Laparoscopic ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes

The objective of the present study was to prospectively evaluate the results of laparoscopic ileal interposition (II) with diverted sleeve gastrectomy (DSG) for control of T2DM and related metabolic abnormalities.

All patients underwent II +DSG. They had T2DM≥5 years with poor glycemic control despite adequate dosage of oral hypoglycemic agents (OHAs) and/or insulin. The primary outcome was remission of diabetes (HbA1C<6.5% without OHAs/insulin), and secondary outcomes were reduction in antidiabetic agent requirement and components of metabolic syndrome.

We report the preliminary postoperative follow-up data of 9.1±5.3 months (range: 3-21 months). There were 17 patients (male:female=12:5) with mean age of 50.7±8.1 (range, 34-66 years), duration of diabetes of 15.1±5.8 years (range, 5-30 years), and preoperative body mass index of 29.2±7.5 kg/m(2)(range, 22.4-37.5 kg/m(2)). Eight patients (45%) had hypertension, while dyslipidemia and microalbuminuria was present in 7 patients (39%) each. Twelve patients (70.5%) had diabetes remission. Seven/eight (87.5%) patients had remission in hypertension. All participants had weight loss ranging between 15% and 30%. Postoperatively statistically significant decline was observed in the glycemic and lipid parameters, microalbuminuria at all intervals (p<0.05). Two patients had vitamin B12 deficiency 1 year after surgery.

Ileal interposition combined with DSG addresses both foregut and hindgut theories and brings about remissions in T2DM patients with reasonable safety. Our preliminary observations demonstrated the feasibility and efficacy of this novel surgical procedure as a promising option in T2DM.