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2012;138(9):391396
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N D E L A R T I C U L O
INFORMACIO
R E S U M E N
La perdida de peso puede mejorar el control metabolico de los pacientes con diabetes mellitus tipo 2,
aunque la ecacia del tratamiento convencional es limitada. La ciruga bariatrica ha demostrado que,
ademas de producir perdidas de peso importantes y mantenidas, puede en la mayora de casos mejorar o
resolver la diabetes. Los cambios anatomicos y la modicacion en la secrecion de las hormonas
intestinales pueden explicar la mayor ecacia de las tecnicas malabsortivas. En la actualidad la ciruga
bariatrica es una alternativa terapeutica en los sujetos diabeticos tipo 2 con obesidad grave de difcil
control metabolico con el tratamiento convencional y la investigacion se centra en el efecto de las
hormonas intestinales, en desarrollar nuevas tecnicas y en conocer que papel puede jugar la ciruga
bariatrica en sujetos sin obesidad.
2011 Elsevier Espana, S.L. Todos los derechos reservados.
Palabras clave:
Diabetes mellitus tipo 2
Ciruga bariatrica
Obesidad
Keywords:
Type 2 diabetes mellitus
Bariatric surgery
Obesity
Weight loss can improve metabolic control in patients with type 2 diabetes mellitus but the results of
conventional therapy in this respect have been discouraging. Besides achieving signicant and sustained
weight loss, bariatric surgery can improve or resolve type 2 diabetes mellitus in the majority of patients.
Anatomical modications and changes in the secretion of intestinal hormones can explain the
superiority of malabsorptive techniques. Currently, bariatric surgery offers a therapeutic alternative for
type 2 diabetes patients with severe obesity and poor metabolic control under conventional therapy.
Ongoing research will provide insights regarding the effect of intestinal hormones, new surgery
techniques and the possible benets of bariatric surgery in non-obese patients.
a, S.L. All rights reserved.
2011 Elsevier Espan
392
Tabla 1
Resultados de las diferentes tecnicas de ciruga bariatrica
Gastroplastia vertical
anillada
Bypass gastrico
en Y de Roux
Derivacion
biliopancreatica
48
48
28
71
0,1
68
72
73
81
0,1
62
84
75
94
0,5
72
98
81
100
1,1
Fuente: resultados del metaanalisis de Buchwald et al12 que incluyo 22.094 pacientes.
[(Figura_1)TD$IG]
Reseccin fundus
gstrico GTL
Ghrelina
Restriccin calrica
393
Reseccin intestinal
BGYRL y DBP
Estimulacin del
intestino distal
PYY IncretinasGLP-1 GIP
Omisin del
intestino proximal
Efecto anti-incretina
Vaciado gstrico
Prdida de peso
Apetito
Adiponectina
Insulinresistencia
Secrecin insulina
394
395
396
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