Argentine consensus of metabolic surgery

Authors

  • Marianela Aguirre Ackermann Comprehensive Center of Endocrinology and Nutrition (CIEN), Corrientes-Misiones, Argentina
  • Omar Alva CIEN-DIAGNOMED Center; Argerich Hospital, Autonomous City of Buenos Aires, Argentina
  • Graciela Álvarez Center for the Study and Treatment of Severe Obesity (CETOS), Autonomous City of Buenos Aires, Argentina
  • Marisa Andreoni Obesity and Mini Invasive Surgery (OCMI), Autonomous City of Buenos Aires, Argentina
  • Eduardo Babor Center for the Study and Treatment of Severe Obesity (CETOS), Autonomous City of Buenos Aires
  • Verónica Bottino Obesity and Mini Invasive Surgery (OCMI), Autonomous City of Buenos Aires
  • Oscar Brasesco Obesity and Mini Invasive Surgery (OCMI), Hospital Austral; Favaloro Foundation; Finochietto Sanatorium, Autonomous City of Buenos Aires, Argentina
  • Lilia Cafaro Obesity and Mini Invasive Surgery (OCMI), Autonomous City of Buenos Aires, Argentina
  • Mónica Coqueugniot Center for the Study and Treatment of Severe Obesity (CETOS), Autonomous City of Buenos Aires, Argentina
  • Susana Fuentes El Cruce High Complexity Hospital, Florencio Varela, Province of Buenos Aires, Argentina
  • Martín Garaycoechea El Cruce High Complexity Hospital, Florencio Varela, Province of Buenos Aires, Argentina
  • Emilio Hidalgo Bariatric and Metabolic Surgery, CIEN Center, Corrientes-Misiones, Argentina
  • Adriana Immerso Obesity and Mini Invasive Surgery (OCMI), Autonomous City of Buenos Aires, Argentina
  • Ana Iturrospe Obesity and Mini Invasive Surgery (OCMI), Autonomous City of Buenos Aires, Argentina
  • Viviana Lasagni Obesity Surgical Clinic (CQO), Mendoza, Argentina
  • León Litwak Italian Hospital of Buenos Aires. Argentine Diabetes Society, Autonomous City of Buenos Aires, Argentina
  • Hugo Montemerlo Mater Dei Sanatorium, Autonomous City of Buenos Aires, Argentina
  • Carla Musso Favaloro Foundation, Autonomous City of Buenos Aires, Argentina
  • Pablo Omelanczuk Italian Hospital of Mendoza; Obesity Surgical Center, Mendoza, Argentina
  • Mariano Palermo Comprehensive Center of Endocrinology and Nutrition (CIEN), Autonomous City of Buenos Aires, Argentina
  • Natalia Pampillón Obesity Surgical Center, Mendoza, Argentina
  • María Quevedo Comprehensive Center of Endocrinology and Nutrition (CIEN), Autonomous City of Buenos Aires, Argentina
  • Clarisa Re¡ynoso British Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina
  • Marcelo Rondina El Cruce High Complexity Hospital, Florencio Varela, Province of Buenos Aires, Argentina
  • Graciela Rubin Private University Hospital of Córdoba S.A., Córdoba, Argentina
  • Magalí Sánchez Obesity Surgical Center, Mendoza, Argentina
  • Edgardo Serra Comprehensive Center of Endocrinology and Nutrition (CIEN), Corrientes-Misiones, Argentina

DOI:

https://doi.org/10.47196/diab.v49i3.206

Keywords:

metabolic surgery, bariatric surgery, diabetes mellitus type 2, obesity

Abstract

Introduction: the worldwide pandemic increase of obesity and type 2 diabetes push us to choose therapeutic options to control metabolic parameters and decrease cardiovascular risk in this group of patients. Metabolic surgery became a useful tool added to lifestyle change and pharmacologic therapy.

Objetives: the aim of the recommendations was to treat patients with y Roux bypass surgery (BPGYR), with BMI between 30-35 kg/m2 and alter metabolic parameters after been treated with the best medical therapy.

Conclusions: the first Argentinean metabolic surgery consensus was done by the Argentinean Diabetes Society (SAD), Argentinean Nutrition Society (SAN) and Argentinean Society of Obesity Surgery (SACO) and the proposal was to consider metabolic surgery in type 2 diabetic patients with BMI between 30-35 kg/m2 after been treated with the best medical therapy.

We describe selection criteria of patients, the important role of the interdisciplinary approach, evaluation, and preparation before surgery and the follow up.

