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Metabolic Surgery

Several conventional procedures of bariatric surgery and novel gastrointestinal operative methods induce long-term relief of type 2 diabetes mellitus (T2DM). These surgical procedures are also strikingly progressing in other metabolic dysfunctions such as hypertension and hyperlipidemia in patients without or with obesity. Many shreds of evidence compiled that these metabolic outcomes are not merely the results of substantial weight loss and reduced calorie intake but might be assignable in part to change of endocrine that derived from operational manipulation of the gastrointestinal tract. The outcome of such surgical intervention termed as metabolic surgery. It is becoming popular in today’s medical practice because of the reason that gastrointestinal tract is the key player in the management of glucose homeostasis and obesity.

What is metabolic surgery?

Bariatric surgery has conventionally been segregated into three groups: restrictive, malabsorptive, or mixed surgery. This division is made on the presumption that bariatric surgery aims to control the intake of food and or absorption of nutrients. Conforming to this traditional view, following methods are adopted for metabolic surgery:

  • Restrictive surgical method — Restrictive surgical methods, like laparoscopic adjustable gastric banding (LAGB) or, vertical banded gastroplasty (VBG) persuade satiety to reduce the size of the stomach.
  • Malabsorptive surgical method — Malabsorptive mechanism like biliopancreatic diversion (BPD), reroute the bile into the ultimate segment of ileum so that the bile and the food can mix in the terminal 50-100 cm of the small bowel, thereby results in drastic reduction of absorption of nutrients.
  • Mixed surgical method — Mixed procedure, like Roux-en-Y gastric bypass (RYGB), comprises reduction of stomach and diversion of bile into the small intestine, which, however, shortens less than it is in BPD.

Other surgical methods such as duodenal–jejuna bypass (DJB), Sleeve gastrectomy and ileal interposition are also effective for their capacity to result in substantial weight loss and or improvement of glycemic control among the non-obese as well as obese patients. Nonetheless, LAGB, BPD, and RYGB are the most widely accepted method of surgery used for the treatment of morbidly obese patients.

Pre-metabolic surgery diet

You will be advised by the surgeon to take clear liquid at least 3/5 days prior to surgery depending upon the method of operation will be undergoing in your case. Patients undergoing gastric bypass surgery need to hydrate with electrolytes and almost zero calorie beverages for the full five days.

Post metabolic surgery diet

The hospital will provide a normal volume of liquids, though it depends on how you regulate consumption of liquid. Better you follow a 4X4 regulatory rule for intake of liquid provided to you. Start off with one ounce of liquid. Sip it slowly for one hour. This does not mean that you will gulp entire one ounce at a time and wait for another hour, rather sip it over whole one hour. Depending upon your tolerance increase the fluid intake by one ounce in every four hours to target four ounces per hour when you are awake.

Post metabolic surgery challenges

On completion of observatory post-operative period, you will be provided with diet chart and exercises which you need to follow throughout the rest of life. Routine lifestyle with balanced diet chart with proper vitamin supplements will provide you a new healthy life.

 

Authored By Dr G Parthasarathy - Surgical Gastroenterologist, Hyderabad