Metabolik cerrahi nedir? Kime ve ne zaman yapılmalıdır?

Metabolik sendrom bazı komplikasyonlara neden olan kardiyometabolik risk faktörleri demetidir.Sendromu oluşturan her bileşen tedavi edilmelidir. Bunun için antilipidemik,antidiyabetik, antihipertansif, ilaçlar kullanılır fakat tedavideki kilit rolde kilo kontrolü oynar.Vücut ağırlığının kontrolünde egzersiz, diyetle günlük alınan kalorinin azaltılması ve fiziksel faaliyetlerin artırılması rol oynar.Değişik tıbbi tedavilerlede deneme yapılmış olup çok başarılı olunamamıştır.Hala en etkin yol cerrahi seçenektir. Kesinkabul edilen tanımı olmamakla berabermetabolik cerrahi, metabolik sendromu tedavi etmek için yapılan cerrahi müdahaleler olarak tarif edilebilir. Genel algı bariatrik cerrahi geçiren hasta kişilerin kilo vermeyle ilişkili tip 2 diyabet hastalığının remisyona girmesidir. Ameliyat sonrası bu hastalar hastanede yatarken kan şeker değerlerinin düzelmeye başladığı görülmüştür. Kan glukozu dengelenmesinde gastrointestinal sistemin önemli rol aldığı anlaşılınca,mekanizmasının ortaya çıkması için çalışmalar yapılmıştır.Ön ve arka barsak hipotezleri ortaya atılmıştır. Arka barsak ameliyatı olan Duodenalswitch’in ön barsak ameliyatı olan gastrikby-pass’a göre hiperinsülinemik cevaba neden olmadan glukoz dengesini ve insülin duyarlılığında iyileşme sağladığı ortaya konmuştur.Arka barsak modulasyonu yapılan ameliyatlar, ön barsak modülasyonu yapılan ameliyatlara göre mineral-vitamin dengesini daha çok bozma eğilimindedir. Son zamanlarda bunu önlemek için transit bipartisyon ameliyatı geliştirilmiştir. Sonuçta metabolik cerrahi ameliyatlarında değişik teknikler tercih edilmektedir. Yapılacak ameliyat yönteminin kişiye özel olması gerektir.

Anahtar Kelimeler:

Metabolik cerrahi, zamanlama, tip 2 diyabet.

What is Metabolic Surgery? To whom and when should it be applied?

Metabolic syndrome is a cluster of cardiometabolic risk factors that cause some complications. Each component of the syndrome needs to be treated. For this purpose, anti-hypertensive, anti-diabetic, and anti-lipidemic agents are used, but weight control plays a key role in treatment. Exercise, reduction of daily calories with diet and increasing physical activity play a role in the control of body weight. Various medical treatments have been tried, but they have not been very effective. The most effective way is still surgery. Although there is no definite accepted definition of metabolic surgery, it can be defined as surgical interventions to treat metabolic syndrome. The general perception in bariatric surgery is that type 2 diabetes enters remission due to patients' weight loss. After the operation in these patients, blood sugar control has been shown to be achieved while patients are still in the hospital. It has been understood that the gastrointestinal system plays an essential role in glucose homeostasis, and its mechanisms have been tried to be revealed. The foregut hypothesis and the hindgut hypothesis have been suggested. A hindgut surgery like a duodenal switch has been shown to improve insulin sensitivity and glucose homeostasis without causing a hyperinsulinemic response compared to a foregut surgery like a gastric bypass. Surgeries that modulate the hindgut have more potential to disrupt the absorption of vitamins and minerals than foregut surgeries. To prevent this, the transit bipartition technique has been developed in recent years.As a result, various methods have been used in metabolic surgery. The choice of a surgical technique should be specific to the patient.

Keywords:

Metabolic Surgery, timing, type 2 diabetes mellitus.,

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