Innovative metabolic operations

Abstract

Bariatric surgery was developed with the aim of weight reduction. Success was defined only by excess weight loss. Other indices of resolution of metabolic comorbidities were reported but were mostly secondary. Several communications have reported that regardless of body mass index (BMI), complete or partial remission of type 2 diabetes mellitus (T2DM) is possible with "traditional gastrointestinal"operations such as the Roux-en-Y gastric bypass, biliopancreatic diversion, and the sleeve gastrectomy. These results mostly occur before weight loss, positioning metabolic surgery as a good tool for controlling the current T2DM epidemic. Surgery aimed mainly at the diseases such as diabetes and not weight loss are referred to as "metabolic surgery."Metabolic surgery can effectively treat T2DM in individuals with any BMI, including those below 35 kg/m2. Concurrently, some new procedures were developed to treat patients that in theory do not need massive weight loss, focusing a pathophysiological approach to T2DM. Those new techniques, mainly duodenal-jejunal bypass, ileal transposition, and the endoscopic duodenal liner, are experimental procedures that showed good metabolic control with no relation to weight loss.