Hamdan Medical Journal (previously the Journal of Medical Sciences)

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Metabolic Surgery. A New Surgical Discipline?

Nicola Scopinaro
Published in : Journal of Medical Sciences ; Vol 3, No 1 (2010)
DOI : 10.2174/1996327001003010028


Metabolic surgery can be considered as part of functional surgery, where the function to be corrected is a metabolic one. The first known example of metabolic surgery is probably the partial ileal bypass for the treatment of hypercholesterolemia. Modern metabolic surgery was preceded and inspired by bariatric surgery, basing on the strong metabolic effect of some obesity surgery operations, especially gastric bypass and biliopancreatic diversion (BPD), mainly active on type 2 diabetes mellitus. A true metabolic operation, primarily aimed at obtaining a favourable metabolic change, should on one side not provoke undue weight loss, on the other side act through specific mechanisms independent of weight changes. BPD, in clinical use since the late 70s, has proven to meet these requirements and is successfully used today in clinical trials for the treatment of the metabolic syndrome. New developed metabolic operations are represented by duodenal-jejunal bypass, endointestinal sleeve, and ileal interposition. All the efforts should be aimed at conceiving an operation equally effective as BPD, yet less invasive.

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Buchwald H. Lowering of cholesterol absorption and blood levels by ileal exclusion: Experimental basis and preliminary clinical report. Circulation 1964; 29: 713-20.

Buchwald H, MooreRB, Lee GB, Baltaxe H, Ampaltz F, Frantz ID, et al. Five years experience with the use of partial ileal bypass in the treatment of hypercholesterolemia and atherosclerosis. Isr J Med Sci 1969;5: 760-5.

Moore RB, Frantz ID, Buchwald H. Changes in cholesterol pool size, turnover rate, and fecal bile acid and sterol excretion after partial ileal bypass in hypercholesterolemic patients. Surgery 1969; 65: 98-108.

Payne JH, De Wind LT. Surgical treatment of obesity.Am J Surg 1969; 118: 141-7.

Dean RH, Orcutt TW, Younger RK, Butts WH, Scott HW Jr. Changes in hyperlipidemia and hyperlipoproteinemia in morbidly obese patients treated by jejunoileal bypass. Surg Forum 1973; 24: 241-3.

Kuzmak LI. A preliminary report on silicone gastric banding for obesity. Clin Nutr 1986; 5: 73-77.

Belachew M, Legrand MJ, Deferecheux TH, Burtheret MP, Jacquet N. Laparoscopic adjustable silicone gastric banding in the treatment of morbid obesity. A preliminary report. Surgical Endosc 1994;8: 1354-6.

Mason EE. Vertical banded gastroplasty for obesity.Arch Surg 1982; 117: 701-6.

Mason EE, Ito C. Gastric bypass in obesity. Surg Clin N Amer 1967; 47: 1345-51.

Wittgrove AC, Clark GW. Tremblay LJ. Laparoscopic gastric bypass Roux-en-Y: preliminary report of five cases. Obes Surg 1994; 4: 353-7.

Scopinaro N, Gianetta E, Civalleri D, Bonalumi U, Bachi V. Biliopancreatic bypass for obesity: II. Initial experience in man. Br J Surg 1979; 66: 618-20.

Scopinaro N, Gianetta E, Civalleri D, Bonalumi U,Friedman D, Bachi V. Partial and total biliopancreatic bypass in the surgical treatment of obesity. Int J Obes 1981; 5: 421-429.

Scopinaro N, Marinari GM, Camerini GB, Papadia FS, Adami GF. Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: A long-term follow-up study. Diabetes Care 2005; 28: 2406-11.

Scopinaro N, Adami GF, Marinari UM, Gianetta E,Traverso E, Friedman D, et al. Biliopancreatic diversion.World J Surg 1998; 22: 936-46.

Scopinaro N, Gianetta E, Friedman D, Adami GF,Traverso E, Bachi V. Evolution of biliopancreatic bypass. Clin Nutr 1986; 5(suppl): 137-46.

Pories W, Swanson MS, MacDonald KG Jr, Long SB, Morris PG, Brown BM, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.Ann Surg 1995; 222: 339-52.

MacDonald KG Jr., Long SD, Swanson MS, Brown BM, Morris P, Dohm GL, et al. The gastric bypass operation reduces the progression and mortality of non-insulin dependent diabetes mellitus. J Gastrointest Surg 1997; 1: 213-20.

