Laparoscopic ileal interposition associated with sleeve gastrectomy for the control of metabolic syndrome in patients with type 2 diabetes

Hyperglycaemia is a critical component of metabolic syndrome. This study was aimed to investigate the results from the laparoscopic interposition of an ileal segment into the proximal jejunum (aimed at generating a neuroendocrine bypass) for the management of metabolic syndrome in patients with type 2 diabetes and a body mass index (BMI) <35. A total of 60 patients diagnosed with metabolic syndrome along with type 2 diabetes mellitus (diagnosed for at least 3 years and with evidence of stable treatment for at least 12 months) took part in the study. Two techniques were performed: ileal interposition (II) into the proximal jejunum and sleeve gastrectomy (II-SG) in 32 patients, or ileal interposition associated with a diverted sleeve gastrectomy (II-DSG) in 28 patients. During a mean post-operative follow-up period of 7.4 months, adequate glycaemic control was achieved in 86.7%, triglycerides normalized in 81.7%, and HDL-C levels higher than 40 mg/dL for men and higher than 50 mg/dL for women were obtained in 90.3%, with control of arterial hypertension achieved in 90.5% of patients. The abdominal circumference reached was less than 102 cm for men and less than 88 cm for women. The II-DSG procedure was more effective for the control of metabolic syndrome. The authors conclude that both laparoscopic procedures appear to be promising therapeutic options for managing patients with both metabolic syndrome and type 2 diabetes.

Abstract

Keywords:
BMI – HDL-C – Hypertension – Metabolic syndrome – Plasma glucose – Triglycerides – Type 2 diabetes – Waist circumference