, Volume 19, Issue 3, pp 307-312

Laparoscopic Duodenal–Jejunal Exclusion in the Treatment of Type 2 Diabetes Mellitus in Patients with BMI < 30 kg/m2 (LBMI)

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Abstract

Background

The association between medical and dietetic–behavioral treatments of type 2 diabetes mellitus (T2DM) has demonstrated to have variable results. The surgical treatment of T2DM is justifiable after the observation of a successful glycemic control in patients submitted to Roux-en-Y gastric bypass and biliopancreatic diversion. Experiments have shown an important role of the proximal intestine in glycemia decrease and diabetes control.

Methods

Twenty diabetic patients underwent laparoscopic duodenal–jejunal exclusion. The variables studied were body mass index (BMI), fasting glycemia, glycosylated hemoglobin (HbA1c), and C-peptide, in the preoperative period and after 3 and 6 months.

Results

There was a BMI decrease up to the third month and a weight stabilization between the third and sixth months. There was a significant reduction in fasting glycemia (43.8%) and HbA1c (22.8%) up to the sixth month (p < 0.001). C-peptide did not show any significant alteration until the third month, although there was a considerable increase (25%) between the third and the sixth months (p < 0.001). Only two patients were on oral medication after the sixth month.

Conclusions

Preliminary results have shown an important effect of the laparoscopic duodenal–jejunal exclusion in the treatment of T2DM. Studies with longer follow-up and a larger number of patients are necessary to better define the role of this new and promising procedure.

Dr. Almino Ramos and Dr. Manoel P. Galvão Neto are international consultants for Ethicon Endo-Surgery® and GI Dynamics®.