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2006 Abstracts: Laparoscopic Surgical Treatment Of Type II Diabetes Mellitus For Patients With BMI Between 22 - 35
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Laparoscopic Surgical Treatment Of Type II Diabetes Mellitus For Patients With BMI Between 22 - 35
Aureo L. De Paula1, Antonio L. Macedo2, Alfredo Halpern2, Nelson Hassi1, Vladimir Schraibman2; 1Surgery, Hospital de Especialidades de Goiania, Goiania, Brazil; 2General Surgery, Albert Einstein Hospital, Sao Paulo, Brazil

Introduction: Type 2 diabetes mellitus is a disease with high prevalence that is related to innumerous complications and is also associated to a diminished life expectancy. Most of the patients are obese and weight reduction is one of the best ways to have a metabolic control of the disease. Bariatric surgery is an efficient procedure for the control of DM2 in morbidly obese patients. Incretins hormones, GLP-1 and GIP, are related to glycemic homeostasis. The objective of this study is to evaluate the possibility of the Laparoscopic transposition of a segment of ileum to the jejunum in order to treat DM2 patients. Method: The Laparoscopic procedure was done in 42 patients between Nov 2003 and Nov 2005. 24 were female and 18 male. Mean age was 51.8 years (29-62). Mean BMI was 26.6 (22 - 34.1). All patients were DM2 with inappropriate control of their glycemia, despite dietetic, oral hypoglycemic therapy and or insulin for at least 3 years. Mean duration of DM2 was 6.8 years (3-14). Three techniques were performed, consisting in different combinations of Ileal interposition in the proximal jejunum and vertical gastrectomy. Results: Mean operative time was 192min. Mean hospital stay was 3.2 days. There were no complications in the short-term (30-days). Mean post-operative follow-up was 9.2 months. 39 (92.9%) patients achieved adequate glycemic control and 3 had improvement. Mean percentage of body weight loss was 22% (11-34). Mean BMI was 23.8 (19-26.8). After 30 days, all patients normalized their cholesterol levels. Triglycerides were also normalized, however later on in the follow-up. The patients that did not normalize their glycemia were using oral hypoglycemic agents (2) and insulin (1) at lower doses. Conclusions: The Laparoscopic Ileal interposition seems to be a promising procedure to be used for the control of DM2, independently of the initial BMI. A longer follow-up period is needed.


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