Author Biographies

Marianela Aguirre Ackermann, Comprehensive Center of Endocrinology and Nutrition (CIEN), Corrientes-Misiones, Argentina

Physician Specialist in Medical Clinic and Nutrition; Master in Diabetes; Bariatric and Metabolic Surgery Team, Comprehensive Center for Endocrinology and Nutrition (CIEN), Corrientes-Misiones

Omar Alva, CIEN-DIAGNOMED Center; Argerich Hospital, Autonomous City of Buenos Aires, Argentina

Medical Specialist in Psychiatry. Bariatric and Metabolic Surgery Team, CIEN-DIAGNOMED Center, Argerich Hospital

Graciela Álvarez, Center for the Study and Treatment of Severe Obesity (CETOS), Autonomous City of Buenos Aires, Argentina

Medical Specialist in Medical Clinic and Nutrition

Marisa Andreoni, Obesity and Mini Invasive Surgery (OCMI), Autonomous City of Buenos Aires, Argentina

Bachelor of Nutrition

Eduardo Babor, Center for the Study and Treatment of Severe Obesity (CETOS), Autonomous City of Buenos Aires

Surgeon

Verónica Bottino, Obesity and Mini Invasive Surgery (OCMI), Autonomous City of Buenos Aires

Bachelor of Nutrition

Oscar Brasesco, Obesity and Mini Invasive Surgery (OCMI), Hospital Austral; Favaloro Foundation; Finochietto Sanatorium, Autonomous City of Buenos Aires, Argentina

Surgeon; Director of Obesity and Mini Invasive Surgery (OCMI), Hospital Austral, Favaloro Foundation, Sanatorio Finochietto

Lilia Cafaro, Obesity and Mini Invasive Surgery (OCMI), Autonomous City of Buenos Aires, Argentina

Nutrition Specialist Doctor

Mónica Coqueugniot, Center for the Study and Treatment of Severe Obesity (CETOS), Autonomous City of Buenos Aires, Argentina

Bachelor of Nutrition

Susana Fuentes, El Cruce High Complexity Hospital, Florencio Varela, Province of Buenos Aires, Argentina

Medical Clinic and Diabetes Specialist; Bariatric and Metabolic Surgery Team, El Cruce High Complexity Hospital

Martín Garaycoechea, El Cruce High Complexity Hospital, Florencio Varela, Province of Buenos Aires, Argentina

Surgeon; Bariatric and Metabolic Surgery Team, El Cruce High Complexity Hospital

Emilio Hidalgo, Bariatric and Metabolic Surgery, CIEN Center, Corrientes-Misiones, Argentina

Physician Specialist in Psychiatry; Bariatric and Metabolic Surgery Team, CIEN Center. Currents-Misiones

Adriana Immerso, Obesity and Mini Invasive Surgery (OCMI), Autonomous City of Buenos Aires, Argentina

Bachelor of Nutrition

Ana Iturrospe, Obesity and Mini Invasive Surgery (OCMI), Autonomous City of Buenos Aires, Argentina

Medical Specialist in Nutrition and Diabetes

Viviana Lasagni, Obesity Surgical Clinic (CQO), Mendoza, Argentina

Bachelor of Psychology; Diploma in Bariatric Psychology

León Litwak, Italian Hospital of Buenos Aires. Argentine Diabetes Society, Autonomous City of Buenos Aires, Argentina

Endocrinology Specialist Physician

Hugo Montemerlo, Mater Dei Sanatorium, Autonomous City of Buenos Aires, Argentina

Nutrition Specialist Doctor

Carla Musso, Favaloro Foundation, Autonomous City of Buenos Aires, Argentina

Medical Specialist in Endocrinology

Pablo Omelanczuk, Italian Hospital of Mendoza; Obesity Surgical Center, Mendoza, Argentina

Surgeon

Mariano Palermo, Comprehensive Center of Endocrinology and Nutrition (CIEN), Autonomous City of Buenos Aires, Argentina

Surgeon; Bariatric and Metabolic Surgery Team

Natalia Pampillón, Obesity Surgical Center, Mendoza, Argentina

Bachelor of Nutrition

María Quevedo, Comprehensive Center of Endocrinology and Nutrition (CIEN), Autonomous City of Buenos Aires, Argentina

Physician Specialist in Medical Clinic and Nutrition; Bariatric and Metabolic Surgery Team, Comprehensive Center for Endocrinology and Nutrition (CIEN)

Clarisa Re¡ynoso, British Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina

Bachelor of Nutrition

Marcelo Rondina, El Cruce High Complexity Hospital, Florencio Varela, Province of Buenos Aires, Argentina

Surgeon; Bariatric and Metabolic Surgery Team

Graciela Rubin, Private University Hospital of Córdoba S.A., Córdoba, Argentina

Physician Specialized in Diabetes

Magalí Sánchez, Obesity Surgical Center, Mendoza, Argentina

hysician Specialist in Medical Clinic

Edgardo Serra, Comprehensive Center of Endocrinology and Nutrition (CIEN), Corrientes-Misiones, Argentina

Surgeon; Bariatric and Metabolic Surgery Team, Comprehensive Center for Endocrinology and Nutrition (CIEN)

References

Rubino F, Cummings DE. The coming age of metabolic surgery. Nat. Rev. Endocrinol. 2012; 8:702-704.

