1st Annual Metabolic Surgery Summit

by Melissa Cuesta-Gonzalez, LPN

Ms. Cuesta-Gonzalez is Bariatric Coordinator, Surgical Weight Loss Institute, Coral Gables, Florida.

Dear Bariatric Times Editor:
The first United States Metabolic Surgery Summit was held in Miami Beach, Florida, at Mount Sinai Medical Center on January 12, 2008. It was hosted by Dr. Nestor de la Cruz-Munoz, Medical Director for Bariatric Surgery at Mount Sinai Medical Center, Cedars Medical Center, and Hialeah Hospital, and head of the Surgical Weight Loss Institute. A prominent and internationally renowned faculty of physicians headed the day-long session that presented the growing evidence of bariatric surgery as a metabolic surgery and how the surgery can be effective in reducing type 2 diabetes and metabolic syndrome. There have been a few international conferences on this topic over the past two years, but this was the first single conference focused strictly on metabolic surgery in the United States. As the idea of metabolic surgery is such a relatively new concept, many bariatric surgeons do not yet understand the proposed hormonal mechanisms and their effects on type 2 diabetes. The purpose of the conference was to provide bariatric surgeons, general surgeons, and medical specialists with the opportunity to become educated on this very important and rapidly developing subject.

Dr. Patrick O’Leary began the day by discussing the prevalence and significance of diabetes and metabolic syndrome. Drs. Phil Schauer and Raul Rosenthal gave details on outcomes and rates of resolution of comorbidities after bariatric surgery. Dr. Christopher Sorli spoke on the limitations of medical therapy and on the mechanisms of appetite control and weight loss.

Drs. Francesco Rubino and de la Cruz-Munoz discussed the proposed metabolic mechanisms of bariatric surgery. The day concluded with presentations on novel and experimental procedures specific to metabolic effects by Drs. Ricardo Cohen and Scott Shikora.

The surgeons and medical specialists alike were able to explore and share in the meeting’s most profound messages, including the following:

• 3.8 million Americans suffer from morbid obesity. Approximately 20 percent are affected with metabolic syndrome and nearly 50 percent have diabetes or impaired glucose tolerance. Ninety percent of patients with type 2 diabetes are obese.
• Metabolic syndrome is characterized by the presence of a combination of diabetes mellitus or impaired glucose intolerance, elevated blood pressure, dyslipidemia, and central/abdominal obesity.
• Eighty percent of patients with type 2 diabetes who had bariatric surgery were able to come off all of their medications; the surgery is associated with long-term sustained weight loss and a reduction in overall mortality.
• Weight loss from all types of bariatric surgery has profound metabolic benefits. Intestinal bypass procedures appear to have additional benefits related to changes in enterohormone secretion. The exact causes of these changes are still being debated as several theories exist, but outcomes data and animal and human studies have documented these changes.
• Gastrointestinal surgeries for the treatment of metabolic disorders may prove to be acceptable options along with medical therapy. Controlled studies are underway to better delineate benefits and outcomes.
• Pros and cons of conventional and novel operations for antidiabetic procedures were emphasized.
• Novel approaches and research trials for the surgical treatment of type 2 diabetes include the following:

• Duodenojejunal bypass decreases insulin resistance and improves diabetes in patients with BMIs of 22 to 34kg/m2. Interim conclusions are promising, as the majority of insulin users ceased medication early in the postoperative period.
• An intraluminal duodenal sleeve may be a lower risk option as it is less invasive and is reversible. Early studies have shown amelioration of diabetes in animals and patients.
• An entrectomy-based procedure has been studied as it theoretically works directly with the neuroendocrine mechanisms of hunger and satiety without nutrient malabsorption.
• Ileal transposition seems to also improve metabolic parameters by stimulating the L cells of the terminal ileum.

Further research is necessary to better understand the potentials of the new technology presented. The Metabolic Surgery Summit provided a forum that introduced many new concepts and proposed that surgery may soon be a treatment option for type 2 diabetes in select patients.

Category: Past Articles, Symposium Synopsis