27 Metabolic Syndrome— Surgical Management

Abstract: The prevalence of obesity is increasing in epidemic proportions worldwide, as is the risk for both Type 2 diabetes and heart disease. The multiple diseases or comorbidities associated with central obsity are termed the “metabolic Syndrome”, “Syndrome X, ” or the “in sulin Resistance Metabolic Syndrome of Obesity. ” Despite aggressive management, current therapies fail to achieve satisfactory control of the problem in majority of patients. It has been observed that operations for morbid obesity not only induce weight loss but also have a significant impact on the course of the Metabolic Syndrome (MS). These procedures include Gastric Banding, Roux-en-Y Gastric Bypass and Biliopancreatic diversion. Gastric Bypass, the “gold standard procedure ” for morbid obesity, has been found to have maximum impact in terms of improvement in glycemic control and overall mortality reduction. The exact mechanism for the dramatic effect of Gastric By pass on MS remains unknown. Various hypothesis have been proposed. Improvement in glycemic control occurs within days after surgery, long before there is any significant weight loss, and this suggests that the control of diabetes is probably mediated by changes in hormones secretion from the gastrointestinal tract. Controlled trials in centers with a wide experience of Bariatric surgery are needed to verify the possibility of a surgical cure specific to the problem. Nevertheless, early studies have shown promising results. Mention must also be made of an experimental novel electrical stimulation device, the IGS (Implantable Gastric Stimulation) system, which can potentially improve glucose levels and induce weight loss in obese patients with Type 2 Diabetes on oral hypoglycemic therapy. Trials are underway to prove its efficacy