Fruhbeck G. Bariatric and metabolic surgery: a shift in eligibility and success criteria. Nat. Rev. Endocrinol. 2015;11:465-477.

Shimizu H, Timratana P, Schauer PR, et al. Review of metabolic surgery for type 2 diabetes in patients with a BMI <35 kg/m2. Journal of Obesity 2012.

National Institutes of Health Consensus Development Panel. Gastrointestinal surgery for severe obesity. Consensus Development Conference Statement. Ann. Intern. Med. 1991; 115:956-61.

Rubino F, Kaplan LM, Schauer PR, Cummings DE. The diabetes surgery summit consensus conference: recommendations for the evaluation and use of the gastrointestinal surgery to treat type 2 diabetes mellitus. Ann. Surg. 2012; 215 (3):339- 405.

American Diabetes Association. Standards of Medical Care in Diabetes-2009. Diabetes Care 2009; 32: S13-S61.

Dixon JB, Zimmet P, Rubino F. Bariatric surgical and procedural interventions in the treatment of obese patients with type 2 diabetes. A position statement from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Surg. Obes. Relat. Dis. 2011; 7: 433-47.

Mechanick JI, Youdim A, Jones DB. Clinical Practice Guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American Association of Clinical Endocrinologists. The Obesity Society and American Society for Metabolic and Bariatric Surgery. Endocrine Practice 2013; 19:1-36.

Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery. Obes. Surg. 2014; 24:42-55.

Pories WJ, Dohm LG, Mansfield CJ. Beyond the BMI: the search for better guidelines for bariatric surgery. Obesity 2010;18: 865-871.

Cohen R. Pinheiro JC, Schiavon C, Salles JE. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care 2012; 35: 1420-1428.

Sjoholm K, Anvenden A, Peltonen M, et al. Evaluation of current eligibility criteria for bariatric surgery: diabetes prevention and risk factor changes in Swedish obese subjects (SOS) study. Diabetes Care 2013; 365:1335-40.

Rubino F, Sula A, Moreira M, et al. Bariatric, metabolic and diabetes surgery: what´s in a name? Ann. Surg. 2014;259:117-122.

Cohen R, Caravatto PP, Petry T. Metabolic surgery for type 2 diabetes in patients with a BMI of <35 kg/m2: a surgeon´s perspective. Obes. Surg. 2013; 23: 809-818.

Schulman AP, del Genio F, Sinha N, Rubino F. Metabolic surgery for treatment of type 2 diabetes mellitus. Endocr. Pract. 2009;15: 624-631.

Ramos-Leví AM, Rubio Herrera MA. Metabolic surgery: quo vadis? Endocrinol. Nutr. 2014; 61: 35-46.

Cohen R. Metabolic surgery: who and when? Is there a good answer. Nutr. Hosp. 2013; 28:14-16.

Neff KJ, le Roux CW. Bariatric surgery: the indications in metabolic disease. Dig. Surg. 2014; 31:6-12.

Nogueira F, y col. Guías prácticas de diagnóstico y tratamiento del síndrome de apneas e hipopneas obstructivas del sueño. Revista Medicina 2013; 73.

Mechanick JI, Kushner RF, Sugerman HJ. American Association of Clinical Endocrinologists, The Obesity Society and the American Society for Metabolic and Bariatric Surgery Medical Guidelines for clinical practice for the perioperative nutritional, metabolic and non surgical support of the bariatric patient. Endocr. Practice 2008; 14: 1-83.

Pampillon N. Consenso Argentino de Nutrición en Cirugía Bariátrica. Actualización en Nutrición 2011; 12:98-141.

Brethauer SA, Schauer PR. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann. Surg. 2013; 258:628-36.

Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care 2009;32:2133-2135

Helmio M, Victorzon M, Ovaska J, et al. SLEEVEPASS: a randomized prospective multicenter study comparing laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: preliminary results. Surg. Endosc. 2012; 26:2521-2526.

