Metabolic Outcomes of Laparoscopic Diverted Sleeve Gastrectomy with Ileal Transposition (DSIT) in Obese Type 2 Diabetic Patients.

ABSTRACT

BACKGROUND: Bariatric surgical techniques are based on mechanical restriction rather than functional restriction. Our purpose is to analyze the outcomes of diverted sleeve gastrectomy with ileal transposition (DSIT) as a mode of functional restrictive therapeutic option for class II and class III obese type 2 diabetes mellitus patients. METHODS: A retrospective analysis was performed on data derived from 159 patients with type 2 diabetes mellitus who underwent DSIT between October 2011 and January 2014. Postoperative changes in body mass index (BMI), HbA1c, cholesterol indexes, and triglycerides, as well as complications and mortality rates, were noted and analyzed. RESULTS: The study group consisted of 88 females and 73 males, with a mean age of 51.8 years. Mean duration of hospital stay was 6.4 (range, 4 to 42) days; mean follow-up was 18.3 months, and no mortality was detected. Mean BMI decreased from 39.33 to 25.51 kg/m(2) (excess BMI loss rate was 75.4 %, p < 0.001). Mean fasting glucose level decreased from 189.8 to 123.5 mg/dl (p < 0.001), and mean postprandial glucose level decreased from 246.1 to 179.4 mg/dl (p < 0.01). Mean HbA1c decreased from 9.24 to 6.14 % 1 year after surgery (p < 0.001). Overall, 88.68 % of patients were off antidiabetic medications at the end of 1 year. Hypertension was diagnosed in 121 of 161 patients preoperatively and resolved in 114 cases (94.2 %, p < 0.001). Triglycerides decreased from a mean of 210.07 to 125.24 mg/dl, and cholesterol decreased from a mean of 208.34 to 163.23 mg/dl (p < 0.001 for each). CONCLUSION: Our results demonstrate that DSIT provided effective remission rates in all components of metabolic syndrome in obese type 2 diabetic patients with acceptable complication and mortality rates.