Nasser S. Hammoud, MD FACS
Laparoscopic and General Surgery
Head of General Surgery Dept., HHUMC
MORBID OBESITY IS THE “DISEASE OF THE CENTURY”. IT IS THE EXCESSIVE ACCUMULATION OF FAT IN THE HUMAN BODY TO THE POINT WHERE IT WILL INDUCE INCREASED MORBIDITIES AND DECREASED LIFE EXPECTANCY.
Morbid Obesity (M.O.) is when Body Mass Index (BMI) is above 30 kg/m2. In the U.S., 300,000 deaths per year is related to Morbid Obesity M.O. According to National Institutes of Health (NIH), M.O. has reached more than 60 % of the U.S. population.
Diabetes Mellitus type II (DM-II) is increasing exponentially worldwide. Therefore, since obesity and DM-II, sometimes go hand in hand, it is imperative to discuss treating M.O. and thus, indirectly treating DM-II.
There are 3 main surgeries in the treatment of M.O.:
I- ADJUSTABLE GASTRIC BANDING (AGB)
This is simply “squeezing” the upper body of the stomach to create a much smaller neo-stomach to receive the food. This is a restrictive procedure
II- SLEEVE GASTRECTOMY (SG)
It is a Surgery that reduces the stomach by 70% of its size by forming a tube in continuity with the esophagus and forming a 50cc pouch in the lower body of the stomach just proximal to the duodenum (Pylorus). This is also a restrictive surgery.
III- GASTRIC BYPASS (GB ROUX EN Y)
It is the Reduction of the stomach size by 70% and connecting that pouch to a distant small bowel, inducing some malabsorption. This is a restrictive and malabsorbative procedure.
All three surgeries are done Laparoscopically, which means it is done via small 4 to 5 / 1 cm incisions. This results in less scaring and much faster recovery time for the patient.
Studies have shown that certain improvement in DM-II is seen with all these surgeries. This improvement ranges from a total cure to a considerable reduction in the anti-diabetic therapy. The improvement in DM-II in these surgeries was seen in the immediate post-operative period. This means that the improvement is not related to the loss of weight, or body mass, but related to some endocrinological process.
This process is being investigated thoroughly to see if it is related to enzymes or hormones being processed in the stomach or the proximal small bowel, such as Ghrelin and others.
Therefore, the indication for weight loss surgery with any of the above mentioned surgeries is encouraged for a BMI of 35 and above, especially when the M.O. is associated with DM-II.