Laparoscopic Duodeno-jejunal Bypass (ldjb) As a Surgical Treatment for Type 2 Diabetes Mellitus in the Non Obese Patients. Early Experience.

Introduction: We know from bariatric surgical literature that all bariatric surgical techniques resolve diabetes (T2DM) from 73% to 98% in obese patients, this resolution occurs among days to weeks after surgery. Based on Dr. Rubino’s research on animals, LDJB has been proposed as an alternative of treatment for T2DM in non obese patients.
Objective: To confirm LDJB as a new treatment for a subset of T2DM in non obese patients
Patients and Methods: Following a strict protocol with ethics committee approval in our institution, 7 T2DM patients underwent a LDJB. Surgical technique: transection of the duodenum 2 cm. distal to the pylorus, duodeno-jejunal anastomosis , biliopancreatic limb of 150 cm, alimentary limb 100 cm. Barium swallow was done on the second postoperative day. All patients are taking metformin upon discharge for at least 6 month after surgery.
Results: 6 Male, 1 Female patient. Mean age: 45 yo (34-54). Mean years of T2DM 5 (1-10), 2 patients were insulin users, Mean Preop BMI 28,7 (26,8-31), Postop BMI: 6 month 27,5 (27-27,9), Pre-op Fasting Blood Glucose 165 (128 – 251), Post-op Fasting Blood Glucose: 1 month 113,9 (95,5 – 130). 3 months: 129 (101-165). 6 months: 108,5 (97 – 120). Pre-op HbA1c: 8,3 (6,9 – 9,3), Post-op HbA1c: 1 month: 6,6 (5,9 – 7,5), 3 month: 6,86 (6,1 – 8,4), 6 month: 6,65 (6,2 – 7,1). No patient on insulin postop. OR time: 150 min. Morbidity: 1 duodeno-jejunal anastomotic leak resolved, gastroparesis in 2 cases (1 at 15 days post discharge, 1 during hospital stay). No mortality.
Conclusion: These early results are encouraging, showing improvement or remission of T2DM in all patients. We believe that duodenal exclusion is the main mechanism that explains these results. Although these preliminary data is very promising, as an alternative treatment for T2DM in non obese patients, longer follow-up is needed.

Session: Podium Presentation

Program Number: S007

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