Essa M Aleassa, MD, Monique Hassan, MD, Kellen Hayes, MD, Stacy Brethauer, MD, Philip R Schauer, MD, Ali Aminian, MD. Bariatric and Metabolic Center, DDI, Cleveland Clinic OH
Introduction: Bariatric surgery significantly improves type 2 diabetes. However, a small percentage of patients after bariatric surgery either have persistent hyperglycemia, or relapse after initial remission of their diabetes. These patients are usually managed with anti-diabetic medications. There is limited data on the antidiabetic effects of revisional bariatric surgery. The aim of this study was to evaluate the effect of revisional surgery on the glycemic status of diabetic patients who either failed to remit or relapsed after an initial remission following bariatric surgery.
Methods: Metabolic parameters and clinical outcomes of 123 patients with persistent or relapsed diabetes at the time of revisional bariatric surgery at an academic center between 2008 and 2014 were assessed. Diabetes remission was defined as glycated hemoglobin (HbA1c) <6.5% and fasting blood glucose (FBG) <126 mg/dL off diabetes medications. Diabetes improvement was defined as significant reduction in HbA1c (by >1%), FBG (by >25 mg/dL), or reduction in HbA1c and FBG accompanied by decrease in antidiabetic medications requirement.
Results: Weight recidivism was the most common indication for revisional surgery (n=94, 66%), followed by gastroesophageal reflux disease (n=17, 12%), and gastric fistula (n=14, 10%). The most common types of revisional surgery were pouch and/or stoma revision of Roux-en-Y gastric bypass (RYGB) (n=29, 24%), conversion of vertical banded gastroplasty (VBG) to RYGB (n=23, 19%), conversion of sleeve gastrectomy (SG) to RYGB (n=19, 15%), and conversion of adjustable gastric banding (AGB) to RYGB (n=18, 15%). In terms of BMI changes (kg/m2) after revisional surgery, BMI reduction of 5.8±0.9 after RYGB pouch and/or stoma revision, 9.5±2.5 after conversion of VBG to RYGB, 4.6±0.6 after conversion of SG to RYGB, and 10.6±1.8 after conversion of AGB to RYGB were observed. Revision of the gastric pouch and/or stoma in RYGB yielded improvement of diabetes in 69% of patients and remission in 25%. Conversion to RYGB yielded improvement of diabetes in 70%, 28%, and 58% of patients who previously had VBG, SG or AGB, respectively. Furthermore, conversion of VBG, SG, and AGB to RYGB was associated with diabetes remission rates of 6%, 27%, and 27%, respectively.
Conclusion: Findings of this study, which is the largest series to date, indicate that revisional surgery in patients with persistent or relapsed diabetes after bariatric surgery can significantly improve the glucose control. Further clinical and mechanistic studies are needed to better demonstrate the role of revisional bariatric surgery in patients with residual diabetes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88433
Program Number: S043
Presentation Session: Bariatrics 2 Session
Presentation Type: Podium