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Laparoscopic Selective Intra-abdominal Denervation associated to a Duodenum Ileal Interposition and Sleeve Gastrectomy for the treatment of Type 2 Diabetes (SID-DISG)

Luciana J El-Kadre, MD, PHD, FACS1, Aureo L De Paula, MD, PHD2, Augusto C Tinoco, MD, PHD, FACS1, Surendra Ugale, MD3, Jose Ribamar De Azevedo, MD, PHD, FACS4, Carolina De Paula, MD2, Leonardo Ferraz, MD5. 1Sao Jose do Avai Hospital, 2Hospital de Especialidades, 3Kirloskar Hospital, 4Americas Hospital, 5Bonsucesso Federal Hospital

No single medication can approach all the pathophysiologic disturbances that characterize type 2 diabetes (T2D). Current medical therapy involves the combined use of multiple drugs to control the disease. With this concept in mind, the laparoscopic duodenum ileal interposition and sleeve gastrectomy (DISG) is an operation that intends to address the different components of the pathophysiology of T2D. The objective of this study is to evaluate the early results of this operation combined with a selective intra-abdominal denervation in diabetic patients with BMI below 35.The procedure was performed in 33 patients. 29 were men and 4 women. Mean age was 56.3 years (34-71). Mean BMI was 32.2 kg/m2 (26.7-34.9). All patients had evidence of stable treatment with oral hypoglycemic agents and or insulin for at least 12 months. Insulin therapy was been used by 36% of the patients. Mean duration of T2DM was 11.4 years (4-32). Mean A1c was 9%. Coronary heart disease was diagnosed in 27.3, hypertension in 72.7, dyslipidemia in 94, retinopathy in 24.2, nephropathy in 24.2 and cholelithiasis in 18.2% of the patients.Mean post-operative follow-up was 22 months (9-33). Mean postoperative BMI was 23.3kg/m2(19.6-27). Mean A1c was 5.8%, ranging 4.6 to 8. Overall, 87.9% of the patients achieved an adequate glycemic control (A1c≤6) without anti-diabetic medication and 83.3% had fasting glucose < 126mg/dl. Arterial hypertension was controlled in 95.8% of the patients, hypercholesterolemia in 96.8%, and hypertrygliceridemia in 93.1%. The results of this short-term study demonstrated that the combination of a selective intra-abdominal denervation to the laparoscopic DISG improved the glycemic, hypertensive and dyslipidemic remission rates of T2D patients with BMI below 35. The scalpel seems to be an effective tool in controlling diabetes using the concept of an endocrine-based, pathophysiological, understanding of the disease.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95566

Program Number: P104

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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