Here I put a comment from an article by Dr. Rubino, the most influential doctor in Metabolic Surgery (Diabetes) of the world, appeared in BariatricNews.Anyone who wants to understand something about metabolic or diabetes surgery should read this.
What is "metabolic surgery"?
After his recent work that has helped define "metabolic surgery" as a broader specialty that covers bariatric surgery, Dr. Francesco Rubino argues that the term better reflects the objectives and mechanisms of surgery and could improve access toSurgery for those who need it most.
Bariatric surgery, of Greek "baros" that mean "weight", is synonymous with weight loss surgery.However, the benefits and mechanisms of gastrointestinal procedures extend beyond weight loss, questioning the suitability of a name and practice entirely based on weight reduction.
In the last five years, the term "metabolic surgery" has become increasingly popular.However, despite the popularity of the nomenclature, a clear definition of metabolic surgery has not been established.
In 2002, we have suggested that gastrointestinal surgery could be used with the primary intention to treat type 2 diabetes, "diabetes surgery."The idea derives not only from the notable clinical effects of bariatric surgery on diabetes, but also the recognition that the gastrointestinal tract is an important player in the regulation of glucose homeostasis.Research shows that the mechanisms of action of bariatric procedures have metabolic effects, not only mechanical, provided scientific support for the surgical treatment of type 2 diabetes. The idea has gained acceptance after a reference point "Diabetes Surgery "in 2007, two world congresses dedicated to the statements of positioning in this regard and several of different organizations, in particular the International Diabetes Federation in 2011.
"Metabolic" and "Diabetes Surgery", however, often refers incorrectly as a surgical approach to the treatment of diabetes in patients with low body mass index.These are the imprecise definitions since they represent, at most, only two potential applications of metabolic surgery, not its defining characteristics.So far, these terms have been used in this way so that the general population of doctors and patients can understand what we are trying.
In fact, surgical disciplines are never defined by specific procedures, much less by BMI ranges;Rather, the definition and names of surgical subspecialties depend on the organ system whose anatomy is modified by the surgeon (as in neurosurgery, cardiac surgery, gastrointestinal surgery) and / or by the diseases that one intends to treat (such asin endocrine surgery).
To help define the discipline of metabolic surgery / diabetes, it was investigated whether the name and, by inference, the main intention of surgery can influence critical aspects of patient care, regardless of the use of new procedures or operate in patientsNot obese.
A "Metabolic Surgery Program" other than the "Bariatric Surgery Service" has been recently established in an American academic medical center.The two programs differ by their declared objectives, but offer the same procedures and the use of identical eligibility criteria in patients with morbid obesity.This unusual situation offered a unique opportunity to compare metabolic and bariatric surgery.
Compared to the bariatric surgery cohort, theGroup of metabolic surgery in our study was greater, it had a more balanced man / woman, they showed a greater incidence of type 2 diabetes, hypertension, dyslipemia, greater cardiovascular risk and cardiovascular disease established at the beginning of the study.
These findings suggest that the name and, by inference, the intention of metabolic surgery / diabetes can induce reasons and perceptions of risks and benefits, which increases the number of patients seeking surgery for medical reasons, instead of physical problemsor concerns related to the body image of patients.
The substantial changes in the demographic and clinical characteristics of surgical candidates have deep repercussions in terms of patient expectations, the definition of success of treatment, preoperative evaluation and diagnosis, choice of procedure, postoperative care and follow -up, multidisciplinary knowledgeand the composition of the attention team.These are the defining aspects of clinical care that characterize metabolic surgery / diabetes as a new surgical subspecialty, different from traditional bariatric surgery.
Based on the result of this study, it is proposed to define metabolic surgery as "a set of gastrointestinal operations used with the intention of treating diabetes (" diabetes surgery ") and metabolic dysfunctions (which include obesity)."
Given the important implications for patient care, standard use, gastric bypass to treat type 2 diabetes in patients with BMI greater than 35 "Metabolic surgery / diabetes" no "bariatric surgery" should be considered.This means that, contrary to common erroneous perceptions, the age of majority of metabolic surgery requires immediate attention to medical and public education, in addition to important changes in health policies.
In fact, in patients with an BMI above 35 the surgical treatment of diabetes is now recommended by practically all professional organizations and is already covered by most public and private health providers.However, less than 2% of these patients in the US and much less in other countries, have access to surgery.Erroneous concepts of the risks and benefits of surgical treatment, possibly encouraged by the name and implicit objectives of bariatric surgery, can act as a barrier to access to this surgery.
The use of a name that better reflects the objectives and mechanisms of surgery can be the first step in the direction of improving access to surgery for those who need it.