Concept of Metabolic Surgery

Abstract

The terms “bariatric surgery” and “metabolic surgery” are often used interchangeably. Although in some circumstances this may be correct, there are critical differences between the two which should be acknowledged. Bariatric surgery was originally conceived as surgical procedures aiming at sustained weight loss - an effect, at the time, largely attributed to caloric reduction.With advancement of our understanding, we now know that such surgeries are associated with significant improvements in metabolic dysfunction associated with obesity and may be beneficial to even those with moderate obesity. This prompted the coining of the term “metabolic surgery” which can be used to describe the same surgical procedures typically associated with bariatric surgery but with specific indications and aims beyond weight loss alone, namely, the improvement in obesity-related metabolic disease. In addition to the more than 10 randomized controlled trials now establishing bariatric surgery as the most effective treatment for patients with obesity and type 2 diabetes mellitus, there are mechanistic studies demonstrating the critical role of the gastrointestinal (GI) tract in the development and regulation of metabolic dysfunction. In light of these advances, came the recognition of the possibility of developing a surgical approach aimed specifically at treating patientswithmetabolic dysfunction, including those beyond the traditionally accepted body mass index (BMI) treatment thresholds. This shift in the focus for treatment has seen the widespread adoption of the term “metabolic surgery” to more accurately reflect the indications and aims of surgery from weight loss centric metrics alone to those looking at improvements in obesity-related metabolic disease. Further advancing the field requires ongoing research into the pre-and postoperative management of diabetes-related comorbidity, identifying means of sustaining surgery-induced metabolic improvements and the development of postoperative treatment algorithms particularly those for patients with persistent or recurrent disease including the use of long-term pharmacotherapy.