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World J Diabetes. Jun 15, 2023; 14(6): 632-655
Published online Jun 15, 2023. doi: 10.4239/wjd.v14.i6.632
State of art on the mechanisms of laparoscopic sleeve gastrectomy in treating type 2 diabetes mellitus
Fa-Shun Liu, Song Wang, Xian-Shan Guo, Zhen-Xiong Ye, Hong-Ya Zhang, Zhen Li
Fa-Shun Liu, Song Wang, Zhen-Xiong Ye, Zhen Li, Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
Xian-Shan Guo, Department of Endocrinology, Xinxiang Central Hospital, Xinxiang 453000, Henan Province, China
Hong-Ya Zhang, Central Laboratory, Yangpu District Control and Prevention Center, Shanghai 200090, China
Author contributions: Liu FS completed the first draft and revised draft of the article; Wang S, Guo XS, Ye ZX, and Zhang HY performed the collected the data; Li Z reviewed the article; All authors have read and approved the final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen Li, MD, Chief Physician, Surgeon, Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, No. 450 Tengyue Road, Yangpu District, Shanghai 200090, China. lizhen3829@126.com
Received: December 17, 2022
Peer-review started: December 17, 2022
First decision: March 24, 2023
Revised: April 1, 2023
Accepted: April 24, 2023
Article in press: April 24, 2023
Published online: June 15, 2023
Processing time: 179 Days and 23.3 Hours
Abstract

Obesity and type-2 diabetes mellitus (T2DM) are metabolic disorders. Obesity increases the risk of T2DM, and as obesity is becoming increasingly common, more individuals suffer from T2DM, which poses a considerable burden on health systems. Traditionally, pharmaceutical therapy together with lifestyle changes is used to treat obesity and T2DM to decrease the incidence of comorbidities and all-cause mortality and to increase life expectancy. Bariatric surgery is increasingly replacing other forms of treatment of morbid obesity, especially in patients with refractory obesity, owing to its many benefits including good long-term outcomes and almost no weight regain. The bariatric surgery options have markedly changed recently, and laparoscopic sleeve gastrectomy (LSG) is gradually gaining popularity. LSG has become an effective and safe treatment for type-2 diabetes and morbid obesity, with a high cost-benefit ratio. Here, we review the me-chanism associated with LSG treatment of T2DM, and we discuss clinical studies and animal experiments with regard to gastrointestinal hormones, gut microbiota, bile acids, and adipokines to clarify current treatment modalities for patients with obesity and T2DM.

Keywords: Obesity; Type-2 diabetes mellitus; Laparoscopic sleeve gastrectomy; Gastrointestinal hormones; Adipokines; Gut microbiota; Bile acids

Core Tip: Obesity and type-2 diabetes mellitus (T2DM) incidence are currently increasing, and these afflictions have become important global health issues. Bariatric surgery is safe and effective for treating obesity and T2DM. The precise processes associated with this treatment, however, are somewhat unclear. Here, we review associated findings with respect to gastrointestinal hormones, intestinal microbiota, bile acids, and adipokines involved in laparoscopic sleeve gastrectomy (the most popular bariatric surgery) of T2DM patients.