Weight-Loss Surgeries for Treatment of Obesity and Diabetes
Weight-loss surgery is currently the most effective long-term medical treatment for obesity. Physicians and scientists have discovered that one type of bariatric surgery, gastric bypass surgery, has been shown to eliminate Type 2 diabetes in 40 to 85 percent of diabetic patients. Glucose levels begin to decline within days after surgery, often before any significant weight loss occurs.
Cedars-Sinai bariatric surgeons and researchers at the Diabetes and Obesity Research Institute (DORI) are working together to ascertain how gastric bypass surgery causes metabolic improvements. They also are exploring whether gastric bypass surgery could be indicated for the treatment of Type 2 diabetes.
Developing and testing novel endoscopic procedures that are minimally invasive and mimic the change in metabolism of gastric bypass surgery are being researched. A new endoscopically delivered device has been designed to circumvent the duodenum to limit calories absorbed. How the gastric bypass affects hormones has not been determined; however, altering the anatomy appears to be the key to metabolic improvements. Another type of bariatric surgery, banding surgery, has not resulted in diabetes resolution as frequently as gastric bypass surgery. Banding surgery restricts the stomach size but still allows food to have contact with all the intestines and, as such, does not appear to alter the metabolism in the same ways.
Miguel Burch, MD, associate director of Minimally Invasive Surgery and director of Minimally Invasive and Bariatric Surgery Fellowship, is a surgeon at the Cedars-Sinai Center for Weight Loss and is treating obesity through bariatric surgeries including gastric bypass, gastric banding, sleeve gastrectomy and revision surgery. Burch has been collaborating with the DORI team to determine how and why mechanisms are being affected through gastric bypass surgery. He focuses on the effects weight-loss surgery has on obesity and on metabolic disorders such as diabetes, high blood pressure and high cholesterol.
Burch is working to find less-invasive, equally effective therapies specifically indicated for Type 2 diabetes that could have a powerful impact on quelling the rising rates of diabetes, even for patients who are not morbidly obese.
- Ionut V, Burch M, Youdim A, Bergman RN. Gastrointestinal hormones and bariatric surgery-induced weight loss. Obesity (Silver Spring). 2013 Jun;21(6):1093-1103. http://onlinelibrary.wiley.com/doi/10.1002/oby.20364/full.
- Elazary R, Phillips EH, Cunneen S, Burch MA. Comments on "increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults." Surg Endosc. 2013 Oct;27(10):3935-3936. http://link.springer.com/article/10.1007%2Fs00464-013-2974-8.
- Pieroni S, Sommer EA, Hito R, Burch M, Tkacz JN. The "O" sign, a simple and helpful tool in the diagnosis of laparoscopic adjustable gastric band slippage. Am J Roentgenol. 2010 Jul;195(1):137-141. http://www.ajronline.org/doi/full/10.2214/AJR.09.3933.
- Lyass S, Cunneen SA, Hagiike M, Misra M, Burch M, Khalili TM, Furman G, Phillips EH. Device-related reoperations after laparoscopic adjustable gastric banding. Am Surg. 2005 Sep;71(9):738-743. http://www.ingentaconnect.com/content/sesc/tas/2005/00000071/00000009/art00009.
- Fisher JC, Masiakos PT, Oviedo J, Burch M, Kondi ES, Wolfe MM, Becker JM. Gastric outlet obstruction as a consequence of a duodenal web masquerading as gastrinoma in an adult. Curr Surg. 2003 Nov-Dec;60(6):602-606. http://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(03)00080-1/abstract.
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8700 Beverly Blvd.
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Los Angeles, CA 90048