MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass

Abstract

Obesity and its associated comorbidities have become one of the largest challenges for health care in the near future. Conservative therapy for obesity and related comorbidities has a very high failure rate and poor long-term results. Similarly, the conservative and medical management of the majority of metabolic diseases such as type 2 diabetes mellitus are only able to slow down disease progression but have no causal effect on the disease process. Obesity surgery has evolved as a highly effective therapy for severe obesity achieving long-lasting weight loss. Furthermore, several studies have demonstrated the beneficial effects of obesity surgery on reduction of overall mortality, reduction of cardiovascular events and superior control of obesity-related diseases such as type 2 diabetes mellitus, dyslipidemia and also the non-alcoholic steatohepatitis compared to medical therapy. Based on these findings, the term 'metabolic surgery' with the focus on treating metabolic diseases independent of body weight has been coined. Of great interest are recent studies that show that even existing complications of metabolic diseases such as diabetic nephropathy or the non-alcoholic steatohepatitis can be reversed by metabolic surgery. Although metabolic surgery has proven to be a safe and effective treatment for obesity, resolution of comorbidities and enhancing quality of life, it is still uncertain and unclear, which surgical procedure is the most effective to achieve these metabolic effects. The aim of this review is to compare the effects of the two currently most widely used metabolic operations, the Roux-en-Y gastric bypass and the sleeve gastrectomy in the treatment of obesity and its related comorbidities.

Bile Acid and Fibroblast Growth Factor 19 Regulation in Obese Diabetics, and Non-Alcoholic Fatty Liver Disease after Sleeve Gastrectomy

“…Our study corresponds to the above, and further investigates the FGF 19 and FLI score on NAFLD in patients with obesity and T2DM after SG. In different metabolic surgery, SG had a better capability to normalize liver function test than Roux-en-Y gastric bypass in patients with obesity and T2DM 1 year after surgery [55]. Non-invasive markers of liver fibrosis scores, including aspartate aminotransferase/alanine aminotransferase ratio, NAFLD fibrosis score, BARD score, and aspartate aminotransferase to platelet ratio index, have been used to evaluate the improvement of NAFLD after SG [56].…”

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

“…It has access to diagnostic, biochemical and imaging facilities necessary for the management of patients with morbid obesity. The operative interventions were performed as previously described [ 29 ] by the same group of experienced surgeons (n = 7). All participating surgeons had performed more than 50 MI sleeve gastrectomy procedures and had experience of at least 10 years in abdominal surgery.…”

Levels of GLP-1 In Response to The Most Common Used Bariatric Procedures in Obese Patients with Type 2 Diabetes Mellitus

“…In the last two decades, extreme obesity and its comorbidities have often been treated with bariatric surgery [1] . Bariatric operations often involve restrictive or a mix of restrictive and malabsorptive approaches [2] .…”