Sleeve Gastrectomy with Jejunal Bypass for the Treatment of Type 2 Diabetes Mellitus in Patients with Body Mass Index <35 kg/m 2. A cohort study
First Online: 19 April 2012 DOI:
10.1007/s11695-012-0652-x Cite this article as: Alamo, M., Sepúlveda, M., Gellona, J. et al. OBES SURG (2012) 22: 1097. doi:10.1007/s11695-012-0652-x Abstract
The objective of this study was to evaluate sleeve gastrectomy with jejunal bypass (SGJB) as a surgical treatment for type 2 diabetes mellitus (T2DM) in patients with a body mass index (BMI) <35 kg/m
2. This is a prospective cohort study. Patients with T2DM and BMI <35 kg/m 2 who underwent SGJB between January 2009 and June 2011 at DIPRECA Hospital, in Santiago, and Hospital Base, Osorno, Chile were included. SGJB consists of creating a gastric tube, which preserves the pylorus, and performing a jejunoileal anastomosis 300 cm distal to the angle of Treitz. Excess weight loss (EWL) and complete or partial remission of T2DM were reported. Forty-nine patients met the inclusion criteria. The mean age was 49 years (36–62), and 53 % of patients were female. Mean preoperative BMI was 31.6 kg/m 2 (25–34.9 kg/m 2). Operation time was 123 ± 14 min, with 94.7 % of operations performed laparoscopically. Mean postoperative hospital stay was 2 days. Mean postoperative follow-up was 12 months. Median EWL at 1, 3, 6, 12, and 18 months postoperatively was 31.9 %, 56.9 %, 76.1 %, 81.5 %, and 76.1 %, respectively. Complete T2DM remission was achieved in 81.6 % of patients (40/49) and partial remission in 18.4 % (9/49). Forty of 41 patients (97.6 %) on oral hypoglycemic agents achieved complete T2DM remission, and 100 % of insulin-dependent patients stopped using insulin but were still being treated for T2DM. One patient experienced postoperative gastrointestinal bleeding. There were no deaths. SGJB is an effective treatment for T2DM in patients with BMI <35 kg/m 2. Keywords Bariatric surgery Obesity surgery Type 2 diabetes mellitus Body mass index Metabolic surgery Sleeve gastrectomy Jejunal bypass Cohort studies New technique References
Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–52.
MacDonald Jr KG, Long SD, Swanson MS, et al. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg. 1997;1(3):213–20 (discussion: 220).
Ferchak CV, Meneghini LF. Obesity, bariatric surgery and type 2 diabetes—a systematic review. Diabetes Metab Res Rev. 2004;20:438–45.
Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.e5.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
Padwal RS. Review: bariatric surgery reduces weight and improves type 2 diabetes in adults. Evid Based Med. 2009;14(5):138.
Fried M, Ribaric G, Buchwald JN, et al. Metabolic surgery for the treatment of type 2 diabetes in patients with BMI <35 kg/m
: an integrative review of early studies. Obes Surg. 2010;20:776–90.
Peterli R, Wölnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250(2):234–41.
DePaula A, Stival A, Halpern A, et al. Surgical treatment of morbid obesity: mid-term outcomes of the laparoscopic ileal interposition associated to a sleeve gastrectomy in 120 patients. Obes Surg. 2011;21(5):668–75.
Alamo M, Sepúlveda C, Zapata L. Vertical isolated gastroplasty with gastro-enteral bypass: preliminary results. Obes Surg. 2006;16(3):353–8.
de Menezes Ettinger JE, Azaro E, Mello CA, et al. Analysis of the vertical isolated gastroplasty: a new bariatric operation. Obes Surg. 2006;16(9):1261–3; author reply 1263–4.
Vandenbroucke JP, von Elm E, Altman DG, et al. STROBE initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147:W163–94.
STROBE Statement. Strengthening the Reporting of Observational studies in Epidemiology.
. Accessed 6 Apr 2011.
American Diabetes Association Position Statement. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33 Suppl 1:S62–9.
Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Reviews/commentaries/ADA statements consensus statement. Diabetes Care. 2009;32:2133–5.
Robinson JD, Lupkiewicz SM, Palenik L, et al. Determination of ideal body weight for drug dosage calculations. Am J Hosp Pharm. 1983;40(6):1016–9.
Bayliss WM, Starling EH. The mechanism of pancreatic secretion. Proc R Soc Lond Biol. 1902;69:352–3.
Elrick H, Stimmler L, Hlad Jr CJ, et al. Plasma insulin response to oral and intravenous glucose administration. J Clin Invest. 1964;24:1076–82.
Neumiller JJ. Differential chemistry (structure), mechanism of action, and pharmacology of GLP-1 receptor agonists and DPP-4 inhibitors. J Am Pharm Assoc (2003). 2009;49(Suppl 1):S16–29.
La Barre J. Sur les possibilités d'un traitement du diabetes par l'incrétine. Bull Acad R Med Belg. 1932;12:620–34.
