Preliminary experience on surgical treatment of T2DM: SADI-S procedure

Erhun Eyuboglu, MD, Professor, Turgut Ipek, MD, Professor. Istanbul Kemerburgaz Univ. Medical Faculty

In two years period (2013 – 2015) 22 patients with type II diabetes were operated on. 13 of them were male and 9 of them were female.Mean age was 40,9 (between 30 – 65 years of age) BMI was lower than 30 kg/m 2?  in the non obese 9 patients.Other 13 patient’s BMI were between 35 kg/ m 2 -? 42 kg/m  2? .?? For this procedure patients were selected based on some criteria (DRS- Diabetes remission score ) such as age, duration of diabetes ,use of insulin ,BMI , micro and macrovasculer complications and stimulated C-peptide. Duration of diabetes is less than 10 years in all of the patients.18 of the patients have been using different type of insulin,4 of the patients have been using oral antidiabetic drugs.   Preoperative upper GI endoscopy, HbA1c levels,  C peptide, blood sugar levels ( fasting, postprandial ), insulin levels, HOMA-IR, ICA, IAA have been done routinely.For remission of type II diabetes Single anastomosis duodeno-ileal by pass + sleeve gastrectomy ( SADI -S ) procedure have been done in all of the patients. In French position we used five trocars ( 3of them 10-12 mm, 2 of them 5 mm. Covidien versaport). After 36F-38F calibrated sleeve gastrectomy (Covidien endoGIA purple Tristaple ) 2cm.below from pylorus duodenum transsected with linear stapler (purple). A distal ileal segment of 250 cm. from ileocecal valv was brought up to the duodenal level and hand-sewn end to side duodenoileostomi has created by using double layer technique with 3/0 suture materials. Methylené blue test has been done routinely.4 -5 day after operation patients discharged.In the first week after the operation , 40,9% of patients had remission of diabetes. After a year the remission rate had increased  89,7 %. These patients have stopped oral antidiabetics and insulin usage. As a conclusion in selected cases SADI-S procedure is a good operation of choice based on hindgut  theory (early activation of GLP-1) .It causes successful diabetic remission and some weight loss in obese patients. But further multicenter studies of patients from various  country are required to confirm our preliminary results.




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