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SLEEVE GASTRECTOMY IN TYPE 2 DIABETIC OBESE PATIENTS (DM2)

Authors:

Dr, M. Berry, Drs.P. Lamoza, L. Urrutia, R. Rossi, A. Bustos

Bariatric Surgical Unit , Clinica Las Condes, Santiago – Chile.

World IFSO TurkeyAugust 29, 2013

IntroductionIntroduction

• The T2DM is a major cause of mortality worldwide.

• About 60% of the diabetic population has some degree of obesity.

• We know from the literature on obesity surgery, which all bariatric surgical techniques solve the T2DM from 73% to 98% in obese patients, this remission occurs days to weeks after surgery.

Concepts

• Medically, cure may be defined as restoration to good health, while remission is defined as abatement or disappearance of the signs and symptoms of a disease. Implicit in the latter is the possibility of recurrence of recurrence of the disease.the disease.

Treatment Goals Treatment Goals

• DIABETES CARE, VOLUME 35, SUPPLEMENT 1, JANUARY 2012

Indication for Surgery in T2DMIndication for Surgery in T2DM

• DIABETES CARE, VOLUME 35, SUPPLEMENT 1, JANUARY 2012

ObjectiveObjective

• Evaluate the results of metabolic control in the treatment of obese patients with T2DM undergoing LSG.

Material and MethodsMaterial and Methods

•63 patients with T2DM •LSG between April 2006 and January 2012.

•Patients included- Patients with newly diagnosed DM2.

- T2DM patients "well-controlled“.

- T2DM patients who refused gastric bypass as a therapeutic alternative (regardless of the quality of metabolic control).

•Patients Excluded– Patients with > 10 years of T2DM of diagnosis.– Patients using insulin.– T1DM.

Material and MethodsMaterial and Methods

•Surgical technique:- Vertical gastrectomy calibrated 36Fr, 4 cm from the pylorus to the angle of Hiss.

- Seamguard ® reinforcement.

- Drain along the suture line

•Mean Follow-up: 24 months (6-46) .

Material and MethodsMaterial and Methods

• Evaluation:

- Demographics: Gender, Age

- BMI.

- Fasting blood glucose.

- HbA1c.

- Treatment.

- Morbidity.

- Mortality.

ResultsResults

•N=63

• Age: 50 years old (24-70).

ResultsResultsT2DM

Time of diagnosis 34 Months (0 – 112)

2 Patients newly Diagnosed at Preoperative Tests

Treatment

Without Treatment

2 3%

Non Pharmacological

0 0%

Pharmacological Monotherapy (55 patients) 87%

Bitherapy (6 patients) 10%

ResultsResultsBMIBMI

36,4 (30,2 – 51) 27,6 (35 – 21,6)

ResultsResults

GlycemiaGlycemia

151 (250 – 84) 95 (120 – 72)

ResultsResults

HbA1cHbA1c

7,05 (5,2-11,6) 5,79 (5,3-6,9)

ResultsResults

Treatment up to 24 months n % Remission

Not Initiated Medical Treatment 2 3%87%

Non Pharmacological 53 84%

Monotherapy (MTF) 2 3% Improvement

Lost of F/U 6 10%

ResultsResults

• Conversions: 0

• Morbidity– 2 patients (3%):

• 1 hemoperitoneum. • 1 Perigastric hematoma.• Reoperations: 0

• Mortality: 0%

DiscussionDiscussion

• In our study, LSG is a safe and effective treatment for patients with well-controlled T2DM, achieving remission in 87% of cases.

DiscussionDiscussion

DiscussionDiscussion

• Close F/U is needed to assess the long-term result, which could provide valuable information to optimize the selection of patients for this procedure.

Thank You Very MuchThank You Very Much

mberry@clc.clmberry@clc.clquestions: 1)insulin levels pre and post

2)Partial vs complete remision