Abstract
Background
The objective of this study was to evaluate the early results of the laparoscopic interposition of a segment of ileum associated with a sleeve gastrectomy (LII-SG) in order to treat patients with type 2 diabetes mellitus (T2DM) and BMI <35. Data regarding morbidly obese diabetic patients subjected to surgery has consistently been validated. To date, there is scarce information about morbidity and mortality related to the surgical treatment of a “true” typical diabetic population with BMI <35.
Methods
The procedures were performed in 454 patients (322 male, 132 female). Mean age was 53.6 ± 8 years (range = 27–75). Mean BMI was 29.7 ± 3.6 kg/m2 (range = 19–34.8). All patients had the diagnosis of T2DM for at least 3 years. Insulin therapy was used by 45.6% of patients. Mean duration of T2DM was 10.8 ± 5.9 years (range = 3–35). Mean hemoglobin A1c was 8.8 ± 1.9%. Dyslipidemia was observed in 78.4%, hypertension in 64.8%, nephropathy in 28.6%, retinopathy in 32.6%, neuropathy in 34.6%, and coronary heart disease in 13%.
Results
There was no conversion to open surgery. All patients were evaluated postoperatively. Mortality was 0.4%. There were 29 major complications (6.4%) in 22 patients (4.8%) and 51 minor complications (11.2%). Reoperations were performed on 8 patients (1.7%). Twenty patients (4.4%) were readmitted to the hospital. Mean postoperative BMI was 25.8 ± 3.5 kg/m2. Mean fasting plasma glucose decreased from 198 ± 69 to 128 ± 67 mg/dl and mean postprandial plasma glucose decreased from 262 ± 101 to 136 ± 43 mg/dl.
Conclusions
The laparoscopic ileal interposition associated with a sleeve gastrectomy was considered a safe operation with low rates of morbidity and mortality in a diabetic population with BMI < 35. An early control of postprandial glycemia was observed.
Similar content being viewed by others
References
Wingard DL, Barrett-Connor EL (1995) Heart disease and diabetes. In: Harris MI, Cowie CC, Stern MP, Boyko EJ, Rieber GE, Bennett PH (eds), Diabetes in America, 2nd edn. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, pp 429-448, NIH Publ. No. 95-1468
Gu K, Cowie CC, Harris MI (1999) Diabetes and decline in heart disease mortality in US adults. JAMA 281:1291–1297
Fox CS, Coady S, Sorlie PD et al (2007) Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart Study. Circulation 115:1544–1550
Chan JCN, Malik V, Jia W et al (2009) Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA 301:2129–2140
American Diabetes Association (2009) Standards of Medical Care in Diabetes—2009. Diabetes Care 32(Suppl 1):S13–S61
Lago RM, Singh PP, Nesto RW (2007) Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis of randomized clinical trials. Lancet 370:1129–1136
ACCORD Study Group (2008) Effects of intensive glucose lowering in type 2 diabetes. The Action to Control Cardiovascular Risk in Diabetes Study Group. New Engl J Med 358:2545–2559
Lancaster RT, Hutter MM (2008) Bands and bypasses: 30-day morbidity and mortality of bariatric surgery procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc 22(12):2554–2563
Yusuf S, Hawken S, Ôunpuu S, on behalf of the INTERHEART Study Investigators (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries: case-control study. Lancet 364:937–952
Song SH, Hardisty CA (2008) Type 2 diabetes mellitus: a high-risk condition for cardiovascular disease irrespective of the different degrees of obesity. QJM 101:875–879
DePaula AL, Macedo ALV, Rassi N et al (2008) Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35. Surg Endosc 22:706–716
Khuri SF, Daley J, Henderson W et al (1995) The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg 180:519–531
Turner RC, Cull CA, Frighi V et al (1999) Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with T2DM mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA 281(21):2005–2012
Buchwald H, Estok R, Fahrbach K et al (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122:248–256
Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737
Dimick JB, Cowan JA Jr, Colletti LM et al (2004) Hospital teaching status and outcomes of complex surgical procedures in the United States. Arch Surg 139:137–141
Guzder RN, Gatling W, Mullee MA et al (2007) Early mortality from the time of diagnosis of type 2 diabetes: a 5-year prospective cohort study with a local age- and sex-matched comparison cohort. Diabet Med 24(10):1164–1167
Gregg EW, Qiuping G, Cheng YJ et al (2007) Mortality trends in men and women with diabetes, 1971 to 2000. Ann Intern Med 147:149–155
Fucks D, Verhaeghe P, Brehant O et al (2009) Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery 145(1):106–113
Tan JR, Kariyawasam S, Wijeratne T et al (2010) Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 20:403–409
Dapri G, Cadiere GM, Himpens J (2010) Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg 20:462–467
Clinical Issues Committee of the American Society for Metabolic, Bariatric Surgery (2010) Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 6:1–5
Gagner M, Deitel M, Kalberer TL et al (2009) The second international consensus summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis 5:476–485
DePaula AL, Macedo AL, Rassi N et al (2008) Laparoscopic treatment of metabolic syndrome in patients with type 2 diabetes mellitus. Surg Endosc 22:2670–2678
DePaula AL, Macedo AL, Schraibman V et al (2009) Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20–34. Surg Endosc 23:1724–1732
DePaula AL, Stival AS, Macedo A et al (2010) Prospective randomized controlled trial comparing 2 versions of laparoscopic ileal interposition associated with sleeve gastrectomy for patients with type 2 diabetes with BMI 21–34 kg/m2. Surg Obes Relat Dis 6:296–304
Holst JJ (2007) The physiology of glucagon-like peptide 1. Physiol Rev 87(4):1409–1439
Muscelli E, Mari A, Casolaro A et al (2008) Separate impact of obesity and glucose tolerance on the incretin effect in normal subjects and type 2 diabetic patients. Diabetes 57(5):1340–1348
Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) Study Group (1999) Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet 354:617–621
Acknowledgment
The authors thank and acknowledge the excellent assistance of Dr. Luiz Fernando Martins in reviewing the data.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
DePaula, A.L., Stival, A., Halpern, A. et al. Thirty-Day Morbidity and Mortality of the Laparoscopic Ileal Interposition Associated with Sleeve Gastrectomy for the Treatment of Type 2 Diabetic Patients with BMI <35: An Analysis of 454 Consecutive Patients. World J Surg 35, 102–108 (2011). https://doi.org/10.1007/s00268-010-0799-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-010-0799-3