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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
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