Innovative Approach to Treatment of the Metabolic Syndrome

In recent decades, we have seen a massive increase in the incidence of the metabolic syndrome. With the advent of bariatric surgery as the most effective method to achieve and maintain weight loss, multiple changes have also been discovered regarding its role in the management of diabetes and the metabolic syndrome. There is now extensive evidence to support metabolic surgery as a treatment not only for obesity but also for the well documented metabolic derangements that accompany it. The site of nutrient delivery in the gastrointestinal tract, malabsorption, and gut hormone secretion are all believed to play important roles in the proposed mechanism of action of metabolic surgery. Although the mechanisms of the longterm remission of diabetes and other obesity-associated co-morbidites are still being outlined, novel techniques and surgical innovations have provided very promising results in select groups of patients. This chapter deals with the history of metabolic surgery and its effects on diabetes and the metabolic syndrome. An overview of several hypotheses and theories behind the surgically induced changes that may lead to sustained remission of this disease is given, along with a discussion of the ongoing trials, to create a better understanding of the future role of surgery in the management of this patient population.