| Obesity and associated type 2 diabetes (T2D) is becoming a serious medical issue worldwide. Bariatric surgery has been shown to be the most effective and durable therapy for the treatment of morbid obese patients. Thus, bariatric/metabolic surgery is becoming the most important division in Gastro-intestinal surgery. I started my career 40 years ago with my teacher Professor Kai-Mo Chen at 1980, from open vertical banded gastroplasty (VBG). The booing of bariatric surgery in Asia started from 1998 when I succeed in laparoscopic VBG, then laparoscopic RYGB at 2000 and MGB at 2001. The work of my journey in the development of bariatric/metabolic surgery in Asia can be classified into 4 major fields. 1) Improvement of safety: The advancement in laparoscopic surgery has made this minimal invasive surgery more than ten times safer and better accepted by the patients. The safety profile of laparoscopic metabolic surgery is compatible with laparoscopic cholecystectomy now. 2) New metabolic surgery: We first pioneered in Laparoscopic single anastomosis (mini) gastric bypass, then sleeve gastrectomy (SG). We also tested the duodeno-jejunal bypass with SG (DJB-SG) which was pioneered by Kasama Kazunoid, but with a modifies technique of single anastomosis. We also tested many new procedures but changed back to MGB/OAGB now. 3) Mechanism of metabolic surgery: We investigated the mechanism of bariatric/metabolic surgery by several landmark randomized clinical trial (RCT). We demonstrated that gut hormone, duodenum exclusion and length of bilio-pancreatic limb may play an important role in durable weight loss as well as in T2D remission. However, weight loss is still the cornerstone of T2D remission after metabolic surgery. 4) Individualized treatment: Bariatric surgery is a functional procedure, patients who may benefit most from bariatric surgery was those who have good quality of life after surgery. We investigated the detail quality of life change in each surgical procedure so as help us to design the procedure for the patients. For T2D treatment, we designed a Diabetes Surgical Score, ABCD score which is a simple system for predicting the success of surgical therapy for T2D. This score help in patient selection and procedure choice, and also help in clinical research. |
