J.Jpn. Surg. Soc.. 124(2): 183-189, 2023

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EFFICACY AND IMPROVING MECHANISMS OF METABOLIC SURGERY FOR TYPE 2 DIABETES

Bariatric surgery aims at weight loss by restricting food intake. This surgery also has a direct effect on improving type 2 diabetes, regardless of weight loss, and it is recognized as a “metabolic surgery.” The main procedures are roughly divided into a restrictive procedure that restricts food intake by reducing stomach volume, and a malabsorptive procedure that suppresses nutrient absorption. In Japan, only laparoscopic sleeve gastrectomy, a restrictive procedure, is covered by national health insurance. The effect of metabolic surgery on improving diabetes is significant, and many patients achieve clinical remission. This effect is more pronounced after malabsorptive surgery. Various mechanisms such as changes in incretin levels, bile acids, and intestinal microbiota have been proposed as the mechanisms of diabetes-improving effects. In 2021, a joint consensus statement on metabolic surgery in the treatment of obese Japanese patients with type 2 diabetes was issued by the Japanese Society for Treatment of Obesity, Japan Diabetes Society, and Japan Society for the Study of Obesity. Recommendations are made regarding surgical indications and perioperative management. We hope that this statement will contribute to the widespread, safe use of this surgery in the future.

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