi.org/10.1007/s11605-008-0759-5.CrossRefPubMedGoogle Scholar
  30. 30.
    Garrison RJ, Kannel WB, Stokes J, Castelli WP. Incidence and precursors of hypertension in young adults: the Framingham offspring study. Prev Med. 1987;16(2):235–51.  https://doi.org/10.1016/0091-7435(87)90087-9.CrossRefPubMedGoogle Scholar
  31. 31.
    Ahmed AR, Rickards G, Coniglio D, et al. Laparoscopic Roux-en-Y gastric bypass and its early effect on blood pressure. Obes Surg. 2009;19(7):845–9.  https://doi.org/10.1007/s11695-008-9671-z.CrossRefPubMedGoogle Scholar
  32. 32.
    Sarkhosh K, Birch DW, Shi X, Gill RS, Karmali S. The impact of sleeve gastrectomy on hypertension: a systematic review. Obes Surg. 2012;22(5):832–7.  https://doi.org/10.1007/s11695-012-0615-2.CrossRefPubMedGoogle Scholar
  33. 33.
    Cohen JB. Hypertension in obesity and the impact of weight loss. Curr Cardiol Rep. 2017;19(10):98.  https://doi.org/10.1007/s11886-017-0912-4.CrossRefPubMedGoogle Scholar
  34. 34.
    Owen JG, Yazdi F, Reisin E. Bariatric surgery and hypertension. Am J Hypertens. 2017;31(1):11–7.  https://doi.org/10.1093/ajh/hpx112.CrossRefPubMedGoogle Scholar
  35. 35.
    de Raaff CAL, de Vries N, van Wagensveld BA. Obstructive sleep apnea and bariatric surgical guidelines: summary and update. Curr Opin Anaesthesiol. 2018;31(1):104–9.  https://doi.org/10.1097/ACO.0000000000000542.CrossRefPubMedGoogle Scholar
  36. 36.
    Glazer SA, Erickson AL, Crosby RD, Kieda J, Zawisza A, Deitel M. The evaluation of screening questionnaires for obstructive sleep apnea to identify high-risk obese patients undergoing bariatric surgery. Obes Surg. 2018;28(11):3544–52.  https://doi.org/10.1007/s11695-018-3391-9.CrossRefPubMedGoogle Scholar
  37. 37.
    Coughlin SR, Mawdsley L, Mugarza JA, Calverley PMA, Wilding JPH. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J. 2004;25(9):735–41.  https://doi.org/10.1016/j.ehj.2004.02.021.CrossRefGoogle Scholar
  38. 38.
    Foster GD, Borradaile KE, Sanders MH, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the sleep AHEAD study. Arch Intern Med. 2009;169(17):1619–26.  https://doi.org/10.1001/archinternmed.2009.266.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of obstructive sleep apnea after surgical weight loss. J Clin Sleep Med. 2008;4(4):333–8.. https://www.ncbi.nlm.nih.gov/pubmed/18763424 PubMedPubMedCentralGoogle Scholar
  40. 40.
    Greenburg DL, Lettieri CJ, Eliasson AH. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med. 2009;122(6):535–42.  https://doi.org/10.1016/j.amjmed.2008.10.037.CrossRefPubMedGoogle Scholar
  41. 41.
    de Raaff CAL, de Raaff CAL, Gorter-Stam MAW, et al. Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline. Surg Obes Relat Dis. 2017;13(7):1095–109.  https://doi.org/10.1016/j.soard.2017.03.022.CrossRefPubMedGoogle Scholar
  42. 42.
    Amin R, Simakajornboon N, Szczesniak R, Inge T. Early improvement in obstructive sleep apnea and increase in orexin levels after bariatric surgery in adolescents and young adults. Surg Obes Relat Dis. 2017;13(1):95–100.  https://doi.org/10.1016/j.soard.2016.05.023.CrossRefPubMedGoogle Scholar
  43. 43.
    Kalra M, Inge T. Effect of bariatric surgery on obstructive sleep apnoea in adolescents. Paediatr Respir Rev. 2006;7(4):260–7.  https://doi.org/10.1016/j.prrv.2006.08.004.CrossRefPubMedGoogle Scholar
  44. 44.
