Thursday, 2 August 2012

Laparoscopic sleeve gastrectomy

Laparoscopic sleeve gastrectomy with ileal interposition sent diabetes into remission in 20 of 43 adults and reduced the need for diabetes medications in the other 23 patients during an average of 20 months of follow-up.

Among the 30 obese (defined as having a body mass index greater than 27 kg/m2) patients in the study, 26 showed remission of diabetes – an 86% success rate that’s similar to results reported for gastric bypass surgery, Dr. Kirtikumar D. Modi said in a press briefing at the annual meeting of the Endocrine Society.
Laparoscopic diverted sleeve gastrectomy diverts food away from parts of the small intestine, including the duodenum, where the absorption of nutrients begins, and the ileal segment is shifted more proximally. Patients who underwent this procedure had had diabetes for 15 years on average, and they had an average BMI of 29 as well as stimulated C-peptide levels greater than 4 ng/mL.
At 9 months after surgery, diabetes was in remission in 12 (70%) of the 17 patients, and the other 5 patients needed fewer oral hyperglycemic medications than did those in the first series.
All patients in both studies had poorly controlled diabetes. The investigators defined diabetes remission as a hemoglobin A1c level less than 6.5% and no further need for insulin or oral hypoglycemic agents.
The reduction in hemoglobin A1c was disproportionately greater than the decline in BMI, suggesting benefits that are "much more than the weight improvement," he said.
More complications were seen in the second series, including three patients with minor intraoperative complications. Another patient developed ileus with ileal perforation 2 weeks after surgery and underwent laparotomy for repair. Three patients experienced nausea and anorexia for 2 weeks. Two patients developed vitamin B12 deficiency at 12 months.
source:http://www.internalmedicinenews.com/news/diabetes-endocrinology-metabolism/single-article/modified-bariatric-surgery-tames-diabetes-in-small-series/793ee9bd8fa374d3737a787d0156a961.html

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