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Ileal Interposition with Sleeve Gastrectomy for Type 2 Diabetes Mellitus and Metabolic Syndrome

  • Surendra M. UgaleEmail author
  • Alper Celik

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.

Keywords

Type-2 diabetes Metabolic syndrome Co-morbidities Ileal interposition GLP-1 Incretins Ileal brake Remission 

Supplementary material

Video 58.1

Third transection with suture marking, confirming wide mesentery base (MPG 89412 kb)

Video 58.2

First anastomosis ileo-ileal 30 cm from ICV (MPG 61128 kb)

Video 58.3

First mesenteric defect closure (MPG 160038 kb)

Video 58.4

Duodenal dissection beyond gastroduodenal artery and transection of first part (MPG 76696 kb)

Video 58.5

Creation of retro-colic opening and delivery of gastroduodenal sleeve (MPG 74082 kb)

Video 58.6

Second anastomosis duodeno-ileal in one layer (MPG 109178 kb)

Video 58.7

Two layer duodeno-ileal anastomosis (MPG 144766 kb)

Video 58.8

Measure 50 cm from ligament of Trietz and suture marking on jejunum (MPG 43164 kb)

Video 58.9

Second mesenteric defect closure with posterior fixation of duodeno-ileal anastomotic region (MPG 159702 kb)

References

  1. 1.
    Ferrannini E, Cobelli C. The kinetics of insulin in man. I. General aspects. Diabetes Metab Rev. 1987;3(2):335–63.CrossRefPubMedGoogle Scholar
  2. 2.
    Vilsboll T, Holst JJ. Incretins, insulin secretion and type 2 diabetes mellitus. Diabetologia. 2004;47(3):357–66.CrossRefPubMedGoogle Scholar
  3. 3.
    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.CrossRefPubMedGoogle Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    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.PubMedCentralPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    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.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    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.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    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.CrossRefPubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Advanced Laparoscopy and Metabolic SurgeryKirloskar HospitalHyderabadIndia
  2. 2.Sisli Kolan International HospitalIstanbulTurkey

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