Bariatric Times - Supplement A - Covidien - (Page 5)

THE 2007 INTERNATIONAL CONSENSUS SUMMIT ON SLEEVE GASTRECTOMY Sleeve Gastrectomy Provides Resolution of Type-2 Diabetes Without Duodenal Exclusion by MICHEL GAGNER, MD, FRCSC, FACS AUTHOR AFFILIATION: Dr. Gagner is Chairman, Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida. ADDRESS CORRESPONDENCE TO: Dr. Michel Gagner, FRCSC, FACS, Department of Surgery, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140;Telephone: (305) 674-3906; Fax: (305) 674-3916; E-mail: gagner.michel@gmail.com ccording to the meta-analysis by Buchwald published in the Journal of the American Medical Association in 2004,1 the efficacy for improvement in diabetes-related outcomes by surgical procedure (Figure 1) shows that gastric banding provides nearly 50 percent of improvement and vertical banded gastroplasty nearly 70 percent, in spite of having an intact duodenum. This seems to have a direct correlation with weight loss, especially given that, in a recent randomized study,2 8 of 30 patients in gastric banding have not had significant weight loss and did not have a resolution of their diabetes. This is, of course, a lesser degree of efficacy when one compares it to Roux-en-Y gastric bypass (80%) and duodenal switch (90%), in which both procedures have most of the duodeno-jejunal axis excluded. This hypothesis has been recently promoted by Dr. Rubino in a series of elegant animal experiments. However, one has to remember that the strongest reversal of type-2 diabetes mellitus (T2DM) was observed more than 30 years ago with the jejuno-ileal bypass, when no duodenum was excluded. Therefore, one may think that another mechanism is respon- A sible for resolution of T2DM, perhaps an early stimulation of the distal GI tract. We have, therefore, reviewed our short-term results of the sleeve gastrectomy on T2DM. METHODS AND RESULTS Laparoscopic sleeve gastrectomy is often performed as part of a twostage procedure. During a period of nearly 40 months, 122 sleeves were reviewed, of which 29 had T2DM (24%). Six were excluded for inadequate follow-up. Use of medication for diabetes, weight loss, resolution interval, and hemoglobin A1c were recorded. Of the 23 patients, an average body mass index (BMI) of 58kg/m2 was measured with an average age of 49 years. There were more female patients (57%), and 39 percent of the total reported the use of insulin. Several patients had immediate cure of their diabetes while in the hospital, and did not have any medications for diabetes on discharge. In spite of a high BMI in this cohort, T2DM had a complete resolution in 65 percent of cases (Figure 2), but 26 percent had improvement and needed less medication or less insulin doses than preoperatively. Only nine percent were unaffected, and were mostly [JUNE seen in male patients with a BMI above 60. In patients who were cured from their T2DM, we observed a lesser degree of preoperative diabetes (less insulin use) and a higher percentage of female gender. Also, the serum hemoglobin A1C (HbAlc), in those who had resolution, had progressed from a preoperative value of 6.6 to 5.7 percent, while those who were improved had progressed from 7.9 to 7.4 percent four months after sleeve gastrectomy. DISCUSSION Studies on the effectiveness of sleeve gastrectomy (SG) in improving or curing T2DM are very rare at the moment. Silecchia, et al., has reported 53-percent resolution of diabetes after SG in a cohort of 41 patients operated on with major comorbidities and the American Society of Anesthesiologists (ASA) Classification III and IV, in a very short interval. Those patients were operated between October 2002, and December 2004. A cohort from Lacy, et al., in Barcelona, in a fourmonth prospective study, was conducted on the changes in glucose homeostasis in 35 severely obese T2DM subjects undergoing laparoscopic SG (LSG) and 50 subjects SUPPLEMENT A] 2008, Bariatric Times 5

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Bariatric Times - Supplement A - Covidien Contents Laparoscopic Sleeve Gastrectomy: From Magenstrasse And Mill To Sleeve Sleeve Gastrectomy Provides Resoultion of Type-2 Diabetes Without Duodenal Exclusion The Relationship Bewtween The Resected Remnant And Weight Loss Laparoscopic Sleeve Gastrectomy: Results After Two And Five Years Laparoscopic Sleeve Gastrectomy As An Initial Weight Loss Procedure For High-Risk Patients With Morbid Obesity Three-Year Results Of Laparoscopic Sleeve Gastrectomy In The Treatment Of Morbid Obesity In Korea Laparoscopic Sleeve Gastrectomy: Nutritional Concerns And PostOperative Dietary Care Laparoscopic Sleeve Gastrectomy: Prevention And Treatment Of Bleeding Prevention And Treatment Of Gerd/Hiatal Hernia And Stenosis Associated With Sleeve Gastrectomy Laparoscopic Revisions Of Sleeve Gastrectomy Survey Results

Bariatric Times - Supplement A - Covidien

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