Sleeve gastrectomy in bahawalpur
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Sleeve gastrectomy in bahawalpur

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This talk was given to General Practioners about Bariatric Surgery

This talk was given to General Practioners about Bariatric Surgery

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    Sleeve gastrectomy in bahawalpur Sleeve gastrectomy in bahawalpur Presentation Transcript

    • Javed Iqbal, FCPS, FRCS Professor of SurgeryQuaid-e-Azam Medical College, Bahawalpur, Pakistan
    • Whats new in surgery for the Diabetics
    •  “240 million people worldwide are living with diabetes; 380 million by 2025” “It kills one person every 10 seconds”
    • The usual domain of the surgeons in Diabetes  Diabetic foot  Infections.  Neuropathies.  Vascular narrowing
    • The Surgical Cure of Diabetes
    • The Key Questions. Is there a surgical cure? Can we cut out Diabetes?
    • Background. The Historical Perspectives of gastrointestinal anastomosis. The Rebirth of Bariatric surgery
    • Metabolic SurgeryTreatment of metabolic derangements withalterations of the gut anatomy remission of diabetes
    • The Evidence There is overwhelming evidence indicating that several types of bariatric operations promote profound weight loss and cause complete remission of type 2 diabetes. Pories and Swanson, Ann surg 222:339-350 Sjostrom and Larsonet al NEJM 357: 741-752
    • Association of Diabetes and ObesityDIABETES + OBESITY = DIABESITY DIABETES OBESITY 90% WEIGHT LOSS T2D WEIGHT GAIN T2D
    • How can we correct it ?  Dietary control  Lifestyle changes.  Medical management
    • Why Surgery ? Non Surgical methods of weight loss are associated with higher failure rates. NIH consensus Panel 1991 recommendation:“Surgery is the only long term sustainable weight loss method” *American Diabetic association has also recommended weight loss surgery in Diabetics with BMI 35 or above. *ADA clinical practice recommendations 2008
    • Benefits of surgical weight loss (morbidity and mortality improvement) Weight loss is associated with resolution of co morbidities. ◦ DM=>80% ◦ Hypertension=>60% ◦ Hyperlipidemia=>60-95% ◦ Obstructive Sleep Apnoea => 80-80% ◦ Pories and Swanson, Ann surg 222:339-350 Swedish obese subjects study shows clear benefit of survival for surgery patients from cardiovascular events.(24%) Sjostrom and Larsonet al NEJM 357: 741-752
    • BARIATRIC SURGERY AND DIABETES Bariatric patients would have a sustained weight loss and thus would have a complete resolution of diabetes T2D even if are not obese still would achieve resolution after SG or GBP Schauer&Burguera AnnalsSurgery 2003;238:467-84 Gann ss& Horgensen ANZ J Surgery 2007;77:958-62
    • BARIATRIC SURGERY Gastric Banding Sleeve Gastrectomy Gastro-Biliary Bypass
    • Bariatric Surgeries
    • Mechanisms of Diabetes Resolution after Gastrointestinal Bypass Surgery Enhanced secretion of something good for glucose homeostasis ?Reduced production of something bad for glucose homeostasis ?
    • What is The Mechanism?  Sudden reduction in caloric intake  Reduced Ghrelin Levels  Increased production of bile acidsBA + TGR 5 c AMP dependant THAE Increased Energy Expenditure
    • The QueryWeight loss surgery patients experience areduction in or resolution of diabeticsymptoms immediately following surgery,before weight loss has had a chance to takeplace.
    • THE ANSWER The Immediate control The Entero insular Axis The Francesco Rubino Experiment. The Foregut Hypothesis The Hindgut Hypothesis The role of GLP-I& GIP
    • The exclusion of theduodenal nutrientpassage may offset anabnormality ofgastrointestinalphysiology responsiblefor insulin resistanceand type 2 diabetes
    • Nutrients reach the distalileum within 5 min of theingestion of food and thisstimulates the secretion ofGLP1 by L cellslocated in this area
    • The Entero Insular Axis Anti-Incretins DPP-4 INCREASED INSULIN AVAILABILTY GLP-1 Insulin Production Incretins GIP b-cell Neogenesis PYY Statiety.
    • THE ANSWER Long Term Resolution Decreased adipose tissue leads to modulation of the Adipo Insular Axis Adipocytokines. Leptin.Adiponectin. Decreased Insulin Resistance Resistin.
    • The Net Effect Decreased insulin destruction  Increased Insulin Production Decreased Insulin Resistance
    • WHO WOULD HAVE THOUGHT IT? An Operation Can be The mosteffective Therapy For Adult Onset Diabetes Mellitus
    • Where do we stand?
    •  Workshop in Rome Workshop with Mufazzal Lakhdawala Spent some time with Prof. Mumtaz Maher Extensive hands of course with Prof Karl Miller Acquired all necessary equipments Extensive training hand-swen gut surgery Developed a team Regularly performing sleeve gastrectomy
    • How much it costs?Nothing is more costly than a healthy life