Skip to main content


Log in

Laparoscopic treatment of metabolic syndrome in patients with type 2 diabetes mellitus

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript



Metabolic syndrome refers to risk factors for cardiovascular disease. Hyperglycemia is a critical component contributing to the predictive power of the syndrome. This study aimed to evaluate the results from the laparoscopic interposition of an ileum segment into the proximal jejunum for the treatment of metabolic syndrome in patients with type 2 diabetes mellitus and a body mass index (BMI) lower than 35.


Laparoscopic procedures were performed for 60 patients (24 women and 36 men) with a mean age of 51.7 ± 6.4 years (range, 27–66 years) and a mean BMI of 30.1 ± 2.7 (range, 23.6–34.4). All the patients had a diagnosis of type 2 diabetes mellitus (T2DM) given at least 3 years previously and evidence of stable treatment using oral hypoglycemic agents, insulin, or both for at least 12 months. The mean duration of type 2 diabetes mellitus was 9.6 ± 4.6 years (range, 3–22 years). Metabolic syndrome was diagnosed for all 60 patients. Arterial hypertension was diagnosed for 70% of the patients (mean number of drugs, 1.6) and hypertriglyceridemia for 70%. High-density lipoprotein was altered in 51.7% of the patients and the abdominal circumference in 68.3%. Two techniques were performed: ileal interposition (II) into the proximal jejunum and sleeve gastrectomy (II-SG) or ileal interposition associated with a diverted sleeve gastrectomy (II-DSG).


The II-SG procedure was performed for 32 patients and the II-DSG procedure for 28 patients. The mean postoperative follow-up period was 7.4 months (range, 3–19 months). The mean BMI was 23.8 ± 4.1 kg/m2, and 52 patients (86.7%) achieved adequate glycemic control. Hypertriglyceridemia was normalized for 81.7% of the patients. An high-density lipoprotein level higher than 40 for the men and higher than 50 for the women was achieved by 90.3% of the patients. The abdominal circumference reached was less than 102 cm for the men and 88 cm for the women. Arterial hypertension was controlled in 90.5% of the patients. For the control of metabolic syndrome, II-DSG was the more effective procedure.


Laparoscopic II-SG and II-DSG seem to be promising procedures for the control of the metabolic syndrome and type 2 diabetes mellitus. A longer follow-up period is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others


  1. Reaven GM (1988) Banting lecture 1988: role of insulin resistance in human disease. Diabetes 37:1595–1607

    Article  PubMed  CAS  Google Scholar 

  2. Alexander CM, Landsman PB, Teutsch SM, Haffner SM Third National Health and Nutrition Examination Survey (NHANES III), National Cholesterol Education Program (NCEP) (2003) NCEP-Defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes 52(5):1210–1214

  3. World Health Organization (1999) Definition, diagnosis, and classification of diabetes mellitus and its complications: report of a WHO consultation. World Health Organization, Geneva

    Google Scholar 

  4. Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the National Cholesterol Education Program (NCEP). Adult Treatment Panel III. JAMA 285:2486–2497

    Article  Google Scholar 

  5. Balkau B, Charles MA, Drivsholm T, Borch-Johnsen K, Wareham N, Yudkin JS, Morris R, Zavaroni I, van Dam R, Feskins E, Gabriel R, Diet M, Nilsson P, Hedblad B, European Group For The Study of Insulin Resistance (EGIR) (2002) Frequency of the WHO metabolic syndrome in European cohorts and an alternative definition of an insulin resistance syndrome. Diabetes Metab 28:364–376

    PubMed  Google Scholar 

  6. Einhorn D, Reaven GM, Cobin RH, Ford E, Ganda OP, Handelsman Y, Hellman R, Jellinger PS, Kendall D, Krauss RM, Neufeld ND, Petak SM, Rodbard HW, Seibel JA, Smith DA, Wilson PW (2003) American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract 9:237–252

    PubMed  Google Scholar 

  7. Ford ES, Giles WH (2003) A comparison of the prevalence of the metabolic syndrome using two proposed definitions. Diabetes Care 26:575–581

    Article  PubMed  Google Scholar 

  8. American Diabetes Association (2004) Prevention or delay of type 2 diabetes. Diabetes Care 27(Suppl 1):S47–S53

    Google Scholar 

  9. Watts NB, Spanheimer RG, DiGirolamo M, Gebhart SS, Musey VC, Siddiq YK, Phillips LS (1990) Prediction of glucose response to weight loss in patients with non-insulin-dependent diabetes mellitus. Arch Intern Med 151:198–201

    Google Scholar 

  10. Hickey MS, Pories WJ, MacDonald KG Jr, Cory KA, Dohm GL, Swanson MS, Israel RG, Barakat HA, Considine RV, Caro JF, Houmard JA (1998) A new paradigm for type 2 diabetes mellitus? Could it be a disease of the foregut? Ann Surg 227:637–644

