In the past, obesity was not considered as a major burden for Asian countries as the prevalence is less than 5%. Hence, even though the first bariatric surgery in Asia had taken place in Taiwan & Japan in 1974, the development of bariatric surgery is slow and not well received by the general surgeons and the publics at the 80s’. However, with the increasing prosperity and Westernization of people’s life, obesity has become an important health topic in Asia. Moreover, with the difference of biology in Asian patients, the prevalence of metabolic syndrome and type 2 diabetes is high at a relative lower BMI than western population. All these factors push the development metabolic and bariatric surgery in Asia in the last two decade. Currently >50% of diabetes patients in the world is located at South-east Asia and Western pacific countries, and the development of metabolic surgery will be focus in Asia-Pacific region in the future.
The laparoscopic era of bariatric surgery started in Taiwan when Prof WJ Lee performed the first laparoscopic vertical banded gastroplasty in1998. The wave of laparoscopic bariatric surgery comes when adjustable gastric band becomes the most popular operation in Australia in the early 2000’. Due to its simplicity with minimal morbidity, Asian countries start to take-up bariatric surgery. Surgeons in Asia received training from western countries like Australia, US and Brazil and start to develop bariatric surgery. Due to the close proximity of most Asian countries, knowledge and skill exchange rapidly among them. The first Asian Bariatric Surgery Group establish in 2004 and establish the Asian Guideline on Bariatric surgery in 2005, which was the first guideline that include T2DM specifically as one of the indication for surgery. Although improvement of glycemic control is expected in T2DM patient after surgery, T2DM remission may not occurs in all patients. Restrictive procedure can improved insulin resistance in obese patients. However, Asian has less pancreatic reserve and lower BMI, GI bypass procedures may be beneficial to us by further improvement islet cell function through weight independent mechanism. By the joint effort of among different Asian diabetes surgery data, currently we can stage the severity of T2D by the ABCD score which can help us in estimating effect of metabolic surgery. However, other factors are also important on the choice of metabolic surgery in Asia, such as cancer risk in remnant bypassed stomach and development of de-novo GERD after sleeve gastrectomy. This give a unique environment for Asia to develop its own surgical strategy in managing obese T2DM.