586
An example is weight loss surgery. The magnitude of weight loss-induced high-
density lipoprotein cholesterol (HDL-C) changes may depend on genetic factors.
Association of SNPs in the gene loci that contribute signifi cantly to plasma HDL-C
levels in obese individuals at baseline persist at follow-up 10 years after bariatric
surgery even after considerable weight loss due to bariatric surgery (Sarzynski et al.
2011 ). The authors did not observe any associations with bariatric surgery-induced
changes in HDL-C levels. The results show that the genetic variants contributing to
overall HDL-C levels in apparently weight-stable individuals have little effect on
inter- individual variation in the changes of HDL-C in response to the weight loss
induced by bariatric surgery. A better understanding of the SNP-HDL associations
in obesity and after weight loss surgery could be used as an aid for improving risk
prediction and in determining the best treatment options for obese patients.
Risks/benefi ts are carefully weighed before embarking on surgical procedures.
Even in standard textbook procedures, the surgeon often modifi es the approach
according to the fi ndings and other anatomical variables that may be encountered.
Algorithms for patient management may contain medical and surgical alterna-
tives, combination of both, or surgery as the only choice after failure of medical
treatment. Improved understanding of the molecular basis of disease and refi ne-
ments in molecular diagnostics have contributed considerably to the decision mak-
ing process as well as prediction of outcome of surgery. Role of surgery, wherever
applicable, is described in the personalized management of various diseases in other
chapters. Surgery is most frequently integrated with medical management and diag-
nostics in case of cancer and neurological disorders.
Response to other non-pharmacological methods may be used to make decision
about surgery. Some of these methods can also be personalized and may be com-
bined with surgery. Examples are personalized radiotherapy in management of can-
cer and personalized hyperbaric oxygen.
Increasing emphasis on personalized medicine with integration of diagnostics
and surgery will likely reduce the need for surgery as well as failed surgical proce-
dures and complications of surgery. Surgery of the future is also being refi ned with
integration of new technologies such as robotics and minimization of the invasive
and traumatic process inherent in surgery.
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Ferguson LR. Nutrigenomics approaches to functional foods. J Am Diet Assoc. 2009;109:452–8.
Go VL, Nguyen CT, Harris DM, Lee WN. Nutrient-gene interaction: metabolic genotype-
phenotype relationship. J Nutr. 2005;135(12 Suppl):3016S–20S.
Jain KK. Textbook of hyperbaric medicine. 5th ed. Göttingen: Hogrefe & Huber; 2009.
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Pach D, Yang-Strobel X, Lüdtke R, et al. Standardized versus individualized acupuncture for
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19 Personalized Non-pharmacological Therapies