Hui Liang

Departmentof GeneralSurgery,The First Affiliated Hospitalwith Nanjing Medical University,Nanjing,Jiangsu 210029,China.

Metabolic surgery:present and future

Hui Liang?

Departmentof GeneralSurgery,The First Affiliated Hospitalwith Nanjing Medical University,Nanjing,Jiangsu 210029,China.

Severalarticles in this issue of the Journal cover a broad range of the new concepts of metabolic surgery, the mechanisms thatleads to sustained metabolic syndrome remission,the new surgicalprocedures,and the perspective of surgeons and endocrinologists.

Obesity is a global health concern.Health surveys from 2005 revealed that the number of overweight and obese individuals in China were 200 million and 60 million,respectively[1].The rising prevalence of obesity is causing a major health burden in terms of morbidity and mortality[2].The complications of obesity and comorbidities,such as hypertension,coronary heartdisease,type 2 diabetes mellitus(T2DM),hyperlipidemia,osteoarthrosis,and an increase in cancer risk,are placing growing demand on healthcare resources[3].The metabolic surgery has been widely recommended as the only effective management for obesity and related metabolic syndromes[4].The global total number of metabolic surgical procedures increased very quickly.In 2011,the globaltotalnumber was 340,768,and surgeons was 6,705[5].

However,there are stilla lotofconsiderable debates over the choice of operative procedure,optimal time, duration of effects,mechanisms behind the effects, new surgicalprocedures,and so on.In the article titled‘‘Recentadvancement in bariatric/metabolic surgery: appraisal of clinical evidence’’[6],Dr.Wei-Jei Lee etal.presenta comprehensive overview of the development of metabolic surgery,including the improvement of safety,the new procedures,the mechanism studies and the option ofpatientselection.In the article titled‘‘The Success of Sleeve Gastrectomy in the Management of Metabolic Syndrome and Obesity’’[7], Dr.Asim Shabbiretal.summarize a new surgicalprocedure,sleeve gastrectomy(SG).The review introduces the development,mechanism,outcome,superiority and the future of the procedure.Based on the most recent basic and clinical data,the health benefits of the sleeve gastrectomy have been clearly established.

Perhaps no endocrinologist,20 years ago,could predict that an operation would cure T2DM.Several studies have demonstrated dramatic improvements in T2DM among patients with morbid obesity following a variety of gastrointestinal surgical procedures.The article‘‘Metabolic bariatric surgery and type 2 diabetes mellitus:an endocrinologistˊs perspective’’[8]by Dr. Kwang-WeiTham in thisissue isanothertestimony from the physicians.Endocrinologistshave focused theirattention on metabolic surgery.The diabetes patients willbenefitfrom the medicaland surgicalcooperation.

There is strong evidence that metabolic surgeries can cure most of the associated T2DM in morbidly obese patients.On the other hand,a dramatic remission of glucose homeostasis even before weight loss occurs has attracted interest.With the current very low morbidity and mortality of metabolic procedures,a‘‘surgical’’treatment of diabetes in normal weight patients seems to be a new target.Dr.Liang et al. in theirarticle‘‘Roux-en-Y gastric bypassforthe treatment of type 2 diabetes mellitus in Chinese patients with a BMI＜28 kg/m2:multi-institutional study’’[9]focuses on the remission of this group.The authors emphasized that Roux-en-Y gastric bypass(RYGB) is effective and safe for treating T2DM patients with a BMI＜28 kg/m2.The data of follow-up was very attractive.

Old age is a contraindication for metabolic surgery. NIH consensus conference had set age of more than 55 years as the upper limit for surgery.With the development of the metabolic surgery,thebenefits and the risks that come with the surgery need to be reweighed in elderly obese patient.Dr.Chih-Kun Huang in his article titled‘‘Bariatric surgery in old age:a comparative study of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomyin an Asia centreof excellence’’[10]suggested that in morbidly elderly patients,RYGB and SG achieved good weight loss and resolution ofcomorbidities.The rapid propagation of minimally invasive approach and comprehensive perioperative care would make metabolic surgery in elderly patients feasible and safer in the near future.

The intention of the Editorial Board of Journal of Biomedical Research in publishing these articles and reviews is to disseminate timely current views and opinions of experts in metabolic surgery,and to stimulate future investigations:(i)With the development of surgical technology and technique,the metabolic surgery has become very safe.Nevertheless,there will always be patients suffering from the perioperative or long-term complications postoperatively.The decision whether an individual is eligible for bariatric surgery should preferably be based on more facts than are available today.This needs more evidence from clinical studies.(ii)It is not yet clear how the altered anatomy after metabolic surgery improve carbohydrate and lipid metabolism.Energy homeostasis,gut hormones,omental gene expression,other unknown hormones and biomarkers are all worth to explore with a greatdesire.The metabolic surgery willteach us the pathophysiology of obesity,T2DM,hyperlipidemia,and all related metabolic syndromes.

[1]Wu YF,Ma GS,Hu YH,et al.The current prevalence status of body overweightand obesity in China:data from the China National Nutrition and Health Survey.Chin J Prev Med 2005;9:316-20.

[2]Kopelman PG.Obesity as a medical problem.Nature 2000;404(6778):635-643.

[3]Fleg al KM,Graubard BI,Williamson DF,et al. Causespecificexcess deaths associated with underweight, overweight,andobesity.JAMA 2007;298(17):2028-2037.

[4]Dixon JB,Zimmet P,Alberti KG,et al.International DiabetesFederation Taskforce on Epidemiology and Prevention.Bariatric surgery for diabetes:The International‘‘Diabetes Federation takes a position.J Diabetes 2011;3(4):261-4.

[5]Buchwald H,Oien DM.Metabolic/Bariatric Surgery Worldwide 2011.Obes Surg 2013;23:427-436.

[6]Lee WJ,Almulaifi A.Recent advances in bariatric/metabolic surgery:appraisalofclinicalevidence.J Biomed Res 2015;29(2):98-104.

[7]Shabbir A,Dargan D.The success of sleeve gastrectomy in the management of metabolic syndrome and obesity. J Biomed Res 2015;29(2):93-97.

[8]Ganguly S,Tan HC,Lee PC,et al.Metabolic bariatric surgery and type 2 diabetes mellitus:an endocrinologistˊs perspective.J Biomed Res 2015;29(2):105-111.

[9]Liang H,Guan W,Yang Y,et al.Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI＜28 kg/m2:a multi-institutional study.J Biomed Res 2015;29(2):112-117.

[10]Huang CK,Garg A,Chang PC,et al.Bariatric surgery in old age:a comparative study of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an Asia centre of excellence.J Biomed Res 2015;29(2):118-124.

?Corresponding author:Hui Liang,M.D.,Department of General Surgery,The First Affiliated Hospital with Nanjing Medical University,300 Guangzhou Road,Nanjing,Jiangsu 210029,China,E-mail:drhuiliang@126.com. Received 21 January 2015,Accepted 28 January 2015,Epub 3 March 2015 The author reported no conflict of interests.

?2015 by the Journal of Biomedical Research.All rights reserved.

10.7555/JBR.29.20150033