Metabolic Outcomes of Laparoscopic Diverted Sleeve Gastrectomy with Ileal Transposition (DSIT) in Obese Type 2 Diabetic Patients.

BACKGROUND: Bariatric surgical techniques are based on mechanical restriction rather than functional restriction. Our purpose is to analyze the outcomes of diverted sleeve gastrectomy with ileal transposition (DSIT) as a mode of functional restrictive therapeutic option for class II and class III obese type 2 diabetes mellitus patients. METHODS: A retrospective analysis was performed on data derived from 159 patients with type 2 diabetes mellitus who underwent DSIT between October 2011 and January 2014. Postoperative changes in body mass index (BMI), HbA1c, cholesterol indexes, and triglycerides, as well as complications and mortality rates, were noted and analyzed. RESULTS: The study group consisted of 88 females and 73 males, with a mean age of 51.8 years. Mean duration of hospital stay was 6.4 (range, 4 to 42) days; mean follow-up was 18.3 months, and no mortality was detected. Mean BMI decreased from 39.33 to 25.51 kg/m(2) (excess BMI loss rate was 75.4 %, p < 0.001). Mean fasting glucose level decreased from 189.8 to 123.5 mg/dl (p < 0.001), and mean postprandial glucose level decreased from 246.1 to 179.4 mg/dl (p < 0.01). Mean HbA1c decreased from 9.24 to 6.14 % 1 year after surgery (p < 0.001). Overall, 88.68 % of patients were off antidiabetic medications at the end of 1 year. Hypertension was diagnosed in 121 of 161 patients preoperatively and resolved in 114 cases (94.2 %, p < 0.001). Triglycerides decreased from a mean of 210.07 to 125.24 mg/dl, and cholesterol decreased from a mean of 208.34 to 163.23 mg/dl (p < 0.001 for each). CONCLUSION: Our results demonstrate that DSIT provided effective remission rates in all components of metabolic syndrome in obese type 2 diabetic patients with acceptable complication and mortality rates.

Technical feasibility and safety profile of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT).

BACKGROUND: In this study, we specifically aimed to analyze the technical and safety aspects of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) in patients with type 2 diabetes (T2DM). METHODS: A total of 360 patients with type 2 diabetes who underwent a DSIT procedure within the past 2-year period (2011-2013) were analyzed. Operation time, length of hospital stay, perioperative and postoperative complications, and mortality were recorded and analyzed. RESULTS: The participants consisted of 229 males (63.6 %) and 131 females (36.4 %). Mean duration of follow-up was 12.4 months (range, 6-31). One early and two late mortalities occurred. Early mortality was due to an anastomotic leak, and late mortalities were related to myocardial infarction and a traffic accident. Leakage and bleeding were the most common surgical complications. The total number of surgical complications was 22 (6.1 %). Of those, 19 occurred within the first month (early) and 3 occurred after the first month (late). Among early complications, seven (1.94 %) required re-operation, two patients (0.55 %) required endoscopic treatment, and the remaining ten were managed conservatively. Late surgical complications (sleeve angulation) were noted in three patients (0.83) and were treated by endoscopic stents. Surgery-related non-surgical complications occurred in 19 cases (5.2 %), and neurological complications were noted in 11 patients (3.05 %). Additional surgical intervention was required in 26 patients (7.22 %). Of those, 15 (4.16 %) required cholecystectomy. CONCLUSIONS: Our data demonstrate that DSIT is a technically feasible operation and can be safely performed in type 2 diabetic patients with acceptable complication and mortality rates.