Endocrinol Metab.  2017 Sep;32(3):307-315. 10.3803/EnM.2017.32.3.307.

Metabolic Surgery in Korea: What to Consider before Surgery

• Kim MK
• Heo Y

• KMID: 2389810
• DOI: http://doi.org/10.3803/EnM.2017.32.3.307

Abstract

Obesity is increasing globally and represents a significant global health problem because it predisposes towards various diseases, such as type 2 diabetes mellitus, cardiovascular disease, degenerative joint disease, and certain types of cancer. Numerous studies have shown that bariatric surgery reduces body mass and ameliorates obesity-related complications, such as hypertension and hyperglycemia, suggesting that surgery is the most effective therapeutic option for severely obese and obese diabetic patients. Recent international guidelines recommend surgical treatment for diabetic patients with class III obesity (body mass index [BMI] >40 kg/m²), regardless of their level of glycemic control or the complexity of their glucose-lowering regimens, and for patients with class II obesity (BMI 35.0 to 39.9 kg/m²) and hyperglycemia that is poorly controlled despite appropriate lifestyle and pharmacological therapy. The most popular procedures are Roux-en-Y gastric bypass and sleeve gastrectomy, but new procedures with better outcomes have been reported. For optimal surgical outcome, comprehensive management including assessments of a medical condition, nutrition, mental health, and social support is needed before and after surgery. However, there is still a lack of understanding regarding metabolic surgery in Korea. Therefore, this article reviews indications for metabolic surgery in patients with a specific focus on the situation in Korea.

Keyword

Bariatric surgery; Diabetes mellitus, type 2; Obesity

MeSH Terms

Bariatric Surgery*
Cardiovascular Diseases
Diabetes Mellitus, Type 2
Gastrectomy
Gastric Bypass
Global Health
Humans
Hyperglycemia
Hypertension
Joint Diseases
Korea*
Life Style
Mental Health
Obesity

Figure

• 

  Fig. 1 A history of bariatric and metabolic surgery. In 1991, the National Institutes of Health (NIH) released the guidelines for bariatric surgery. Since then, based on numerous studies, the guidelines concerning the use of the body mass index (BMI) as an indication for bariatric surgery and metabolic surgery have undergone numerous changes. The important events are highlighted in the blue-colored boxes. ASBS, American Society for Bariatric Surgery; ASMBS, American Society for Metabolic and Bariatric Surgery; DSS, Diabetes Surgery Summit; ADA, American Diabetes Association; IDF, International Diabetes Federation; KSMBS, Korean Society of Metabolic and Bariatric Surgery; DJB, duodenojejunal bypass; APBSG, Asia-Pacific Bariatric Surgery Group; ACMOMS, Asian Consensus Meeting on Metabolic Surgery; IFSO, International Federation for the Surgery of Obesity and Metabolic Disorders; APC, Asia-Pacific Chapter; APMBSS, Asia Pacific Metabolic and Bariatric Surgery Society; KDA, Korean Diabetes Association. aBMI threshold was reduced to 2.5 kg/m2 for Asians.

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