Miller LJ, Malagelada JR, Taylor WF, et al. Intestinal control of human postprandial gastric function: the role of components of jejunoileal chyme in regulating gastric secretion and gastric emptying. Gastroenterology. 1981;80:763–9.
Layer P, Holst JJ, Grandt D, et al. Ileal release of glucagon-like peptide-1 (GLP-1). Association with inhibition of gastric acid secretion in humans. Dig Dis Sci. 1995;40:1074–82.
Bose M, Oliván B, Teixeira J, et al. Do incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: what are the evidence? Obes Surg. 2009;19(2):217–29.
Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract. 2008;14 Suppl 1:1–83.
Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146(2):143–8.
Nocca D, Guillaume F, Noel P, et al. Impact of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on HbA1c blood level and pharmacological treatment of type 2 diabetes mellitus in severe or morbidly obese patients. Results of a multicenter prospective study at 1 year. Obes Surg. 2011;21(6):738–43.
Gill RS, Birch DW, Shi X, et al. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis. 2010;6(6):707–13.
Cohen RV, Schiavon CA, Pinheiro JS, et al. Duodenaljejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22–34 kg/m2: a report of two cases. Surg Obes Relat Dis. 2007;3:195–7.
DePaula AL, Macedo AL, Mota BR, et al. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21-29. Surg Endosc. 2009;23(6):1313–20.
Tinoco A, El-Kadre L, Aquiar L, et al. Short-term and mid-term control of type 2 diabetes mellitus by laparoscopic sleeve gastrectomy with ileal interposition. World J Surg. 2011;35(10):2238–44.
Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239(1):1–11.
Rubino F, Forgione A, Cummings D, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244:741–9.
Rodriguez L, Reyes E, Fagalde P, et al. Pilot clinical study of an endoscopic, removable duodenal-jejunal bypass liner for the treatment of type 2 diabetes. Diabetes Technol Ther. 2009;11(11):725–32.
Gersin KS, Keller JE, Stefanidis D, et al. Duodenal-jejunal bypass sleeve: a totally endoscopic device for the treatment of morbid obesity. Surg Innov. 2007;14:275–8.
Rodriguez-Grunert L, Neto MPG, Alamo M, et al. First human experience with endoscopically delivered and retrieved duodenal-jejunal by-pass sleeve. Surg Obes Relat Dis. 2008;4:55–9.
Boza C, Muñoz R, Yung E, et al. Sleeve gastrectomy with ileal transposition (SGIT) induces a significant weight loss and diabetes improvement without exclusion of the proximal intestine. J Gastrointest Surg. 2011;15(6):928–34.
Cable CT, Colbert CY, Showalter T, et al. Prevalence of anemia after Roux-en-Y gastric bypass surgery: what is the right number? Surg Obes Relat Dis. 2011;7(2):134–9.
Simon SR, Zemel R, Betancourt S, et al. Hematologic complications of gastric bypass for morbid obesity. South Med J. 1989;82:1108–10.
Alvarez-Cordero R, Aragon-Viruette E. Post-operative complications in a series of gastric bypass patients. Obes Surg. 1992;2:87–9.
Halverson JD. Micronutrient deficiencies after gastric bypass for morbid obesity. Am Surg. 1986;52:594–8.
Loss AB, de Souza AA, Pitombo CA, et al. Analysis of the dumping syndrome on morbid obese patients submitted to Roux en Y gastric bypass. Rev Col Bras Cir. 2009;36(5):413–9.
Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978–90.
Quigley E, Abu-Shanab A. Small intestinal bacterial overgrowth. Infect Dis Clin N Am. 2010;24:943–59.
Greco M, De Micheli E, Lonardo A. Multifactorial hepatopathy in a patient with biliopancreatic diversion. Ann Ital Med Int. 2003;18(2):99–103. Italian.
Papadia F, Marinari GM, Camerini G, et al. Short-term liver function after biliopancreatic diversion. Obes Surg. 2003;13(5):752–5.
Riordan SM, McIver CJ, Williams R. Liver damage in human small intestinal bacterial overgrowth. Am J Gastroenterol. 1998;93(2):234–7.
Reinshagen K, Zahn K, Buch C, et al. The impact of longitudinal intestinal lengthening and tailoring on liver function in short bowel syndrome. Eur J Pediatr Surg. 2008;18(4):249–53.
Martin GR, Beck PL, Sigalet DL. Gut hormones, and short bowel syndrome: the enigmatic role of glucagon-like peptide-2 in the regulation of intestinal adaptation. World J Gastroenterol. 2006;12(26):4117–29.
Hartmann B, Thulesen J, Hansen BS, et al. Elevated plasma glucagon-like peptide 1 and 2 concentrations in ileum resected short bowel patients with a preserved colon. Gut. 2000;47:370–6.
Santoro S, Milleo FQ, Malzoni CE. Enterohormonal changes alter digestive adaptation: five-year results of a surgical proposal to treat obesity and associated diseases. Obes Surg. 2008;18(1):17–26.
PubMed CrossRef Copyright information
© Springer Science + Business Media, LLC 2012