A large number of clinical studies indicate that bariatric surgery leads to improvement or resolution of type 2 diabetes. The outcomes vary depending on procedure adopted. Biliopancreatic diversion(BPD) is associated with the highest cure rate(98%), followed by Roux-en-Y gastric bypass(RGBP)(80%). However, the mechanism is still unclear and controversial. The changes of many hormones after surgery are different between BPD and RGBP, especially some gastrointestinal hormones such as GLP-1 and GIP,however it cannot be fully explained by the widely known hindgut hypothesis and the foregut hypothesis. This review is intended to compare the anatomical structures and postoperative gastrointestinal hormones GLP-1 and GIP changes between the two procedures according to the latest researches in the world, and discussed different mechanisms which may take effect in improving diabetes.
Biliopancreatic Diversion ; Diabetes Mellitus, Type 2 ; surgery ; Gastric Bypass ; Humans

While conventional laparoscopy is the gold standard for bariatric procedures, robot platforms can provide better ergonomics for the surgeon, better visualization of the anatomy, easier dissection through articulated devices, which cannot be supported by laparoscopy. This review explores the literature and examines the reported outcomes and complications in using robotics for bariatric surgery. Robotic approaches to adjustable gastric banding, sleeve gastrectomy, gastric bypass, biliopancreatic diversion with duodenal switch, and revisional surgery are examined. Although many studies suffer from low levels of evidence, robotic application in the field of bariatric surgery continues to evolve with increasing literature and technology in surgical robotics.
Bariatric Surgery* ; Biliopancreatic Diversion ; Gastrectomy ; Gastric Bypass ; Human Engineering ; Laparoscopy ; Robotics

Current evidence suggests that only bariatric surgery results in durable and substantial weight loss with resolve various comorbid medical conditions, improve quality of life, and prolong survival for patients with morbid obesity. Demand for bariatric surgery is increasing worldwide at an exponential rate. With rapid rise of morbidly obese patients, introduction of laparoscopy, use of mass media and internet to convey information to public, coverage of medical insurance might contribute to the Bariatric revolution. Bariatric surgery involve either restrictive of caloric intake or malabsorption of nutrients, or both. Bariatric surgery would bring about neurohormonal changes that affect satiety and glucose homeostasis as well. Laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass, biliopancreatic diversion with/without duodenal switch, and laparoscopic sleeve gastrectomy are the most commonly performed procedures at present. Each procedure has its advantages and disadvantages and any operative procedure cannot be thought to be predominant over another. We hope more effective, safer, and durable operative method to be developed. The author intended to provide a comprehensive overview of the current status of bariatric surgery.
Bariatric Surgery ; Biliopancreatic Diversion ; Energy Intake ; Gastrectomy ; Gastric Bypass ; Glucose ; Homeostasis ; Humans ; Insurance ; Internet ; Laparoscopy ; Mass Media ; Obesity, Morbid ; Quality of Life ; Surgical Procedures, Operative ; Weight Loss

We report a case of a 52-year-old man in whom a cystic pancreatic tumor was successfully removed by laparoscopic enucleation. The patient had a followup CAT-scan for a resolving right upper lobe pneumonia which demonstrated a unilocular hypodense 3.9x2.2 cm sized cyst in the uncinate process of the pancreas. He had a laparoscopic biliopancreatic diversion with duodenal switch in July 2002, and also had laparoscopic cholecystectomy for cholelithiasis in December 2003. Laparoscopic intraoperative ultrasonography revealed a solitary cystic tumor in the inferior portion of pancreatic head. Laparoscopic enucleation of the tumor was performed using Ultracision(R) between the cyst outer wall and the normal pancreatic parenchyma. The operative time was 160 minutes, the estimated blood loss was 20 ml, and there were no perioperative complications. The patient's postoperative course was uneventful, and he was discharged on the first postoperative day. The histopathologic diagnosis showed a mucinous cystadenoma. We reported a new technique for safe management of small cystic tumors located on surface of the pancreas.
Biliopancreatic Diversion ; Bone Cysts ; Cholecystectomy, Laparoscopic ; Cholelithiasis ; Cystadenoma, Mucinous* ; Diagnosis ; Follow-Up Studies ; Head ; Humans ; Laparoscopy ; Middle Aged ; Mucins* ; Operative Time ; Pancreas ; Pancrelipase ; Pneumonia ; Ultrasonography

