By Lynn Woods
International Diabetes Association (IDA) has taken the position that bariatric (weight loss) surgery should be considered early on as a cost-effective treatment option to avoid serious complications in type 2 diabetics who are moderately or severely obese.
The IDA 2011 position statement was released around the same time that the FDA expanded the approval of the Lap-Band Adjustable Gastric Banding System procedure for use in a wider range of obese patients, including diabetics.
The Lap-Band procedure was first approved by the FDA in 2001 for patients with a body mass index (BMI) of 40 or higher, or for those with a BMI of 35 and at least one other serious obesity-related condition, such as diabetes mellitus or high blood pressure.
Lap-Band gastric banding is now approved for those with a BMI of 30 to 35. But bariatric surgery of any kind should only be used when conventional methods weight loss methods such as diet and exercise have failed. Any such surgery must be accompanied by long-term lifestyle changes such as diet and exercise to be successful.
Both gastric banding and sleeve gastrectomy are minimally invasive laparoscopic surgeries, performed through small incisions in the abdomen. In gastric banding surgery, an inflatable silicone device is place on the top portion of the stomach to create a small pouch.
This pouch will only hold about ½ cup of food, as opposed to the 6 cups a normal stomach will hold. The smaller stomach not only helps the patient eat less by making them feel full sooner, it also slows the passage of food into the rest of the stomach and the digestive tract. As the patient loses (or gains) weight, the band is adjusted to maintain comfort and effectiveness.
In a sleeve gastrectomy, the stomach is surgically reduced to about one-quarter of its normal size, leaving it the shape of a narrow "sleeve" or tube. The portion of the stomach that is removed secretes an appetite hormone called Ghrelin. Once removed, the patient's appetite is said to decrease. The procedure is irreversible.
A gastric bypass is a more complicated irreversible gastrointestinal surgery in which a pouch is created at the top of the stomach, and then connected directly to the middle of the small intestine, bypassing the rest of the stomach and the upper intestine, or duodenum. The part of the intestines that is bypassed is where vitamins and minerals are the most easily absorbed, meaning patients must guard against nutritional deficiencies following a gastric bypass.
Studies published in the Archives of Surgery comparing the newer laparoscopic gastric banding surgery and sleeve gastrectomy to the conventional gastric bypass surgery found that, while conventional bypass surgery resulted in higher weight loss, the less invasive Lap-Band procedure was "safer", with fewer complications.
Many bariatric surgery experts believe that surgery which bypasses the duodenum is the most effective for diabetes control because the duodenum plays a role in insulin resistance, and bypassing it reduces insulin resistance in patients with diabetes mellitus. A gastric bypass also results in the most weight loss. "It's very clear - bypass is better than band, period," states bariatric surgeon Dr. Guilherme M. Campos from the University of the Wisconsin School of Medicine, "And if you are diabetic with obesity, the best treatment is a Roux-en-Y gastric bypass."
International Diabetes Association (IDA) has taken the position that bariatric (weight loss) surgery should be considered early on as a cost-effective treatment option to avoid serious complications in type 2 diabetics who are moderately or severely obese.
The IDA 2011 position statement was released around the same time that the FDA expanded the approval of the Lap-Band Adjustable Gastric Banding System procedure for use in a wider range of obese patients, including diabetics.
The Lap-Band procedure was first approved by the FDA in 2001 for patients with a body mass index (BMI) of 40 or higher, or for those with a BMI of 35 and at least one other serious obesity-related condition, such as diabetes mellitus or high blood pressure.
Lap-Band gastric banding is now approved for those with a BMI of 30 to 35. But bariatric surgery of any kind should only be used when conventional methods weight loss methods such as diet and exercise have failed. Any such surgery must be accompanied by long-term lifestyle changes such as diet and exercise to be successful.
Both gastric banding and sleeve gastrectomy are minimally invasive laparoscopic surgeries, performed through small incisions in the abdomen. In gastric banding surgery, an inflatable silicone device is place on the top portion of the stomach to create a small pouch.
This pouch will only hold about ½ cup of food, as opposed to the 6 cups a normal stomach will hold. The smaller stomach not only helps the patient eat less by making them feel full sooner, it also slows the passage of food into the rest of the stomach and the digestive tract. As the patient loses (or gains) weight, the band is adjusted to maintain comfort and effectiveness.
In a sleeve gastrectomy, the stomach is surgically reduced to about one-quarter of its normal size, leaving it the shape of a narrow "sleeve" or tube. The portion of the stomach that is removed secretes an appetite hormone called Ghrelin. Once removed, the patient's appetite is said to decrease. The procedure is irreversible.
A gastric bypass is a more complicated irreversible gastrointestinal surgery in which a pouch is created at the top of the stomach, and then connected directly to the middle of the small intestine, bypassing the rest of the stomach and the upper intestine, or duodenum. The part of the intestines that is bypassed is where vitamins and minerals are the most easily absorbed, meaning patients must guard against nutritional deficiencies following a gastric bypass.
Studies published in the Archives of Surgery comparing the newer laparoscopic gastric banding surgery and sleeve gastrectomy to the conventional gastric bypass surgery found that, while conventional bypass surgery resulted in higher weight loss, the less invasive Lap-Band procedure was "safer", with fewer complications.
Many bariatric surgery experts believe that surgery which bypasses the duodenum is the most effective for diabetes control because the duodenum plays a role in insulin resistance, and bypassing it reduces insulin resistance in patients with diabetes mellitus. A gastric bypass also results in the most weight loss. "It's very clear - bypass is better than band, period," states bariatric surgeon Dr. Guilherme M. Campos from the University of the Wisconsin School of Medicine, "And if you are diabetic with obesity, the best treatment is a Roux-en-Y gastric bypass."
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