Metabolic Laparoscopic Gastric Bypass for Obese Patients with Type 2 Diabetes

Abstract

Gastric bypass in obese patients is associated with a high remission rate of diabetes and improvement of the metabolic control. Although confirmation with randomized controlled studies is needed, these results suggest that this type of surgery might be particularly indicated for obese diabetic patients with good pancreatic reserve.

Detailed characterization of incretin cell distribution along the human small intestine

“…The relative distribution of GLP-1-immunoreactive cells in the small intestine found in the present study is consistent with the hindgut hypothesis [20]. The role of GLP-1 in the improvement of glucose metabolism after intestinal anatomy rearrangement has been recently reinforced by studies in rats submitted to duodenojejunal bypass and small bowel resection with the preservation of the terminal ileum, which displayed increased GLP-1 and improved glucose control [40,41].…”

“…Diabetes remission rate varies with the type of surgical procedure, ranging from 48% after purely restrictive procedures to 95% after malabsorptive procedures, and 84% after mixed procedures, such as RYGB [19]. In addition, diabetes remission rates observed in patients undergoing RYGB variations using long biliopancreatic limbs, compared with the classic procedure, have been reported to be greater than those previously described [18][19][20]37,38].…”

“…It might also help to explain the potential differences observed between classic RYGB technique and variations to this technique in the magnitude of the antidiabetic effects [18,20].…”

“…Among the different hypothesis proposed for this glycemic improvement, the anatomic rearrangement of the GI tract and its putative impact on the incretin cell physiology has been greatly emphasized, by affecting the levels of hormones such as GLP-1, oxyntomodulin, PYY, and ghrelin, which help signal satiety and hunger to the human brain and to improve metabolic control [18][19][20]. The rearrangement created promotes the early arrival of undigested nutrients to the distal intestine, the so-called hindgut hypothesis, with possible overstimulation of L-cells and GLP-1 secretion [21].…”

Comparative analysis of laparoscopic sleeve gatrectomy and laparoscopic gastric bypass surgery in patients with type 2 diabetes mellitus and impaired glucose tolerance

“…Отмечается, что ЛРРЖ представляет собой более простую и менее травматичную операцию, а ЛЖШ обеспечивает несколько большую метаболическую эффективность, особенно в отдаленные сроки [12][13][14][15][16][17]. Потребность в заместительной терапии прак-тически никогда не возникает после выполнения ЛРРЖ и наблюдается в редких случаях после про-ведения ЛЖШ.…”