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Current status and problems of laparoscopic bariatric/metabolic surgery in Japan
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Masayuki Ohta1,
Yuichi Endo2,
Masafumi Inomata2 |
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1Global Oita Medical Advanced Research Center for Health, Oita University, 2Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine |
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| In Japan, open bariatric surgery had been covered by the health insurance since 1988 but performed in limited hospitals due to the low safety and high invasiveness. Laparoscopic Roux-en-Y gastric bypass (LRYGB) was introduced in 2000, but the bypass procedure was considered to be not suitable for Japanese people due to the gastric cancer problem. Therefore, laparoscopic sleeve gastrectomy (LSG) has rapidly replaced LRYGB. In addition, Kasama et al. developed LSG with duodenojejunal bypass (LSG-DJB) as diabetes surgery in 2007. LSG for morbid obesity (BMI≧35) with comorbidities has covered by the health insurance since 2014, and the number is rapidly increasing. LSG-DJB for morbid obesity (BMI≧35) with diabetes has been approved as an advanced medical treatment since 2018. In Japan, about 70 obese patients had annually received laparoscopic bariatric/metabolic surgery until 2010, but 671 patients received it in 2018. LSG accounts for over 90% of the procedures, and LSG-DJB for a few percentages. Naitoh et al. demonstrated in the multicenter study that LSG-DJB is clearly superior to LSG in severe diabetes patients. The current problems include that only LSG has been covered by the insurance, metabolic surgery (BMI<35) has not been covered, the number is still small, and many physicians have not known the evidence of the safety and effectiveness. |
Index Term 1: bariatric surgery
Index Term 2: metabolic surgery
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