Bariatric surgery for Diabetes

Overview

Bariatric surgery is surgery intended to help people lose weight. In some people with type 2 diabetes, bariatric surgery also improves blood glucose control. Bariatric surgery may be considered as a treatment for type 2 diabetes in adults with a body mass index (BMI) above 35, whose blood glucose levels are poorly controlled with diet, exercise, and medications.

What does it involve?

There are two main types of bariatric surgery: gastric bypass and laparoscopic gastric banding. The goal of both surgeries is to shrink the stomach and limit the number of calories you can absorb.

You will be under general anesthetic for gastric bypass surgery. For gastric bypass surgery, the surgeon may use a traditional wide incision (laparotomy) or make several small, minimally invasive incisions (laparoscopy) to open your abdomen. The surgeon will remove a portion of your stomach, making it significantly smaller. Gastric bypass surgery is not reversible.

Laparoscopic gastric banding surgery may be done as an outpatient or inpatient procedure. You may receive local or general anesthetic for laparoscopic gastric banding. During laparoscopic gastric banding, the surgeon will make several small, minimally invasive incisions and place a sleeve or band around the upper part of the stomach. The sleeve is adjustable and filled with fluid. After you receive the gastric band, the surgeon can easily adjust the amount of fluid in the sleeve as an outpatient procedure as your health and nutrition needs change. Gastric banding surgery is reversible.

Recovery

After gastric bypass or inpatient gastric banding surgery, you can expect to stay in the hospital for one or two days. It will take about two weeks to recover from the surgery at home before you can return to work and regular activities.

Results

After bariatric surgery, type 2 diabetes is completely resolved in approximately 78 percent of those who had a BMI higher than 35. In others, although diabetes is not completely resolved, blood glucose control is likely to be significantly improved.

Constraints

Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.

Since people with type 2 diabetes heal more slowly, there is increased risk for death after receiving bariatric surgery.

Some bariatric procedures can result in malabsorption of nutrients and nutritional deficiencies. Malabsorption can also result in gas, constipation, and diarrhea.

After bariatric surgery, there is a risk for complications such as reflux, incisional hernias, leaks, and bowel obstructions.

If surgery is successful, you will need to change your lifestyle significantly after bariatric surgery. You will need to change what and how much you eat and be sure to get enough exercise. You will still need to check your blood glucose levels regularly. Hyperglycemia (high blood glucose levels) can return after bariatric surgery.

If you lose a lot of weight quickly after bariatric surgery, you may develop significant amounts of loose skin. Some people feel embarrassed about the way the loose skin looks, and some choose to have plastic surgery to remove it.