Metabolic surgery: new indications – benefits and risks

Bariatric surgery has confirmed its efficacy and safety for the treatment of patients with severe obesity. In such cases, rapid improvement of diabetes usually occurs leading several authors to suggest an extension of surgery to diabetic patients with a moderate increment of weight or to subjects at risk of severe complications such are adolescents super obese, diabetic subjects over 55 years with impaired glycaemic equilibrium, diabetic or pre-diabetic women before pregnancy, subjects presenting with impaired fasting glucose. However many unresolved questions must be evoked regarding mechanisms involved in the resolution of glycaemic disorders, the risk of recurrence of diabetes, the occurrence of nutritional disorders after surgery in pregnant women and old subjects, the risk of perioperative complications and the efficacy and safety of new endoluminal techniques recently proposed. So, long term prospective randomized studies are needed to clear unresolved questions related to the use and extension of metabolic surgery.