By Philip Schauer, MD

Cleveland Clinic’s Bariatric and Metabolic Institute is a world leader in the field of metabolic and bariatric surgery, particularly for patients who are high risk or require complex revisional surgery that cannot be managed elsewhere.

Our multidisciplinary team of surgeons, obesity medicine specialists, endocrinologists, psychologists and dietitians offers world-class, comprehensive medical and surgical management of complex and high-risk obesity, diabetes and related co-morbidities with excellent outcomes and impressive value of healthcare. Our anesthesiologists, in particular, are well versed in managing the most challenging bariatric patients, even those exceeding 1,000 lbs.

Vignette:

Our patient is a 45-year-old female with prior history of gastric bypass in Mexico and then a revision for weight gain in Pittsburgh. She presented with poorly controlled type 2 diabetes (HbA1c = 11.9) and weight regain (BMI = 43). She also had polycystic ovarian syndrome (PCOS), metabolic syndrome, fatty liver disease and multiple abdominal procedures, including multiple laparoscopies for PCOS.

She was noted to have a difficult airway on the two prior operations. She was worried about her ever-progressing diabetes, despite prior gastric bypass surgery and the life-long requirement of insulin shots. This led her to search for a possible surgical remedy at Cleveland Clinic’s Bariatric and Metabolic Institute.

In June 2016, she underwent a revision to a distal gastric bypass, a variation of standard gastric bypass but with a larger degree of intestinal bypass.

At her one year follow-up, her BMI decreased to 30 and her diabetes is in complete remission with a normal blood sugar (HbA1c = 5.3) off all diabetes medications, including oral agents and insulin. Her PCOS, metabolic syndrome and fatty liver disease have resolved as well. All of her nutritional lab values are normal and she has resumed a vigorous exercise program.

Studies suggest that she will likely remain in complete diabetes remission long-term and thus avoid the long-term cardiovascular, renal and ophthalmic complications of diabetes.

References:

1. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, Navaneethan SD, Singh RP, Pothier CE, Nissen SE, Kashyap SR.  Bariatric Surgery versus Intensive Medical Therapy for Diabetes – 5-Year Outcomes.  N Engl J Med. 2017 Feb 16;376(7):641-651
2. Daigle CR, Chaudhry R, Boules M, Corcelles R, Kroh M, Schauer PR, Brethauer SA. Revisional bariatric surgery can improve refractory metabolic disease. Surg Obes  Relat Dis. 2016 Fe: 12 (2): 392-7.
3. Augustin T, Aminian A, Romero-Talamás H, Rogula T, Schauer PR, Brethauer SA.  Reoperative Surgery for Management of Early Complications After Gastric Bypass.  Obes Surg 2016 Feb;26(2):345-9