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Does Reconstruction Type After Gastric Resection Matters for Type 2 Diabetes Improvement?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Gastrointestinal (GI) surgery involving gastric resection and bypass of intestinal segments was reported to facilitate glucose control in obese patients with type 2 diabetes (T2D).

Aim

Our aim was to assess whether the type of post-gastrectomy GI reconstruction also influences glucose control in T2D patients with BMI below 35 kg/m2 submitted to gastrointestinal surgery without bariatric intention.

Methods

A cohort of T2D Caucasian patients (n = 40) with upper GI malignancy (n = 33) or complicated reflux disease (n = 7) were submitted to either a gastrectomy plus Billroth II (BII) gastrojejunal anastomosis (n = 17), a gastrectomy plus Roux-en-Y gastrojejunostomy (RY) reconstruction (n = 18; subtotal gastrectomy n = 7 and total gastrectomy n = 11), or atypical gastrectomy without reconstruction (no-R) (n = 5). Patients were evaluated before and 2 years after surgery for body weight, Hb1Ac, need of glucose lowering drugs, and presence of diabetes.

Results

Body mass index (BMI) decreased after every surgical procedure when compared to baseline (− 0.9 ± 0.8 kg/m2 for BII vs − 4.3 ± 2.6 kg/m2 for RY vs − 4.6 ± 2.5 kg/m2 for no-R, p < 0.05), which was only significantly different after RY surgeries. Diabetes remission occurred in 5.9% of BII patients, in 27.8% of RY patients, and 0% of no-R patients, while in patients with persistent T2D, the needs for glucose-lowering drugs were significantly also decreased after RY (31.3% BII vs 66.7% RY vs 25% no-R, p = 0.03).

Conclusions

T2D Caucasian patients undergoing post-gastrectomy GI reconstructions without a bariatric intention experience a significant improvement of T2D, in a magnitude that could be influenced by the technical procedure performed in favor of RY reconstruction. Thus, presence of T2D should be taken into consideration when deciding for the type of post-gastrectomy GI reconstruction.

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Abbreviations

BMI:

Body weight index

BII:

Billroth II

GLP-1:

Glucagon-like peptide-1

HbA1c:

Glycated hemoglobin A1c

RY:

Roux-en-Y reconstruction

T2D:

Type 2 diabetes

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Author information

Authors and Affiliations

  1. Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Hospital São Sebastião, Rua Dr. Cândido de Pinho, Santa Maria da Feira, Portugal

    Mariana Costa, Artur Trovão Lima, Rui F. Almeida, Mário Nora & Marta Guimarães

  2. Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal

    Tiago Morais, Mário Nora, Marta Guimarães & Mariana P. Monteiro

  3. Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal

    Marta Guimarães & Mariana P. Monteiro

Authors
  1. Mariana Costa
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  2. Artur Trovão Lima
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  4. Rui F. Almeida
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  5. Mário Nora
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  7. Mariana P. Monteiro
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Contributions

Mariana Costa was responsible for the data acquisition and by writing the manuscript; Marta Guimarães was responsible for the conception of the work and revising it critically; Mário Nora and Mariana P. Monteiro were responsible for drafting the work and revising it critically; Tiago Morais was responsible for analysis and interpretation of data; Trovão Lima, Rui Almeida, Marta Guimarães, and Mário Nora were the surgeons responsible for performing all surgical procedures

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Correspondence to Marta Guimarães.

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Supplementary Figure S1

–Duration of follow-up (time since surgery in years) for each type of surgical procedure. (PDF 89 kb)

Supplementary Figure S2

– Percentage of patients with diabetes remission vs persistent diabetes (%) submitted either to Partial or Total gastrectomy followed by Roux-en-Y Reconstruction. (PDF 87 kb)

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Costa, M., Trovão Lima, A., Morais, T. et al. Does Reconstruction Type After Gastric Resection Matters for Type 2 Diabetes Improvement?. J Gastrointest Surg 24, 1269–1277 (2020). https://doi.org/10.1007/s11605-019-04255-4

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  • DOI: https://doi.org/10.1007/s11605-019-04255-4

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