Ileal Interposition with Gastric Bipartition and a Weight-Adjusted Sleeve Gastrectomy: A New Model of Metabolic Surgery
DOI:
https://doi.org/10.17140/SROJ-4-120Keywords:
Gastric bipartition, Weight-adjusted sleeve gastrectomy, Duodenoileal interposition, Transit bipartion, Type 2 diabetes, Metabolic surgery, Obesity, Gastroileostomy anastomosisAbstract
Background: Metabolic surgery for the treatment of type 2 diabetes patients, with body mass index (BMI) less than 35 kg/m2 has been found to be increasing every year. Duodenoileal interposition with sleeve gastrectomy and transit bipartition (TB) has strong effects on control of type 2 diabetes mellitus. However, both procedures may have long-term problems. Due to duodenal exclusion, endoscopic evaluation of the duodenum and biliary tract becomes impossible after duodenoileal interposition. The TB may have the risk of severe malabsorption due to enlargement of the gastroileostomy. We performed ileal interposition and TB in patients with class 1 obesity having type 2 diabetes, with ethical approval. The new modification included in this paper, was performed in 3 patients, one of whom had a BMI of 30 kg/m2. The aim of this innovation is to treat obese (BMI >30 kg/m2), type 2 diabetes patients with an effective, but less
malabsorptive procedure.
Objectives: The modification that we propose, aims to preserve normal duodenal anatomy and prevent possible duodenal transection related surgical problems and secure the absorptive component of proximal intestines without the need of an adjustment in gastroileostomy anastomosis.
Materials and Methods: All patients underwent total laparoscopic ileal interposition with gastric bipartition and a weight-adjusted sleeve gastrectomy.
Results: All tree patients stopped insulin use after surgery. No complications occurred.
Conclusions: Ileal interposition with gastric bipartition and a weight-adjusted sleeve gastrectomy is a safe and effective procedure for treatment of type 2 diabetes patients with or withoutobesity.
References
Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: A joint statement by international diabetes organizations. Obes Surg. In press.
De Paula AL, Macedo ALV, Prudente AS, et al. Laparoscopic sleeve gastrectomy with ileal interposition (“neuroendocrine break”)-pilot study of a new operation. Surg Obes Relat Dis. 2006; 2(4): 464-467. doi: 10.1007/s00464-007-9472-9
De Paula AL, Macedo ALV, Rassi N, et al. Laparoscopic treat-ment of metabolic syndrome in patients with type 2 diabetes mellitus. Surg Endosc. 2008; 22(12): 2670-2678. doi: 10.1007/ s00464-008-9808-0
De Paula AL, Macedo ALV, Rassi N, et al. Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less tahn 35. Surg Endosc. 2008; 22: 706-716. doi: 10.1007/s00464-008-9808-0
De Paula AL, Macedo ALV, Schraibman V, Mota BR, Vencio S. Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20-34. Surg Endosc. 2009; 23(8): 1724-1732. doi: 10.1007/s00464-008-0168-6
De Paula AL, Macedo ALV, Mota RB, Schraibman V. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21-29. Surg Endosc. 2009; 23(6): 1313-1320. doi: 10.1007/s00464-008-0156-x
De Paula AL, Stival A, Halpern A, Vencio S. Thirty-day morbidity and mortality of the laparoscopic ileal interposition associated with sleeve gastrectomy for the treatment of type 2 diabetic patients with BMI<35: An analysis of 454 consecutive patients. Worl J Surg. 2011; 35(1): 102-108. doi: 10.1007/ s00268-010-0799-3
De Paula AL, Stival AR, Macedo ALV et al. Prospective randomized controlled trial comparing 2 versions of laparoscopic ileal interposition associated with sleeve gastrectomy for patients with type 2 diabetes with BMI 21-34 kg/m2. Surg Obes Relat Dis. 2101; 6(3): 296-305. doi: 10.1016/j.soard.2009.10.005
De Paula AL, Stival AR, De Paula CCL, Halpern A, Vêncio S. Impact on dyslipidemia of the laparoscopic ileal interposition associated to sleeve gastrectomy in type 2 diabetic patients. J Gastrintest Surg. 2010; 14(8): 1319-1325. doi: 10.1007/s11605- 010-1252-5
Venchio S, Stival AR, Alfredo H, Depaula CC, DePaula AL. 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 by the euglycemic hyperinsulinemic clamp in type 2 diabetic patients with BMI below 35. Dig Surg. 2011; 28: 293-298. doi: 10.1159/000330272
De Paula AL, Stival A, Halpern A, et al. Improvement in insülin sensitivity and b-cell function following ileal interposition with sleeve gastrectomy in type 2 diabetic patients: Potential mechanisms. J Gastrintest Surg. 2011; 15: 1344-1355. doi: 10.1007/s11605-011-1550-6
De Paula AL, Stival AR, DePaula CC, Halpern A, Vencio S. 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. J Gastrintest Surg. 2012; 16(5): 967-976. doi: 10.1007/s11605- 011-1807-0
Tinocco A, El-Kadre L, Aquiar L, Tinoco R, Savassi-Rocha P. Short-term and mid-term control of type 2 diabetes mellitus by laparoscopic sleeve gastrectomy with ileal interposition. World J Surg. 2011; 35(10): 2238-2244. doi: 10.1007/s00268- 011-1188-2
Kumar KV, Ugale S, Gupta N, et al. Ileal interposition with sleeve gastrectomy for control of type 2 diabetes. Diabetes Technol Ther. 2009; 11(12): 785-789. doi: 10.1089/ dia.2009.0070
Kota SK, Ugale S, Gupta N, et al. Ileal Interposition with Diverted sleeve gastrectomy for treatment of Type 2 diabetes. Indian J Endocrinol Metab. 2012; 16(Suppl 2): S458-S459. doi: 10.1089/dia.2009.0070
Kota SK, Ugale S, Gupta N, Modi KD. Laparoscopic ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes. Diabetes Metab Syndr. 2012; 6(3): 125-131. doi: 10.1016/j.dsx.2012.09.014
Kota SK, Ugale S, Gupta N, et al. Ileal interposition with sleeve gastrectomy for treatment of type 2 diabetes mellitus. Indian J Endocrinol Metab. 2012; 16(4): 589-598. doi: 10.4103/2230-8210.98017
Ugale S, Gupta N, Modi KD, et al. Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes - a retrospective cohort study. J Diabetes Metab Disord. 2014; 13(1): 89. doi: 10.1186/s40200-014-0089-y
Celik A, Ugale S, Ofluoglu H, et al. Metabolic outcomes of laparoscopic diverted sleeve gastrectomy with ileal Transposi-tion (DSIT) in obese type 2 diabetic patients. Obes Surg. 2015; 25(11): 2018-2022. doi: 10.1007/s11695-015-1671-1
Ramakrishnapillai P, Pai M, Shams F, et al. Effectiveness of minimally invasive hybrid surgery for ileal interposition (MIHSII) for the resolution of type 2 diabetes. Surg Innov. 2015 pii: 1553350615589523. doi: 10.1177/1553350615589523
Santoro S, Castro LC, Velhote MC, et al. Sleeve gastrectomy with transit bipartition: A potent intervention for metabolic syndrome and obesity. Ann Surg. 2012; 256(1): 104-110. doi: 10.1097/SLA.0b013e31825370c0
Mui WL, Lee DW, Lam KK. Laparoscopic sleeve gastrec-tomy with loop bipartition: A novel metabolic operation in treat-ing obese type II diabetes mellitus. Int J Surg Case Rep. 2014; 5(2): 56-58. doi: 10.1016/j.ijscr.2013.12.002
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