Patients that are morbidly obese require various treatments to reduce the potential health risks associated with obesity-related chronic diseases. Compared to medical management, bariatric surgery can effectively reduce body weight and treat obesity-associated metabolic diseases. Although there are some endoscopic bariatric procedures, the most commonly performed bariatric surgeries are Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), sleeve gastrectomy (SG) and biliopancreatic diversion (BPD). These types of bariatric surgery can be performed laproscopically with low rates of complications, and generally result in comparable weight loss to medication and lifestyle modification and remission of type 2 diabetes mellitus. Thus, in this study, we describe the current options for bariatric surgery and offer a synopsis of the data on post-operative outcomes.
Bariatric Surgery ; Biliopancreatic Diversion ; Body Weight ; Chronic Disease ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Gastrectomy ; Gastric Bypass ; Humans ; Life Style ; Metabolic Diseases ; Weight Loss

Through continuous development, metabolic and bariatric surgery (MBS) has become widely recognized in academic and medical circles. In China, the volume of MBS operations has increased year by year. Therapeutic goals of MBS have evolved from treating obesity to treating Type 2 diabetes mellitus, and further to treating a series of obesity-associated metabolic diseases (including conditions in the endocrine system, circulatory system, respiratory system, reproductive system, and etc). Surgical approach of MBS has also been evolving continuously. Currently the common surgical procedures include laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric banding (LAGB) and bilio-pancreatic diversion with duodenal switch (BPD-DS). All surgical procedures have pros and cons, and the choice of surgical procedures should be based on the conditions of patients, the surgeon's technical ability, and benefits and operative risks. With the development of MBS, the proportions of different surgical procedures also changed in China. In recent five years, the proportion of AGB has decreased continuously and LAGB is no longer a common procedure. The proportion of LSG has increased rapidly, rising from 9% in 2010 to 55% in 2015. The proportion of RYGB has increased from 57% to 64% between 2010 and 2013, and remained at 45% afterwards. Since 2010, most MBS operations are laparoscopic surgery. 3D Laparoscopic surgery, laparoendoscopic single-site surgery and da Vinci Robotic Surgery have also been introduced in MBS. This review discusses the status quo and changes of MBS in china, as well as the new technology in MBS, aiming to strengthen the information and comprehension of MBS in china.
Bariatric Surgery ; methods ; statistics & numerical data ; trends ; Biliopancreatic Diversion ; statistics & numerical data ; trends ; China ; Diabetes Mellitus, Type 2 ; surgery ; Disease Management ; Endoscopy, Digestive System ; statistics & numerical data ; trends ; Gastrectomy ; statistics & numerical data ; trends ; Gastric Bypass ; statistics & numerical data ; trends ; Humans ; Laparoscopy ; statistics & numerical data ; trends ; Metabolic Diseases ; surgery ; Obesity ; surgery ; Robotic Surgical Procedures ; statistics & numerical data ; trends

Along with the soaring prevalence of obesity and type 2 diabetes mellitus (T2DM) globally, metabolic and bariatric surgery (MBS) has been rapidly developing into a major surgical subspecialty. However, the indications, benefits and potential risks of MBS are still controversial so far. In September 2015, the 2nd Diabetes Surgery Summit (DSS-II() was successfully convened, and later on an international joint statement on metabolic surgery in the treatment algorithm for T2DM was released based upon the consensus reached in DSS-II(, aiming to serve as a new global clinical guideline. The DSS-II( joint statement was initiated and endorsed by 5 leading international diabetes organizations, including American Diabetes Association (ADA), International Diabetes Federation (IDF), Chinese Diabetes Society (CDS), Diabetes India, as well as Diabetes UK, and was developed by an expert committee comprised of 48 international authorities as voting delegates. Up to the date of publication, the DSS-II( statement has been officially endorsed by 45 international professional associations/societies, including 30 non-surgical and 15 surgical organizations. In this statement, the following six aspects were recommended to differentiate MBS from traditional bariatric surgery: 1)The primary goal of MBS is to treat T2DM and to reduce the risk of T2DM complications; 2) In addition to a 50% or more of excess weight loss and normalization of glycemia, outcomes of diabetes complications should also be considered as clinical endpoints of MBS; 3) For patient selection, body mass index (BMI), T2DM treatment, as well as long-term risks versus benefits, including its effects on cardiovascular events (CVD), should all be considered; 4) T2DM and its complications, as well as pancreatic function reserve should be assessed pre-operatively; 5) Major surgical options include laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric banding (LAGB), and bilio-pancreatic diversion with duodenal switch(BPD-DS). BPD-DS has the best outcome in T2DM remission followed by LRYGB, LSG and LAGB; 6) Glycemic variation should be intensively monitored, and if needed, managed following surgery. Clinical follow-up should be conducted at least once every six months within two years after surgery. For patients achieving complete remission from T2DM, diabetes complications should still be monitored within five years after surgery with the same frequency and protocols as pre-operatively.
Aftercare ; standards ; Bariatric Surgery ; methods ; standards ; Biliopancreatic Diversion ; Blood Glucose ; physiology ; Body Mass Index ; Diabetes Mellitus, Type 2 ; surgery ; Disease Management ; Gastrectomy ; Gastric Bypass ; Gastroplasty ; Humans ; Hyperglycemia ; surgery ; Laparoscopy ; Obesity ; surgery ; Patient Care Planning ; standards ; Practice Guidelines as Topic ; standards ; Remission Induction ; methods ; Treatment Outcome ; Weight Loss