    PCOS and Diabetes, Heart Disease, Stroke...|Features & Spotlights|Resources & Publications|Diabetes|CDC. https://www.cdc.gov/diabetes/library/spotlights/pcos.html. Published March 15, 2018. Accessed 22 Apr 2019.
  45. 45.
    Sam S. Obesity and polycystic ovary syndrome. Obes Manag. 2007;3(2):69–73.  https://doi.org/10.1089/obe.2007.0019.CrossRefPubMedGoogle Scholar
  46. 46.
    Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, Sancho J, San Millán JL. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. J Clin Endocrinol Metab. 2005;90(12):6364–9.  https://doi.org/10.1210/jc.2005-1490.CrossRefPubMedGoogle Scholar
  47. 47.
    Eid GM, Cottam DR, Velcu LM, et al. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1(2):77–80.  https://doi.org/10.1016/j.soard.2005.02.008.CrossRefPubMedGoogle Scholar
  48. 48.
    Cardoso L, Rodrigues D, Gomes L, Carrilho F. Short- and long-term mortality after bariatric surgery: a systematic review and meta-analysis. Diabetes Obes Metab. 2017;19(9):1223–32.  https://doi.org/10.1111/dom.12922.CrossRefPubMedGoogle Scholar
  49. 49.
    Dixon JB, OʼBrien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. Obstet Gynecol Surv. 2008;63(6):372–3.  https://doi.org/10.1097/01.ogx.0000314848.71777.69.CrossRefGoogle Scholar
  50. 50.
    Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.  https://doi.org/10.1056/nejmoa1200111.CrossRefPubMedGoogle Scholar
  51. 51.
    Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.  https://doi.org/10.1056/nejmoa1200225.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Sjöström L, Peltonen M, Jacobson P, et al. Association of Bariatric Surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297.  https://doi.org/10.1001/jama.2014.5988.CrossRefPubMedGoogle Scholar
  53. 53.
    Sjöström L, Gummesson A, David Sjöström C, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish obese subjects study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10(7):653–62.  https://doi.org/10.1016/s1470-2045(09)70159-7.CrossRefPubMedGoogle Scholar
  54. 54.
    Sarkhosh K, Switzer NJ, El-Hadi M, Birch DW, Shi X, Karmali S. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg. 2013;23(3):414–23.  https://doi.org/10.1007/s11695-012-0862-2.CrossRefPubMedGoogle Scholar
  55. 55.
    Bower G, Toma T, Harling L, et al. Bariatric surgery and non-alcoholic fatty liver disease: a systematic review of liver biochemistry and histology. Obes Surg. 2015;25(12):2280–9.  https://doi.org/10.1007/s11695-015-1691-x.CrossRefPubMedGoogle Scholar
  56. 56.
    Pareek M, Schauer PR, Kaplan LM, Leiter LA, Rubino F, Bhatt DL. Metabolic surgery. Weight Loss Diabetes Beyond J Am Coll Cardiol. 2018;71(6):670–87.  https://doi.org/10.1016/j.jacc.2017.12.014.CrossRefPubMedGoogle Scholar
  57. 57.
    Murphy R, Clarke MG, Evennett NJ, et al. Laparoscopic sleeve gastrectomy versus banded Roux-en-Y gastric bypass for diabetes and obesity: a prospective randomised double-blind trial. Obes Surg. 2018;28(2):293–302.  https://doi.org/10.1007/s11695-017-2872-6.CrossRefPubMedGoogle Scholar
  58. 58.
    Nguyen NT, Kim E, Vu S, Phelan M. Ten-year outcomes of a prospective randomized trial of laparoscopic gastric bypass versus laparoscopic gastric banding. Ann Surg. 2018;268(1):106–13.  https://doi.org/10.1097/SLA.0000000000002348.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Rene Aleman
    • 1
  • Francesco Rubino
    • 2
  • Emanuele Lo Menzo
    • 3
  • Raul J. Rosenthal
    • 3
  1. 1.Minimally Invasive Surgery and Bariatric Surgery DepartmentCleveland Clinic FloridaWestonUSA
  2. 2.Bariatric and Metabolic SurgeryKing’s College London Consultant, King’s College HospitalLondonUK
  3. 3.Department of General SurgeryThe Bariatric and Metabolic Institute, Cleveland Clinic FloridaWestonUSA

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