Surendra Ugale, MS, Neeraj Gupta, MBBS, Vishwas Naik, MS, Kd Modi, MD, Sunil Kota, DNB. Kirloskar Hospital and Medwin Hospitals, Hyderabad, Andhra Pradesh, India
Aim- To evaluate the results of Laparoscopic Ileal Interposition (II) with diverted sleeve gastrectomy (DSG) (II+DSG) for control of type 2 diabetes (T2DM) and related metabolic abnormalities, with weight reduction without causing malabsorption.
Methods- Sixteen (M: F=11:5) patients were selectively subjected to II+DSG, based on their adverse baseline clinical profiles like duration of diabetes > 5-10 years, lower BMIs, poorer basal and stimulated C-peptide response, strong family history of T2DM, requirement of maximum dosages ≥ 3 OHAs and/or Insulin, presence of end organ impairment. Patients had mean age of 50.9 ± 8.3 years (range 34-64 years), duration of diabetes 15.1± 5.8 years (range- 9 to 32 years). All had poorly controlled T2DM (mean HbA1c- 10.1 ± 2.8 %) despite medication. 7 (44%) patients had hypertension, 6 (37%) had dyslipidemia and 6 (37%) had microalbuminuria. The primary outcome was remission of diabetes (HbA1C < 6.5% without OHAs/ Insulin) and secondary outcomes were changes in OHA requirement and components of metabolic syndrome.
Results- Table 1 shows results of II+DSG. Mean follow up was 8.5 ± 5.5 months (range: 1-18 months). Results are in table 1. 11 patients (69 %) had remission in diabetes and others showed significant reduction in medication. 6 patients (85.7 %) had remission in hypertension. There was a significantly declining trend in both lipids and microalbuminuria.
Conclusions- Laparoscopic II+DSG seems to be a very promising procedure for control of Type 2 DM. Amongst the Baraitric operations which are now finding their use in remission of diabetes, Ileal interposition stands alone as a procedure devised specifically for remission of Diabetes. This procedure is especially meant for bringing about remissions in patients with low C-Peptides, Strong family history of diabetes, rapidly increasing insulin requirements, Microalbuminuria and Dyslipidemia. This is achieved without significant issues of nutrient malabsorption , post operative dumping, intractable hypoglycemia and pancreatic exhaustion.
Table 1: Postoperative follow up data of 16 patients. Data expressed as Mean ± SD.
| Parameter ————— Months | BMI (kg/m2) | FBS(mg%) | PLBS(mg%) | HbA1C (%) | Total Cholest(mg%) | LDL-Chol (mg%) | HDL-Chol | TriGly(mg%) | Micralb.(mg/24hr) |
| Pre-op | 28.8± 7.5 | 243.2 ± 92.5 | 310.8 ±133.1 | 10.1±1.9 | 175. 2±47.3 | 107± 36.9 | 40.3 ± 7.9 | 195.3 ± 87.5 | 40.2± 23.9 |
| 3 mths | 23.7± 3.5* | 100.6 ±37.8* | 156.5 ± 34.6* | 7.4± 0.5* | 151.6 ± 14.7* | 93.5± 15.8* | 44.3 ± 2.5* | 140.3 ± 13.2* | 28.3± 16.8* |
| 6 mths | 22.1± 3.8* | 147.4 ± 28.4* | 136 ±32.4* | 6.9± 0.5* | 145.5 ± 40.5* | 85 ± 35.8 * | 42.5 ± 5.2* | 98.2 ± 41.3* | 32.9± 52.5* |
| 12 mths | 21.4± 2.4* | 99.4± 17.8* | 138.4 ±38.9* | 6.5± 0.6* | 134.7 ±28.2* | 85.6±15.2* | 47.7 ±5.9* | 85.6 ±15.1* | 17.5 ±7.7* |
| 18 mths | — | 114# | 134# | 6.4# | 180# | 94# | 46# | 130# | 10# |
*P < 0.05, statistically significant
# Only single patient has completed 18 mths follow up, so no SD could be calculated
Session Number: Poster – Poster Presentations
Program Number: P506
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