Bariatric and metabolic surgery has become the clinical hot topic of the treatment of metabolic syndromes including obesity and diabetes mellitus, but how to choose the appropriate surgical procedure remains the difficult problem in clinical practice. Clinical guidelines of American Society for Metabolic and Bariatric Surgery(ASMBS)(version 2013) introduced the procedures of bariatric and metabolic surgery mainly including biliopancreatic diversion with duodenal switch(BPD-DS), laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy(LSG). To choose the appropriate bariatric and metabolic procedure, the surgeons should firstly understand the indications and the contraindications of each procedure. Procedure choice should also consider personal condition (body mass index, comorbidities and severity of diabetes), family and socioeconomic status (postoperative follow-up attendance, understanding of potential surgical risk of gastrectomy and patient's will), family and disease history (patients with high risk of gastric cancer should avoid LRYGB; patients with gastroesophageal reflux disease should avoid LSG) and associated personal factors of surgeons. With the practice of bariatric and metabolic surgery, the defects, especially long-term complications, of different procedures were found. For example, LRYGB resulted in higher incidence of postoperative anemia and marginal ulcer, high risk of gastric cancer as well as the requirement of vitamin supplementation and regular follow-up. Though LSG has lower surgical risk, its efficacy of diabetes mellitus remission and long-term weight loss are inferior to the LRYGB. These results pose challenges to the surgeons to balance the benefits and risks of the bariatric procedures. A lot of factors can affect the choice of bariatric and metabolic procedure. Surgeons should choose the procedure according to patient's condition with the consideration of the choice of patients. The bariatric and metabolic surgery not only manages the diabetes mellitus and weight loss, but also results in the reconstruction of gastrointestinal tract and side effect. Postoperative surgical complications and nutritional deficiency should also be considered. Thereby, individualized bariatric procedure with the full consideration of each related factors is the ultimate objective of bariatric and metabolic surgery.
Anemia ; epidemiology ; Bariatric Surgery ; adverse effects ; methods ; statistics & numerical data ; Biliopancreatic Diversion ; adverse effects ; methods ; statistics & numerical data ; Body Mass Index ; Comorbidity ; Contraindications ; Diabetes Mellitus ; surgery ; Disease Management ; Gastrectomy ; adverse effects ; methods ; statistics & numerical data ; Gastric Bypass ; adverse effects ; methods ; statistics & numerical data ; Gastroesophageal Reflux ; Gastroplasty ; methods ; mortality ; statistics & numerical data ; Humans ; Informed Consent ; Laparoscopy ; adverse effects ; methods ; statistics & numerical data ; Long Term Adverse Effects ; epidemiology ; Malnutrition ; epidemiology ; Obesity ; surgery ; Patient Acuity ; Patient Care Planning ; Patient Compliance ; Postgastrectomy Syndromes ; epidemiology ; Postoperative Complications ; epidemiology ; Risk Assessment ; methods ; Risk Factors ; Stomach Neoplasms ; epidemiology ; Treatment Outcome ; Weight Loss