Early Mechanisms of Glucose Improvement following Laparoscopic Ileal Interposition Associated with a Sleeve Gastrectomy Evaluated by the Euglycemic Hyperinsulinemic Clamp in Type 2 Diabetic Patients with BMI below 35

Vencio, Sérgio; Stival, Alessandro R.; Halpern, Alfredo; DePaula, Carolina C. L.; DePaula, Aureo L.

doi:10.1159/000330272

Cited by 11 publications

(6 citation statements)

References 65 publications

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“…These effects have been documented in other publications and its effects on lipid metabolism have been particularly associated with the change in bilio-enteric circulation (Yang et al 2013 ; DePaula et al 2010 ). Similarly, beneficial effects on glycemia have been attributed to the improvement in insulin sensitivity and beta cell function confirmed by prospective studies (Vencio et al 2011 ). Other reports of short term (18 months) follow up of non-morbidly obese patients treated by DSIT yielded 80 % remission in T2DM along with appropriate weight control without significant nutritional deficiencies.…”

Section: Discussionmentioning

confidence: 83%

The impact of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) on short term diabetic medication costs

Çelik¹,

Asci²,

Celik³

et al. 2015

SpringerPlus

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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.

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Section: Discussionmentioning

confidence: 83%

The impact of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) on short term diabetic medication costs

Çelik¹,

Asci²,

Celik³

et al. 2015

SpringerPlus

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“…-In Vencio et al, [12] , the mean BMI pre-operative was (29.01 ±3.3), and post-operative was (25.8 ± 2.9).…”

Section: • Mean Bmi (Kg/m 2 )mentioning

confidence: 91%

“…-In Vencio et al, [12] , the pre-operative mean HbA 1 c was more than 7.5, and there was no post-operative change as the follow-up period was a month while HbA1c is recommended every 3 months.…”

Section: • Mean Hba1 C (%)mentioning

confidence: 96%

Role of Laparoscopic Ileal Interposition Associated with Sleeve Gastrectomy in Management of Type 2 Diabetes Mellitus

Kordy¹,

Khalil

Omar

2020

The Medical Journal of Cairo University

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Background: Type 2 diabetes mellitus has reached pandemic levels with associated many co-morbidities and decrease in life expectancy. Bariatric surgery presented its value as a definitive solution for type 2 diabetes mellitus management especially with the laparoscopic surgery evolution which occurred since the 1990s. Bariatric surgery has a significant role in remission or alleviation of type 2 diabetes mellitus, weight loss, remission of comorbidities, and the improvement in the quality of life. Aim of Study: We attempt to illustrate, through the available researches, the role of laparoscopic ileal interposition associated with sleeve gastrectomy in management of type 2 diabetes mellitus and the feasibility and efficacy of this procedure as an option in management of type 2 diabetes mellitus and assess the risk to benefit profiles. Material and Methods: The search is carried out using the electronic national library of medicine's PubMed database plus manual reference checks of articles published on laparoscopic ileal interposition associated with sleeve gastrectomy in management of type 2 diabetes mellitus in the period between February 2019 to February 2020. The jejuno-ileal interposition associated with sleeve gastrectomy can be an effective method used for management of type 2 diabetes mellitus in patients with BMI less than 35 kg/m 2. Results: The results of this procedure are promising regarding its outcome in remission of T2DM and remission of its co-morbidity diseases. The operative time of the procedure along with its reasonable post-operative hospital stay and its results in type 2 diabetes mellitus remission may present the procedure as an alternative for other more complex bariatric procedures in management of type 2 diabetes mellitus. Conclusion: The duration time of T2DM, the drug used, the dose of the drug and the BMI of the patient affect the rate of complete remission of T2DM. The procedure can produce adequate control of hyperglycemic state in T2DM patients and satisfactory weight loss without signs of nutritional deficiencies. The procedure seems to be safe and an effective option in the management of type 2 diabetes patients with affordable risk comparing to its long term benefits.

