Surgical Treatment of Type 2 Diabetes in Patients with BMI Below 35: Mid-term Outcomes of the Laparoscopic Ileal Interposition Associated with a Sleeve Gastrectomy in 202 Consecutive Cases

Abstract

Both JII-SG and DII-SG demonstrated to be safe, effective, and long-lasting alternatives for the treatment of T2DM patients with BMI <35. Beyond glycemic control, other benefits were achieved.

Effects of sleeve gastrectomy and ileal transposition, alone and in combination, on food intake, body weight, gut hormones, and glucose metabolism in rats

“…Other important factors that may contribute to the variation in these effects are the different lengths of transposed segment and insertion site of ileal segment. Previously, IT was studied primarily in rodents (43,45,46) but recently IT surgery is considered as a potential anti-diabetic surgery in humans subjects with BMI ≥ 35 (47).…”

Ileal interposition with sleeve gastrectomy for the treatment of type 2 diabetes

“…Although BPD and DS provide the highest rates of remission in terms of weight control and glycemic regulation, they are still being practiced by less than 3% of the bariatric community since these techniques require a life-long multi drug supplementation and may eventually necessitate a revisional surgery. Theoretical steps of success in the field of Bariatric & Metabolic Surgery are listed below: [7,8,18] 1. Caloric restriction and weight adjustments 2.…”

“…To this end, the only surgical method applied to overweight type 2 diabetic patients from the start has been ileal transposition (IT). [7,8] However, recent popular approach is to adapt obesity surgery procedures like gastric bypass to overweight patients and name them as "Metabolic Surgery". The purpose of this article was to discuss surgical procedures with specific emphasis on IT and review possible solutions against probable scenarios awaiting us in the future.…”

“…IT maximizes distal gut activity interposing a segment of ileum right after the stomach and minimizes proximal activity excluding the duodenum. [7,8] TB enhances distal activity bringing the whole ileum to the antrum and diminishes proximal activity shifting food from the duodenal route, which is left intact, further minimizing malabsorption (and amplifying endoscopic access, instead of reducing it). Both procedures aim at functional (and not the mechanical) restriction, trying to avoid malabsorption, instead of having it as a beneficial goal.…”

Operative Outcomes of Bariatric Surgery in Patients with a Low Body Mass Index (30–35 kg/m2)

“…The mean BMI decreased from 29.7 to 23.5 kg/m 2 , which was accompanied by improvement in blood glucose, lipid levels, and hypertension. The mean HbA1c decreased from 9.7 % to 6.2 %, and 90 % of the patients had HbA1c < 7 % at 39 months [ 21 ]. It seems that II is effective; however, it is a very complex procedure.…”