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Understand better the controversy of Romário surgery

Understand better the controversy of Romário surgery

In January 2017 the former soccer player Romário generated controversy by stating that he had an ileal interposition surgery to control diabetes and that led him to lose almost 15 kg. But do you know what this surgery is?

What is an ileal interposition?

Long-term weight loss is a 'side effect' of metabolic surgeries

ileal interposition is a type of metabolic surgery, in which a segment is removed from the end of the small intestine (called ileum) and replaces it near the beginning of the intestine (the duodenum). In this surgery, there is also that usually associated with the technique of bariatric surgery in which the stomach is transformed into a narrower tube (the vertical gastrectomy) and the exclusion of food contact with the onset of the intestine.

Metabolic surgeries arose from of patients with grade 3 obesity (ie, those with a BMI greater than 40 or a BMI above 35 associated with other diseases) who underwent bariatric surgeries and presented improvement in glycemic rates without a direct relation to weight loss, but through a mechanism that directly acts on type 2 diabetes (DMT2). ​​

Illustration of a vertical gastrectomy - Photo: Getty Images

A series of clinical studies to evaluate whether it was feasible to perform this type of surgery in obese diabetic grade 1. The results indicated that patients with clinical conditions of pancreatic function deficiency in producing insulin, tissue resistance (insulin resistance) and difficulties in maintaining the drug treatment may benefit from the surgical treatment, thus creating the definition of metabolic surgery.

It can be defined that the interventions on the digestive tract who have control of type 2 diabetes almost immediately postoperatively, through several direct mechanisms against the disease, initially unrelated to weight loss, are called metabolic operations, in which long-term weight loss is a However, ileal interposition surgery is a technical variant of metabolic surgeries not yet regulated by the Federal Council of Medicine (CFM) because it has not yet that demonstrate safety and efficacy when compared to regulated techniques and that have a history of decades of and use for both weight reduction and type 2 diabetes control. As there are many variables adapted from other bariatric and metabolic procedures (such as association with vertical gastrectomy and duodenal exclusion), it is difficult to action of ileal interposition for weight loss and control of diabetes. It is said that this technique has been used since 1928, but it has been used in urology, far from the objectives of bariatric or metabolic surgery.

The major current issue of ileal interposition, due to the lack of important studies, is the worldwide medical community not to glimpse its advantages over consecrated operations. There is only a small Brazilian study, done with few patients and only one year of postoperative follow-up presented in Congress (not published), insufficient for any regulatory decision.

So the ileal interposition can not be made? It can but following research protocols approved by Research Ethics Committees and follow a number of conditions set forth in Resolution 466/2012 which is the refinement of former National Health Council Resolutions as the cost exemption for the research participant, which must be financed by a governmental development agency or obtain private support, among other things.

Any new medical procedure must in our country follow the resolution of the Federal Council of Medicine No. 1982/2012 that determines the conditions for approval of new therapies and procedures and must follow a careful way to clarify the conduct of research on animals and humans in the which mainly addresses safety and long-term results.

What are the options for metabolic surgery for diabetes approved today?

Type 2 diabetes is a chronic disease, progressive and clinical treatment. When this type of treatment fails, metabolic surgery can be associated with the medication. The technique suggested in the literature is Roux-en-Y gastric bypass.

What is the difference between metabolic and bariatric surgery?

Bariatric surgeries are those indicated for those individuals who have complications due to high weight, such as diseases articular, disc hernias, acid reflux from the stomach to the esophagus, and so on. Metabolic interventions have as their primary goal the control of diabetes and its complications and have nothing to do with the patient's BMI, but with the severity and inadequate control of diabetes, regardless of BMI, whether above or below 35 kg / m². Metabolic surgery primarily treats diabetes and the conditions that come along, such as high blood pressure, cholesterol, and high triglycerides.

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