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“…A brecha mesentérica dessa anastomose também é fechada com pontos separados, fio inabsorvível. A terceira e última enteroanastomose é uma íleo-jejunostomia realizada conforme descrito anteriormente, assim como o fechamento da brecha mesentérica 2,4,9,11,12,15,16 .…”

Section: Interposição Ileal Na Altura Do Jejuno Proximalunclassified

Aspectos técnicos da interposição ileal com gastrectomia vertical como possível opção ao tratamento do diabetes mellitus tipo 2

Paula

Silva

Paula

et al. 2010

ABCD, arq. bras. cir. dig.

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DESCRITORES -Obesidade. Diabetes mellitus. Cirurgia Bariátrica.RESUMO -Introdução -Há evidências que os melhores resultados em termos de resolução do diabetes mellitus tipo 2 (DM2) em pacientes obesos mórbidos são atingidos com as derivações biliopancreáticas, em especial o duodenal switch. Essas operações caracterizamse por redução do estômago através de gastrectomia e o rápido trânsito dos alimentos para o íleo distal, através de expressiva derivação de segmentos do intestino delgado. A idéia da realização da técnica aqui apresentada baseou-se nestes princípios. Método -Os procedimentos são habitualmente realizados por via laparoscópica após pneumoperitônio com 12 a 15 mmHg e seis trocárteres. O paciente é inicialmente posicionado em proclive de 30º com o cirurgião à direita. Inicia-se a gastrectomia vertical tendo como referência anatômica a trifurcação distal do vago anterior. A desvascularização da grande curvatura é realizada e se estende até o ângulo esofagogástrico. Com um calibrador intra-gástrico de 20 mm posicionado ao longo da pequena curvatura gástrica inicia-se a ressecção gástrica no antro com grampeador linear e adicionalmente é feita uma sutura contínua. Para a realização da interposição ileal na altura do jejuno proximal o ângulo duodenojejunal é identificado e o jejuno seccionado 20 a 30 cm à jusante com grampeador linear. O ceco é identificado e o íleo distal seccionado a 30 cm no sentido proximal. Um segmento de 150 a 170 cm de íleo é medido em sentido proximal e seccionado com grampeador linear. O segmento de íleo é interposto de forma isoperistáltica no jejuno proximal previamente seccionado. Em seguida, são realizadas três enteroanastomoses: a primeira íleo-ileal próxima ao ceco; outra próxima ao ângulo duodenojejunal; a terceira íleo-jejunal. O procedimento pode também ser feito com interposição ileal na primeira porção do duodeno. Conclusão -Esta técnica demonstrou-se segura, com baixa morbidade e mortalidade, factível cirurgicamente pela via laparoscópica e passível de ser ofertada como opção operatória ao tratamento da diabetes mellitus tipo 2.ABSTRACT -Introduction -There is an evidence that the best results in terms of resolution of diabetes in morbidly obese patients are achieved with bilio-pancreatic bypass, especially the duodenal switch. These operations are characterized by partial gastrectomy and the rapid transit of food into the distal ileum through derivation of a significant segment of small intestine. The idea of performing the technique presented here was based on these principles. Method -The procedures are usually performed laparoscopically, after establishment of a pneumoperitoneum at 12-15 mmHg and introduction of six trocars. The patient is initially positioned in 30° reverse Trendelenburg with the surgeon on the right side of the patient. The sleeve gastrectomy is performed using the anatomical distal trifurcation of the anterior vagus nerve as a reference. The devascularization of the greater curvature is performed and extends to the oesophagogastric junction. Wit...

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Early Mechanisms of Glucose Improvement following Laparoscopic Ileal Interposition Associated with a Sleeve Gastrectomy Evaluated by the Euglycemic Hyperinsulinemic Clamp in Type 2 Diabetic Patients with BMI below 35

Cited by 11 publications

References 65 publications

The impact of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) on short term diabetic medication costs

The impact of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) on short term diabetic medication costs

Role of Laparoscopic Ileal Interposition Associated with Sleeve Gastrectomy in Management of Type 2 Diabetes Mellitus

Aspectos técnicos da interposição ileal com gastrectomia vertical como possível opção ao tratamento do diabetes mellitus tipo 2

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