Raghavendra S. Rao

GIP and bariatric surgery.

Bariatric surgery is the most effective modality of achieving weight loss as well as the most effective treatment for type 2 diabetes mellitus (T2DM). Glucose-dependent insulinotropic polypeptide (GIP) is an incretin and is implicated in the pathogenesis of obesity and T2DM. Its role in weight loss and resolution of T2DM after bariatric surgery is very controversial. We have made an attempt to review the physiology of GIP and its role in weight loss and resolution of T2DM after bariatric surgery. We searched PubMed and included all relevant original articles (both human and animal) in the review. Whereas most human studies have shown a decrease in GIP post-malabsorptive bariatric surgery, the role of GIP in bariatric surgery done in animal experiments remains inconclusive.

Animal Models in Bariatric Surgery—A Review of the Surgical Techniques and Postsurgical Physiology

Bariatric surgery is considered the most effective current treatment for morbid obesity. Since the first publication of an article by Kremen, Linner, and Nelson, many experiments have been performed using animal models. The initial experiments used only malabsorptive procedures like intestinal bypass which have largely been abandoned now. These experimental models have been used to assess feasibility and safety as well as to refine techniques particular to each procedure. We will discuss the surgical techniques and the postsurgical physiology of the four major current bariatric procedures (namely, Roux-en-Y gastric bypass, gastric banding, sleeve gastrectomy, and biliopancreatic diversion). We have also reviewed the anatomy and physiology of animal models. We have reviewed the literature and presented it such that it would be a reference to an investigator interested in animal experiments in bariatric surgery. Experimental animal models are further divided into two categories: large mammals that include dogs, cats, rabbits, and pig and small mammals that include rats and mice.

Diabetic and bariatric surgery: a review of the recent trends.

IntroductionBariatric surgery is currently the most effective treatment for diabetes associated with morbid obesity.MethodsA Pubmed search was made for all articles on bariatric surgery and diabetes from 2009 to present (March 2011) in order to identify the recent advances in this field. Herein we review the recent data available on the long-term effects of bariatric surgery on diabetes. We also review the efficacy of gastrointestinal surgery done for diabetic patients having body mass index (BMI) <35 kg/m2 and also the effect of novel bariatric procedures on diabetes associated with obesity. Finally, the efficacy of bariatric surgery in adolescent diabetes and the recent epidemiological trends of type 2 diabetes are also dealt with briefly.ConclusionRYGB and biliopancreatic diversion (BPD) are effective surgical options for diabetes in the long term (>5 yrs). The efficacy of sleeve gastrectomy on diabetes in the long term is not yet known. Gastrointestinal procedures for non morbidly obese and non obese patients have shown great promise as surgical optional for diabetes, though their efficacy and safety in the long term are unknown. Novel endoscopic techniques and TANTALUS have shown some promise in resolving diabetes in obese patients. Bariatric surgery is very effective is resolving adolescent diabetes.

Management of ventral hernias in bariatric surgery

n s r g p o s m u m o A ventral hernia is an important co-morbid condition in ariatric surgery candidates that influences the operative pproach and postoperative follow-up. Open bariatric proedures have had a high incidence of incisional hernia. The xtensive use of laparoscopy has not eliminated the incience of incisional hernias, because they can cause port site ernias. In the present report, we have reviewed the operaive approach for bariatric surgery in a patient with a ventral ernia, with particular emphasis on the timing of the hernia epair. We also reviewed the management of incisional and ort site hernias occurring after bariatric procedures.