Our results demonstrate that DSIT provided effective remission rates in all components of metabolic syndrome in obese type 2 diabetic patients with acceptable complication and mortality rates.

BackgroundIn this study, we specifically aimed to analyze the technical and safety aspects of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) in patients with type 2 diabetes (T2DM).MethodsA total of 360 patients with type 2 diabetes who underwent a DSIT procedure within the past 2-year period (2011–2013) were analyzed. Operation time, length of hospital stay, perioperative and postoperative complications, and mortality were recorded and analyzed.ResultsThe participants consisted of 229 males (63.6 %) and 131 females (36.4 %). Mean duration of follow-up was 12.4 months (range, 6–31). One early and two late mortalities occurred. Early mortality was due to an anastomotic leak, and late mortalities were related to myocardial infarction and a traffic accident. Leakage and bleeding were the most common surgical complications. The total number of surgical complications was 22 (6.1 %). Of those, 19 occurred within the first month (early) and 3 occurred after the first month (late). Among early complications, seven (1.94 %) required re-operation, two patients (0.55 %) required endoscopic treatment, and the remaining ten were managed conservatively. Late surgical complications (sleeve angulation) were noted in three patients (0.83) and were treated by endoscopic stents. Surgery-related non-surgical complications occurred in 19 cases (5.2 %), and neurological complications were noted in 11 patients (3.05 %). Additional surgical intervention was required in 26 patients (7.22 %). Of those, 15 (4.16 %) required cholecystectomy.ConclusionsOur data demonstrate that DSIT is a technically feasible operation and can be safely performed in type 2 diabetic patients with acceptable complication and mortality rates.

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BackgroundType 2 diabetes mellitus (T2DM) has gained pandemic proportions becoming a global threat within the last few decades. In parallel to the increasing prevalence, healthcare costs have become a huge economic burden for the hospital and governments. Bariatric surgery has been proven to induce glycemic control in obese type 2 diabetics. However, the cost effectiveness of metabolic surgery in overweight, obese and morbidly obese individuals has not been documented. We aimed to demonstrate the efficacy and reduced diabetic-medication cost after diverted sleeve gastrectomy with ileal interposition (DSIT) in type 2 diabetic individuals followed more than 1 year.MethodsRecords of 116 type 2 diabetic patients operated by DSIT at a dedicated metabolic surgery clinic between October 2011 and April 2013 were retrospectively reviewed. A comparison was made between the annual diabetic medication cost before and after surgery using the paired t test. The alterations in BMI and HbA1c were recorded and analyzed.ResultsDiverted sleeve gastrectomy with ileal interposition led to a marked reduction in BMI and improved glycemic control after 1 year follow-up. Mean HbA1c levels decreased from a mean of 8.9 ± 1.7 to 6.6 ± 1.1 1 year after surgery (p < 0.001). Mean preoperative BMI declined from 32.9 ± 4.3  to 24.7 ± 2.7 kg/m2 (p < 0.001). Cost of diabetic medication decreased from a mean 660.08 USD/year to 65.12 USD 1 year after surgery (p < 0.001).ConclusionOur results have shown that DSIT operation leads to a significantly better glycemic control and lower diabetic medication costs at 1 year.