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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
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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.
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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.
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Treatment Goals Treatment Goals
• DIABETES CARE, VOLUME 35, SUPPLEMENT 1, JANUARY 2012
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Indication for Surgery in T2DMIndication for Surgery in T2DM
• DIABETES CARE, VOLUME 35, SUPPLEMENT 1, JANUARY 2012
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ObjectiveObjective
• Evaluate the results of metabolic control in the treatment of obese patients with T2DM undergoing LSG.
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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.
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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) .
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Material and MethodsMaterial and Methods
• Evaluation:
- Demographics: Gender, Age
- BMI.
- Fasting blood glucose.
- HbA1c.
- Treatment.
- Morbidity.
- Mortality.
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ResultsResults
•N=63
• Age: 50 years old (24-70).
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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%
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ResultsResultsBMIBMI
36,4 (30,2 – 51) 27,6 (35 – 21,6)
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ResultsResults
GlycemiaGlycemia
151 (250 – 84) 95 (120 – 72)
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ResultsResults
HbA1cHbA1c
7,05 (5,2-11,6) 5,79 (5,3-6,9)
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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%
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ResultsResults
• Conversions: 0
• Morbidity– 2 patients (3%):
• 1 hemoperitoneum. • 1 Perigastric hematoma.• Reoperations: 0
• Mortality: 0%
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DiscussionDiscussion
• In our study, LSG is a safe and effective treatment for patients with well-controlled T2DM, achieving remission in 87% of cases.
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DiscussionDiscussion
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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.
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Thank You Very MuchThank You Very Much
[email protected]@clc.clquestions: 1)insulin levels pre and post
2)Partial vs complete remision