Abstract
“Diabesity,” ie a combination of type 2 diabetes mellitus (T2DM) and obesity, is increasing in epidemic proportions. Medical management of diabetes mellitus requires that patients remain compliant to their medication regimen and monitor the condition closely; patients are also required to make changes in lifestyle and diet. However, over time the pancreatic B cell function deteriorates and this leads to increased requirement of medications and may also lead to introduction of insulin based therapy. Laparoscopic ileal interposition (II) with sleeve gastrectomy (SG) is an evolving procedure that offers good control of type-2 diabetes and other metabolic derangements and also helps in weight reduction without causing significant malabsorption. In this chapter, the two versions of this procedure, jejunal (non-diverted) and duodenal (diverted) ileal interposition, along with patient selection criteria, mechanisms of action, postoperative care and follow up, and its advantages are described. This is a promising procedure for control of type 2 diabetes, hypertension, obesity, and associated metabolic abnormalities in obese but also in non-obese.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ferrannini E, Cobelli C. The kinetics of insulin in man. I. General aspects. Diabetes Metab Rev. 1987;3(2):335–63.
Vilsboll T, Holst JJ. Incretins, insulin secretion and type 2 diabetes mellitus. Diabetologia. 2004;47(3):357–66.
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.
DePaula AL, Macedo AL, Rassi N, Machado CA, Schraibman V, Silva LQ, et al. Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35. Surg Endosc. 2008;22(3):706–16.
DePaula AL, Macedo AL, Rassi N, Vencio S, Machado CA, Mota BR, et al. Laparoscopic treatment of metabolic syndrome in patients with type 2 diabetes mellitus. Surg Endosc. 2008;22(12):2670–8.
Tinoco A, El-Kadre L, Tinoco R, Savasi-Rocha P. Short-term and mid-term control of type 2 diabetes mellitus by laparoscopic sleeve gastrectomy with ileal interposition. World J Surg. 2011;35(10):2238–44.
DePaula AL, Macedo AL, Mota BR, Schraibman V. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21–29. Surg Endosc. 2009;23(6):1313–20.
Kota SK, Ugale S, Gupta N, Modi KD. Laparoscopic ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes. Diabetes Metab Syndr. 2012;6(3):125–31.
Kota SK, Ugale S, Gupta N, Krishna S, Modi KD. Ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes. Indian J Endocrinol Metab. 2012;16 Suppl 2:S458–9.
De Paula AL, Stival AR, Macedo A, Ribamar J, Mancini M, Halpern A, et al. 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. 2010;6(3):296–305.
Astiarraga B, Gastaldelli A, Muscelli E, Baldi S, Camastra S, Mari A, et al. Biliopancreatic diversion in nonobese patients with type 2 diabetes: impact and mechanisms. J Clin Endocrinol Metab. 2013;98(7):2765–73.
Celik A, Ugale S. Functional restriction and a new balance between proximal and distal gut: the tools of the real metabolic surgery. Obes Surg. 2014;24(10):1742–3.
Ugale S, Gupta N, Modi DK, Kota KS, Satwalekar V, Naik V, et al. Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes—a retrospective cohort study. J Diabetes Metab Disord. 2014;13(1):89.
Parikh M, Issa R, Vieira D, McMacken M, Saunders JK, Ude-Welcome A, et al. Role of bariatric surgery as treatment for type 2 diabetes in patients who do not meet current NIH criteria: a systematic review and meta-analysis. J Am Coll Surg. 2013;217(3):527–32.
DiGiorgi M, Rosen DJ, Choi JJ, Milone L, Schrope B, Olivero-Rivera L, et al. Re-emergence of diabetes after gastric bypass in patients with mid to long term follow-up. Surg Obes Relat Dis. 2010;6(3):249–53.
Chikunguwo SM, Wolfe LG, Dodson P, Meador JG, Baugh N, Clore JN, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6(3):254–9.
Keidar A, Hershkop KJ, Marko L, Schweiger C, Hecht L, Bartov N, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type-2 diabetes: a randomized trial. Diabetologia. 2013;56(9):1914–8.
Lee WJ, Chong K, Ser KH, Lee YC, Chen SC, Chen JC, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146(2):143–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
1 Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Third transection with suture marking, confirming wide mesentery base (MPG 89412 kb)
First anastomosis ileo-ileal 30 cm from ICV (MPG 61128 kb)
First mesenteric defect closure (MPG 160038 kb)
Duodenal dissection beyond gastroduodenal artery and transection of first part (MPG 76696 kb)
Creation of retro-colic opening and delivery of gastroduodenal sleeve (MPG 74082 kb)
Second anastomosis duodeno-ileal in one layer (MPG 109178 kb)
Two layer duodeno-ileal anastomosis (MPG 144766 kb)
Measure 50 cm from ligament of Trietz and suture marking on jejunum (MPG 43164 kb)
Second mesenteric defect closure with posterior fixation of duodeno-ileal anastomotic region (MPG 159702 kb)
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Ugale, S.M., Celik, A. (2016). Ileal Interposition with Sleeve Gastrectomy for Type 2 Diabetes Mellitus and Metabolic Syndrome. In: Agrawal, S. (eds) Obesity, Bariatric and Metabolic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-04343-2_58
Download citation
DOI: https://doi.org/10.1007/978-3-319-04343-2_58
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-04342-5
Online ISBN: 978-3-319-04343-2
eBook Packages: MedicineMedicine (R0)