De la chirurgie bariatrique à la chirurgie métabolique : vers un nouveau paradigme dans le traitement du diabète de type 2

Bariatric surgery induces numerous hormonal changes that could contribute to reduce hunger sensation and improve glucose homeostasis in patients with type 2 diabetes. The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures to be proposed them to patients with type 2 diabetes but without severe obesity (body mass index <35 kg/m² or even <30 kg/m²). Therefore, we may progress in a near future from bariatric surgery to a so-called metabolic surgery, which may open a new paradigm for the management of type 2 diabetes. This innovative approach, promising but still insufficiently validated yet, deserves further careful evaluation in a multidisciplinary approach involving digestive surgeons, gastroenterologists, endocrinologists and diabetologists.