Schauer PR, Burguera B, Ikuamuddin S, Cottam D,Gourash W, Harnad G, et al. Effect of laparoscopic Rou-en-Y gastric bypass on type 2 diabetes mellitus.Ann Surg 2003; 238: 467-84.

Torquati A, Luffi R, Abumrad N, Richards WO. Is Roux-en-Y gastric bypass surgery the most effective treatment for type 2 diabetes mellitus in morbidly obese patients? J Gastrointest Surg 2005; 9: 1112-8.

Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and metaanalysis.Am J Med 2009; 122: 248-56.

Morinigo R, Moizé V, Musri M, Lacy AM, Navarro S, Marin JL, et al. Glucagon-like-peptide-1, peptide YY, hunger, and satiety after gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab 2006; 91: 1735-40.

Hayes MR, Bradley L, Grill HJ. Endogenous hindbrain glucagon-like peptide-1 receptor activation contributes to the control of food intake by mediating gastric satiation signaling. Endocrinology 2009; 150:2654-9.

Pironi L, Stanghellini V, Miglioli M, Corinaldesi R, De Giorgio R, Ruggeri E, et al. Fat-induced ileal brake in humans: a dose-dependent phenomenon correlated to the plasma levels of peptide YY. Gastroenterology 1993: 105: 733-9.

Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease.Ann Surg 2004; 239: 1-11.

Rubino F, Zixxari P, Tomasetto C, Blue-Pajot MT, Forgione A, Vix M, et al. The role of small bowel in the regulation of circulating ghrelin levels and food intake in the obese Zucker rat. Endocrinology 2005;146: 1745-52.

Rubino F, Kaplan LF, Schauer PR, Cummings DE. On behalf of the Diabetes Surgery Summit Delegates. The diabetes surgery summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg 2009 Nov 19 [Epub ahead of print].

Cohen R, Pinheiro JS, Corres JL, Schiavon CA.Laparoscopic Roux-en-Y gastric bypass for BMI

28.Scopinaro N, Papadia F, Marinari G, Camerini G, Adami GF. Long-term control of type 2 diabetes mellitus and the other major components of the metabolic syndrome after biliopancreatic diversion in patients with BMI

29.Chiellini C, Rubino F, Castagneto M, Nanni G,Mingrone G. The effect of biliopancreatic diversion on type 2 diabetes in patients with BMI

Scopinaro N, Marinari GM, Camerini G, Pretolesi F,Papadia F, Murelli F, et al. Energy and nitrogen absorption after biliopancreatic diversion. Obes Surg 2000; 10: 436-41.

Greco AV, Mingrone G, Giancaterini A, Manco M,Morroni M, Cinti S, et al. Insulin resistance in morbid obesity: reversal with intramyocellular fat depletion.Diabetes 2002; 5: 144-51.

Adami G, Parodi RC, Papadia F, Marinari, Camerini G, Corvisieri R, et al. Magnetic resonance spectroscopy facilitates assessment of intramyocellular lipid changes: a preliminary short-term study following biliopancreatic diversion. Obes Surg 2005; 15:1233-7.

Adami GF, Cordera R, Camerini G, Marinari GM,Scopinaro N. Recovery of insulin sensitivity in obese patients at short term after biliopancreatic diversion.J Surg Res 2003; 113: 217-21.

Adami GF, Cordera R, Camerini G, Marinari GM,Scopinaro N. Long-term normalization of insulin sensitivity following biliopancreatic diversion for obesity.Int J Obes Relat Metab Disord 2004; 28: 671-3.

Unger RH, Eisentraut AM. Entero-insular axis. Arch Intern Med 1969; 123: 261-6.

Creutzfeld W. The incretin concept today.Diabetologia 1979; 16: 75-85.

Creutzfeld W, Ebert R, Willms B, Frerichs H, Brown JC. Gastric inhibitory polypeptide (GIP) and insulin in obesity: increased response to stimulation and defective feedback control of serum levels. Diabetologia 1978; 14: 15-24.

Doyle ME, Egan JM. Mechanisms of action of glucagone-like peptide 1 in the pancreas. Pharmacol Ther 2007; 113: 546-93.