    Article  PubMed  CAS  Google Scholar 

  11. Greenway SE, Greenway FL, Klein S (2002) Effects of obesity surgery on non-insulin-dependent diabetes mellitus. Arch Surg 137:1109–1117

    Article  PubMed  Google Scholar 

  12. De Paula AL, Macedo AL, Prudente AS, Queiroz L, Schraibman V, Pinus J (2006) Laparoscopic sleeve gastrectomy with ileal interposition (“neuroendocrine brake”): pilot study of a new operation. Surg Obes Relat Dis 2:464–467

    Article  PubMed  Google Scholar 

  13. Grundy SM, Brewer Jr B, Cleeman JI, Smith Jr. SC, Lenfant C (2004) Definition of metabolic syndrome. Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on scientific issues related to definition. Circulation 109:433–438

    Article  PubMed  Google Scholar 

  14. Scopinaro N, Papadia F, Marinari G, Camerini G, Adami G (2007) Long-term control of type 2 diabetes mellitus and the other components of the metabolic syndrome after biliopancreatic diversion in patients with BMI <35 kg/m2. Obes Surg 17:185–192

  15. Zhou H, Yamada Y, Tsukiyama K, Miyawaki K, Hosokawa M, Nagashima K, Toyoda K, Naitoh R, Mizunoya W, Fushiki T, Kadowaki T, Seino Y (2005) Gastric inhibitory polypeptide modulates adiposity and fat oxidation under diminished insulin action. Biochem Biophys Res Commun 335:937–942

    Article  PubMed  CAS  Google Scholar 

  16. Onat A, Ceyhan K, Basar O, Erer B, Toprak S, Sansoy V (2002) Metabolic syndrome: major impact on coronary risk in a population with low cholesterol levels: a prospective and cross-sectional evaluation. Atherosclerosis 165:285–292

    Article  PubMed  CAS  Google Scholar 

  17. Laws A, Reaven GM (1992) Evidence for an independent relationship between insulin resistance and fasting plasma HDL-cholesterol, triglyceride and insulin concentrations. J Intern Med 231:25–30

    Article  PubMed  CAS  Google Scholar 

  18. Lindholm LD, Ibsen H, Dahlof B, Devereux RB, Beever G, de Faire U, Fyhrquist F, Julius S, Kjeldsen SE, Kristiansson K, Kederballe-Pedersen O, Niemine MS, Omvik P, Oparil S, Wedel H, Aurup P, Edelman J, Snapin S (2002) Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention for Endpoint Reduction in Hypertension Study (LIFE): a randomized trial against atenolol. Lancet 359:1004–1010

    Article  PubMed  CAS  Google Scholar 

  19. UK Prospective Diabetes Study Group (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS38. BMJ 317:703–713

    Google Scholar 

  20. Stern SE, Williams K, Ferrannini E, DeFronzo RA, Bogardus C, Stern MP (2005) Identification of individuals with insulin resistance using routine clinical measurements. Diabetes 54:333–339

    Article  PubMed  CAS  Google Scholar 

  21. Ferrannini E, Balkau B (2002) Insulin: in search of a syndrome. Diabet Med 19:724–729

    Article  PubMed  CAS  Google Scholar 

  22. Kahn R, Buse J, Ferrannini E, Stern M (2005) The metabolic syndrome: time for a critical appraisal: Joint Statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 28:2289–2303

    Article  PubMed  Google Scholar 

  23. Rask E, Olsson T, Soderberg S, Holst JJ, Tura A, Pacini G, Ahrén B (2004) Insulin secretion and incretin hormones after oral glucose in nonobese subjects with impaired glucose tolerance. Metabolism 53:624–631

    Article  PubMed  CAS  Google Scholar 

  24. Ridker PM, Buring JE, Cook NR, Rifai N (2003) C-reactive protein: the metabolic syndrome and risk of incident cardiovascular events: an 8-year follow-up of 14,719 initially healthy American women. Circulation 107:391–397

    Article  PubMed  Google Scholar 

  25. Pearson TA, Mensah GA (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107:499–511

  26. Weyer C, Funahashi T, Tanaka S, Hotta K, Matsuzawa Y, Pratley RE, Tataranni PA (2000) Hypoadinoponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia. J Clin Endocrinol Metab 86:1930–1935

    Article  Google Scholar 

  27. Chandran M, Phillips SA, Ciaraldi T, Henry RR (2003) Adiponectin: more than just another fat cell hormone? Diabetes Care 26:2442–2450

    Article  PubMed  CAS  Google Scholar 

  28. Garg JP, Bakris GL (2002) Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease. Vasc Med 7:35–43

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to A. L. DePaula.

Rights and permissions

Reprints and permissions

About this article

Cite this article

DePaula, A.L., Macedo, A.L.V., Rassi, N. et al. Laparoscopic treatment of metabolic syndrome in patients with type 2 diabetes mellitus. Surg Endosc 22, 2670–2678 (2008).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: