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The Science of Sweetness

Michael Melkonian, MD

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Bariatric Surgery for Diabetic Patients with a BMI Under 35

In 1991, the National Institutes of Health (NIH) released criteria that patients must meet in order to have bariatric surgery.  For over 20 years, surgeons have used those criteria to select appropriate candidates for weight loss surgery.  With improvements in techniques and procedures over the years, researchers have been questioning whether the NIH guidelines should be broadened to allow more people to take advantage of the benefits of weight loss surgery.  This is especially true for people with type 2 diabetes who have a body mass index (BMI) less than 35.  Under current guidelines, such people do not qualify for bariatric surgery.

An article in this month’s “Journal of the American College of Surgeons,” examines this issue ...

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What To Do With The Gallbladder During Bariatric Surgery

Occasionally, patients ask me if I will remove their gallbladder during bariatric surgery.  The short answer is no.  Removing the gallbladder is only necessary when a person has both gallstones and symptoms from those gallstones.  Gallstones that are asymptomatic do not mandate cholecystectomy (the medical term for gallbladder removal).

The question then becomes, “well won’t bariatric surgery make me get gallstones, and if so why not just take out the gallbladder to prevent that problem?”  Studies have shown that the chances of developing gallstones after bariatric surgery are about 5-9%.  That overall risk is still low.  I would have to remove around 93 gallbladders unnecessarily for every 7 people I could possibly help.  That wouldn’t be fair to those 93 people.  For this reason it is best to only ...

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