Laparoscopic Ileal Interposition (ii) With Diverted Sleeve Gastrectomy (dsg) Is Very Effective for Metabolic Disorders

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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