Hickey MS, Pories WJ, MacDonald KG Jr., Kory KA, Dohm GL, Swanson MS, et al. A new paradigm for type 2 diabetes mellitus: could it be a disease of the foregut? Ann Surg 1998; 227: 637-43,

Rubino F, Forgione A, Cummings DE, Vix M, Gnulli D,Mingrone G, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 2006; 244:741-9.

Xu G, Stoffers DA, Habener JF, Bonner-Weir S. Exendin-4 stimulates both beta-cell replication and neogenesis, resulting in increased beta-cell mass.Diabetes 1999; 48: 2270-6.

Farilla L, Bulotta A, Hirshberg B, Li CS, Khouri N,Noushmehr H, et al. Glucagon-like peptide 1 inhibits cell apoptosis and improve glucose responsiveness of freshly isolated human islets. Endocrinology 2003; 144: 5149-58.

Borg CM, le Roux CW, Ghatei MA, Bloom SR, Patel AG. Biliopancreatic diversion in rats is associated with intestinal hypertrophy and with increased GLP-1, GLP-2 and PYY levels. Obes Surg 2007; 17: 1193-8.

Valverde I, Puente J, Martín-Duce A, Molina L, Lozano O, Sancho V, et al. Changes in glucagon-like peptide-1 (GLP-1) secretion after biliopancreatic diversion or vertical banded gastroplasty in obese subjects. Obes Surg 2005; 15: 387-97.

Csendes A, Maluenda F, Burgos AM. A prospective randomized study comparing patients with morbid obesity submitted to laparotomic gastric bypass with or without omentectomy. Obes Surg 2009 ; 19 :490-4.

Cohen RV, Schiavon CA, Pinheiro JS, Correa JL,Rubino F. Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22-34 kg/m2: a report of 2 cases. Surg Obes Relat Dis 2007; 3: 195-7.

Ferzli GS, Dominique E, Ciaglia M, Bluth MH, GonzalezA, Fingerhut A. Clinical improvement after duodenal jejunal bypass for non obese type 2 diabetes despite minimal improvement in glycemic homeostasis. World J Surg 2009; 33: 972-9.

Gersin KS, Keller JE, Stefanidis D, Simms CS, Abraham DD, Deal SE. Duodenal-jejunal bypass sleeve:a totally endoscopic device for the treatment of morbid obesity. Surg Innov 2007; 14: 275-8.

Rodriguez-Grunert L, Galvao-Neto MP, Alamo M,Ramos AC, Baez PB, Tarnoff M. First human experience with endoscopically delivered and retrieved duodenal-jejunal bypass sleeve. Surg Obes Relat Dis 2008; 4: 55-9.

Koopmans HS, Sclafani A, Fichtner C, Aravich PF.The effect of ileal transposition on food intake and body weight loss in VMH-obese rats. Am J Clin Nutr1982; 35: 284-93.

Atkinson RL, Whipple JH, Atkinson SH, Stewart CC.Role of the small bowel in regulating food intake in rats. Am J Physiol 1982; 242: 429-33.

Strader AD, Vahl TP, Jandacek RJ, Woods SC,D’Alessio DA, Seeley RJ. Weight loss through ileal transposition is accompanied by increased ileal hormone secretion and synthesis in rat. Am J Physiol Endocrinol Metab 2005; 288: 447-53.

Patriti A, Aisa MC, Annetti C, Siconi A, Galli F, Ferri I,et al. How the hindgut can cure type 2 diabetes. Ileal transposition improved glucose metabolism and beta-cell function in Goto-Kakizaki rats through an enhanced Proglucagon gene expression and Lcell number. Surgery 2007; 142: 74-85.

Wang TT, Hu SY, Gao HD, Zhang GY, Liu CZ, Feng JB, et al. Ileal transposition controls diabetes as well as modified duodenal jejunal bypass with better lipid lowering in a non obese rat model of type II diabetes by increasing GLP-1. Ann Surg 2008: 247:968-75.

De Paula AL, Macedo ALV, Prudente AS, Qyeroz L,Schraibman V, Pinus J. Laparoscopic sleeve gastrectomy with ileal interposition (“neuroendocrine brake”) – pilot study of a new operation. Surg Obes Relat Dis 2006; 2: 464-7.

De Paula AL, Macedo AL, Mota BR, Schraibman V.Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21-29. Surg Endosc 2009; 23: 1313-20.

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