Increasing in prevalence in the whole world, Metabolic Syndrome and especially type 2 diabetes present a serious health problem. Search for a permanent solution for Metabolic Syndrome and its components continue in the whole world.
In the light of today’s scientific knowledge, it is known that the most effective treatment option for Metabolic Syndrome is surgical procedures. However, serious problems regarding surgical treatment exist. It is possible to express these problems in the following order:
1) The purpose of our association is absolutely neither to criticize nor to vilify any treatment method. But, any healthcare professional working towards the goal of the treatment for Metabolic Syndrome has to interpret scientific data with an objective view. Because the essential reason why Metabolic Surgery and other treatment alternatives received emphasis is the negative results obtained through conservative treatment options.
It has been shown that in terms of weight and blood sugar control, success rate of surgical therapy is 9.8-15.8 times higher than the success rate of medication therapy. Of course, success rate of surgery is not entirely %100. However, especially with Duodenal Switch, Biliopacreatic Diversion and Ileal Interposition operations, the success rate is above %90 in the long term. As of this moment, achieving such a success rate with another treatment options is far from real.
2) Still, many of our colleagues confuse Bariatric Surgery (Obesity Surgery) with Metabolic Surgery. Since such confusion is present even among healthcare professionals, it is natural for the public to confuse Bariatric and Metabolic Surgery with each other even more.
3) Main purpose of Bariatric Surgery procedures is weight control, which is why they are performed only on individuals with serious weight problems. There are 2 important points that should be considered regarding this matter. These are:
a) Plasma sugar control is easier for diabetic patients with weight problems following surgery. Hypocaloric diet studies also support this thesis. But for type 2 diabetes patients who don’t suffer from serious weight problems (on which, diabetes shows a more severe progression), blood sugar control by surgical treatment is not dependent solely on weight control. But rather ‘glucagonocentric’ diabetes is in question here. In order to establish an effective blood sugar control for such patients, a strong ‘GLP-1 effect’ is required. Only with Metabolic Surgery procedures, can this effect be provided.
b) Any doctor working in the field of Bariatric and Metabolic Surgery should take ‘malabsorption’ and ‘maldigestion’ problems into consideration. Also every surgeon must ask the following question to oneself: ‘Do I have the right to save my patient from using certain medication and insulin only to condemn him/her into using another (vitamin, mineral, iron, calcium)?’
4) Each team providing healthcare service in the field of Bariatric and Metabolic Surgery must have a patient follow-up program and protocol. Because even in the best series, patient follow-up in 5 years and above is around %50. Therefore, follow-up of malabsorptive and maldigestive procedures gain even more importance.
5)Unfortunately, these days anyone who performs a few sleeve gastrectomy or watches videos of Metabolic Surgery operations declare themselves as ‘Obesity Surgeon’ or ‘Metabolic Surgery Expert’. However, these techniques demand serious training, technical skill, experience and dedication.
Our association receives numerous complaints of malpractice issues. It is possible to overcome all these difficulties through appropriate training programs and certification processes.
Our aim is that the radical and rational treatment options against Metabolic Syndrome and especially diabetes pandemic which threaten the whole world to be performed, to be known and to be spread.
Our association will continue to serve our colleagues and our people with certification and education programs.
Associate Professor Alper Çelik
President of Metabolic Surgery Association