Dr. Gagner’s Letter to the Editor Questions Recent Article

Dr. Michel Gagner recently published a Letter to the Editor in Obesity Surgery (April 2017) called “What Is a Favourable Risk-Benefit Profile Concerning Metabolic Surgery for Patients with Type 2 Diabetes?” The letter addressed many recommendations listed in an article called “Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: a Joint Statement by International Diabetes Organizations,” in which the choice of procedure was discussed.

In his letter, Dr. Gagner disagreed with a number of the article’s recommendations, especially because the authors showed considerable bias towards Roux-en-Y Gastric Bypass (RYGB) surgery as the most favourable risk-benefit profile for patients with Type-2 diabetes. The article, according to Dr. Gagner, provides misleading information, which has the potential to cause harm to future patients. Dr. Gagner proposed to eliminate the “choice of procedure” recommendation part of the article as it does not accurately represent a Type-2 diabetes patient’s best options. In many instances, sleeve gastrectomy or duodenal switch is the best operation for type-2 diabetes.

While Dr. Gagner does not entirely rule out the benefits of a Roux-en-Y Gastric Bypass procedure, he does insist that the risk-benefit profile is not measured appropriately and that the risks involved in a RYGB should not be understated. The risks for Type-2 diabetes patients undergoing RYGB surgery include:

?      Long-term nutritional deficiencies, such as bone demineralisation
?      40% weight loss failure rate in patients with an initial BMI > 50 kg/m2
?      33% recurrence rate of diabetes
?      Nutritional micronutrient deficiencies
?      Intestinal complications
?      Hypoglycaemia and dumping syndromes

There are a number of article recommendations that Dr. Gagner does not agree with, such as bundling a biliopancreatic diversion and duodenal switch, which, in his opinion, is a “grave scientific mistake.” The classic biliopancreatic diversion called “Scopinaro procedure” is now abandoned due to frequent nutritional complications and duodenal switch has replaced entirely this old procedure. Most of the recommendations that Dr. Gagner takes issue with are seemingly caused by lack of understanding and experience.

If you have Type-2 diabetes and are considering undergoing weight loss surgery, the most important thing to remember is that there is no one-size-fits-all procedure. Your situation is unique, so it is very important to consult with a physician that won’t recommend a procedure strictly based on bias. The American Diabetes Association has not recommended one particular type of surgery, therefore, the choice of procedure is ultimately yours to make.

Clinique Michel Gagner specializes in many forms of metabolic surgery. Fill out our patient questionnaire or contact us today to arrange a consultation.

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