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Combined procedure

Ileal interposition with SG promising for diabetes

Patients also demonstrated further declines in glycaemic, lipid parameters and microalbuminuria

Indian researchers have reported that a laparoscopic ileal interposition with diverted sleeve gastrectomy is a promising procedure for controlling type 2 diabetes and associated metabolic abnormalities.

The study, ‘Ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes’, presented at the Society for Endocrinology’s annual conference in Harrogate, UK, revealed that 70.5% of patients who underwent the procedure had diabetes remission and 93% who previously had hypertension no longer had the condition.

Procedure

The study authors from Medwin Hospital and Kirloskar Hospital, Hyderabad, India, explained that ileal interposition with diverted sleeve gastrectomy addresses the foregut and hindgut mechanisms for diabetes control.

The diverted sleeve gastrectomy component restricts calorie intake and induces ghrelin loss, as well as excluding the duodenal loop, which negates the effect of insulin resistance. The ileal interposition leads to earlier and rapid stimulation of interposed ileal segment by ingested food resulting in augmented GLP-1 secretion (Figure 1).

Figure 1: Diagrammatic representation of ileal interposition with diverted sleeve gastrectomy.

The study included 32 patients (21 males) with mean age of 48.7±7.8, a mean duration of diabetes of 13.1±5.8 years and pre-operative BMI of 29.1±6.9kg. They had poorly controlled diabetes demonstrated by their mean fasting blood sugar (236.52±88.4mg/dl), post lunch blood sugar (305.1±124.3 mg/dl) and hyperglycaemia (9.8±1.8%). Twelve patients (39%) had dyslipidemia and microalbuminuria.

The mean operative time was 387.7±84.3 minutes and the mean postoperative hospital stay was 8.8±5.4 days. Intraoperative complications were noted in four patients (12.5%). Nausea and loss of appetite was observed in three patients (10%), which improved over a period of two weeks. After three months follow up, none of these patients had any complications with regards to the intraoperative and immediate postoperative events

Postoperatively statistically significant decline was observed in the glycaemic, lipid parameters, and microalbuminuria at all intervals (p<0.05). Patients with follow up more than six months demonstrated further delines in glycaemic, lipid parameters and microalbuminuria. Three patients had vitamin B12 deficiency one year after surgery.

The researchers have previously reported that this combined procedure has the maximum benefit for patients who have had type 2 diabetes for less than ten years.

 

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