Cohen R, Schiavon C, Pinheiro J, et al. Duodeno-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22-34 kg/m2: a report of 2 cases. Surg. Obes. 2007; 3:195-197.

Elahi D, Galiatsatos P, Rabiee A, et al. Mechanisms of type 2 diabetes resolution after Roux-en-Y gastric bypass. Surgery for Obesity and Related Diseases 2014; 10: 1028-1040.

Rubino F. Is type 2 diabetes an operable intestinal disease? Diabetes Care 2008; 31:S290-296.

Seeley R, Chambers A, Sandoval D. The role of gut adaptation in the potent effects of multiple bariatric surgerie on obesity and diabetes. Cell Metab 2015; 3: 369-378.

Madsbad S, Dirksen C, Holst J. Mechanisms of changes in glucose metabolism and bodyweight after bariatric surgery. Lancet Diabetes Endocrinol. 2014; 2: 152-64.

Dutia R, Brakoniecki K, Bunker P, et al. Limited recovery of b-cell function after gastric bypass despite clinical diabetes remission. Diabetes 2014; 63:1214-1223.

Young Min Cho. A gut feeling to cure diabetes: potential mechanisms of diabetes remission after bariatric surgery. Diabetes Metab. J 2014; 38:406-415.

Weiss R, Ram Weiss. Effects of Roux-en-Y gastric bypass on b-cell function Diabetes 2014; 63:1171-1173.

Rubino F, Amiel AA. Is the gut the “sweet spot” for the treatment of diabetes? Diabetes 2014; 63:2225-2228.

Bojsen-Möller K, Dirksen C, Jörgensen N, et al. Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y Gastric Bypass. Diabetes 2014;63:1725-1737.

Manning S, Pucci A, Batterham R. GLP-1: a mediator of the beneficial metabolic effects of bariatric surgery? Physiology 2015; 30: 50-62.

Nannipieri M, Baldi S, Mari A, et al. Roux-en-Y Gastric Bypass and sleeve gastrectomy: mechanisms of diabetes remission and role of gut hormones. J. Clin. Endocrinol. Metab. 2013; 98: 4391-4399.

Kashyap SR, Daud S, Kelly KR, et al. Acute effects of gastric bypass versus gastric restrictive surgery on b-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes. International Journal of Obesity (2009) 1-10.

Gerhard G, Styer A, Wood C, et al. A role for fibroblast growth factor 19 and bile acids in diabetes remission after Roux-en-Y gastric bypass. Diabetes Care 2013; 36: 1859-1864.

Sweeney T, Morton J. Metabolic surgery: action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature. Best Practice & Research Clinical Gastroenterology 2014; 28: 727-740.

Saedi N. Control in rats after gastric bypass reprogramming of intestinal glucose metabolism and glycemic. Science 2013; 341: 406-410.

Troy S, Sooty M, Ribeiro M, et al. Intestinal gluconeogenesis is a key factor for early metabolic shanges after gastric bypass but not after gastric lap-band in mice. Cell Metab. 2004; 3: 201-211.

Zietek T, Daniel H. Intestinal nutrient sensing and blood glucose control. Curr. Opin. Clin. Nutr. Metab. Care 2015, 18:381-388.

Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for the adult- onset diabetes mellitus. Ann. Surg. 1995;222:339-50.

Schauer PR, Burguera B, Ikramuddin S, et al. Effect of iaparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann. Surg. 2003;238:467-84.

Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA 2012; 308:1122-31.

Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N. Engl. J. Med. 2007; 357: 753-61.

Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N. Engl. J. Med. 2007; 357: 741-52.

Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann. Surg. 2004; 240: 416-24.

Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery a systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann. Surg. 2011; 253: 484-7.

Flum DR. Impact of gastric bypass operation on survival: a population-based analysis. J. Am. Coll. Surg. 2004; 199:543-51.

Dixon JB, le Roux CW, Rubino F, Zimmet P. Bariatric surgery for type 2 diabetes. Lancet 2012; 379: 2300-11.

Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N. Engl. J. Med. 2012; 366:1577-1585.

Kashyap SR, Bhatt DL, Wolski K, et al. Metabolic effects of bariatric surgery in patients with moderate obesity and type 2diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes Care 2013; 36: 2175-82.

Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N. Engl. J. Med. 2012; 366:1567-76.

Kashyap SR, Bhatt DL, Schauer PR. Bariatric surgery vs. advanced practice medical management in the treatment of type 2 diabetes mellitus: rationale and design of the Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently trial (STAMPEDE). Diabetes Obes. Metab. 2010; 12:452-4.

