Abstract
The rapid reversal of diabetes, hypertension, hyperlipidaemia and obesity by surgical means has challenged accepted doctrines regarding the management of metabolic syndrome. Sleeve gastrectomy, which developed initially as a preparatory procedure for biliopancreatic diversion with duodenal switch, has seen an exponential rise in popularity as an effective lone laparoscopic bariatric procedure. Superior excess weight loss, a low complication rate, and excellent food tolerance, combined with a short hospital stay, have made this the procedure of choice for patients and surgeons across the globe. High volume centres nurture the ongoing development of experienced and specialized teams, pathways and regimens. Optimum surgical outcomes allow minimization of metabolic syndrome, reducing cardiovascular and cerebrovascular risk.
Highlights
The most widely used definition of metabolic syndrome is that of the Third Report of the American National Cholesterol Education Program[1]
Pharmacological glucagon-like peptide 1 (GLP-1) agonists have been approved by the United States Food and Drug Administration (FDA), as have inhibitors of dipeptidyl peptidase 4 (DPP 4), a protease which degrades GLP-1 and glucose dependent insulinotropic peptide (GIP)
Sleeve gastrectomy can be employed for obese patients with metabolic syndrome who are at high risk of developing complications after malabsorptive procedures, including chronic smokers and non-steroidal antiinflammatory drug users
Summary
The most widely used definition of metabolic syndrome is that of the Third Report of the American National Cholesterol Education Program[1]. The ongoing expansion from bariatric into metabolic surgery for sleeve gastrectomy reflects international recognition of its role in the correction of co-morbidities in the moderately obese, insulin resistance diabetes. Basso et al in their study reported a ‘‘gastric hypothesis’’ for this restoration of 1st phase insulin secretion, which improves glycaemic control They proposed that a decrease in hydrochloric acid-stimulated, vagally-innervated, antral mucosa secretion of gastrin releasing peptide (GRP) in turn stimulated GLP-1 release[9]. Pharmacological GLP-1 agonists have been approved by the United States Food and Drug Administration (FDA), as have inhibitors of dipeptidyl peptidase 4 (DPP 4), a protease which degrades GLP-1 and GIP While such medications may control hyperglycaemia in diabetes, and even produce slight weight loss and hypertension reduction, the effects are not comparable to metabolic surgery
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