Schauer PR, Bhatt DL, Kirwan J, et al. Bariatric surgery versus intensive medical therapy for diabetes 3-year outcomes. N. Engl. J. Med. 2014.

Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study Randomized Clinical Trial. JAMA 2013; 309: 2240-49.

Courcoulas AP, Goodpaster BH, Eagleton JK, et al. Surgical vs medical treatments for type 2 diabetes mellitus: a randomized clinical trial. JAMA Surg 2014; published online 4 Jun.

Halperin F, Ding SA, Simonson DC, et al. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. JAMA Surg 2014; published online 4 Jun.

Gloy VL, Briel M. Bariatric surgery versus non surgical treatment for obesity: a systematic review for weight loss. BMJ 2013; 347: f5934. Doi: 10.1136/bmj.f5934.

Dixon JB, O' Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 2008; 299: 316-23.

Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N. Engl. J. Med. 2004; 351:2683-93.

Sjöström L. Association of bariatric surgery with long term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA 2014; 311:2297-304.

Miras A, le Roux C. Metabolic surgery: shifting the focus from glycaemia and weight to end-organ health. Lancet Diabetes Endocrinol. 2014; 2: 141-51.

Carlsson LMS, Romeo S, Jacobson P, et al. The incidence of albuminuria after bariatric surgery and usual care in Swedish obese subjects (SOS): a prospective controlled intervention trial. International J. Obes. 2015; 39:169-175.

Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery, 2007; 142: 621-635.

Khuri SF, Najjar SF, Daley J, et al. Comparison of surgical outcomes between teaching and nonteaching hospitals in the Department of Veterans Affairs. Annals of Surgery 2001; 234:370-383.

Ngiam KY, Lee WJ, Lee YC, et al. Efficacy of metabolic surgery on HbA1c decrease in type 2 diabetes mellitus patients with BMI <35 kg/m2. A review. Obes. Surg. 2014; 24:148-158.

Kellene A. Nutrition and metabolic support recommendations for the bariatric patient. Nutr. Clin. Pr 2014; 29:6: 718-739.

Amaya García MJ. Micronutrientes en cirugía bariátrica. Nutrición Hospitalaria 2012; 27:349-361.

Savino P, Carvajal C, Nassar R, et al. Necesidades nutricionales específicas después de cirugía bariátrica. Rev. Colomb. Cir. 2013; 28:161-171.

Ikramuddin S, Klingman D, Swan T, et al. Cost-effectiveness of Roux-en-Y gastric bypasses in type 2 diabetes patients. Am. J. Manag. Care. 2009 Sep; 15(9):607-15.

Keating CL, Dixon JB, Moodie ML, et al. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care. 2009 Apr; 32(4):580-4.

Picot J, Jones J, Colquitt JL, et al. Weight loss surgery for mild to moderate obesity: a systematic review and economic evaluation. Obes. Surg. 2012 Sep; 22(9):1496-506.

Moize V, Geliebter A, Gluck ME, et al. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes. Surg. 2003; 13:23-8.

Welch G, Wesolowski C, Zagarins S, et al. Evaluation of clinical outcomes for gastric bypass surgery: results from a comprehensive follow-up study. Obes. Surg. 2011; 21: 18-28.

Arterburn DE, Bogart A, Sherwood N, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes. Surg. 2013; 23: 93-102.

Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA 2012; 307: 56-65.

Romeo S, Maglio C, Burza MA. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care 2012; 35:2613-2617.

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Published

2023-01-10

How to Cite

Aguirre Ackermann, M., Alva, O., Álvarez, G., Andreoni, M., Babor, E., Bottino, V., Brasesco, O., Cafaro, L., Coqueugniot, M., Fuentes, S., Garaycoechea, M., Hidalgo, E., Immerso, A., Iturrospe, A., Lasagni, V., Litwak, L., Montemerlo, H., Musso, C., Omelanczuk, P., Palermo, M., Pampillón, N., Quevedo, M., Re¡ynoso, C., Rondina, M., Rubin, G., Sánchez, M., & Serra, E. (2023). Argentine consensus of metabolic surgery. Journal of the Argentine Society of Diabetes, 49(3), 95–110. https://doi.org/10.47196/diab.v49i3.206

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Vol. 49 No. 3 (2015): September/December 2015

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Dirección Nacional de Derecho de Autor, Exp. N° 5.333.129. Instituto Nacional de la Propiedad Industrial, Marca «Revista de la Sociedad Argentina de Diabetes - Asociación Civil» N° de concesión 2.605.405 y N° de disposición 1.404/13.

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