Gastric stimulation in treatment in type 2 diabetes mellitus.

UNLABELLED: Metabolic surgery is a dynamic field providing a wide range of new techniques. The aim of our paper is to inform about gastric electrostimulation in the treatment of type 2 diabetes mellitus. Gastric electrostimulation in type 2 diabetes mellitus treatment is performed by means of implanting Tantalus system (Metacure). When triggered by food intake, the Tantalus system generates signals for the stomach to contract. Early after the food intake, thus before the stomach distends completely, the system increases spontaneous stomach contractions. Via afferent vagal signals, these increased contractions are evaluated by the central nervous system as a sign that satiety has been reached. Three pairs of electrodes connected with a stimulator are implanted laparoscopically. The system comes equipped with a battery as well. Laparoscopically implanted system of stomach electrostimulation presents a simple and easily regulated system without disturbing the integrity of gastrointestinal tract. It is a reversible system. In accord with preliminary results, Tantalus offers a safe and effective treatment of type 2 diabetes mellitus by reducing other cardiometabolical risky factors. The operation safety is comparable with that of similar minimally invasive surgical techniques. In order to improve our understanding of diabetes mellitus pathophysiology as well as of effects of gastric electrostimulation, more trials need to be performed. The surgical diabetes treatment represents an interesting chance for patients and it might become a common technique in the future (Fig. 1, Ref. 29). KEYWORDS: diabetes mellitus, obesity, gastric stimulation, pacemaker.

[ACE procedure for life long constipation in adult]. / ACE operace pro dlouhodobou obstipaci u dospelého.

AIM: The authors present a possibility of Malon Operation in adult patients with chronic constipation. They determine the quality of life at a pre-operative time and 3 months post-operatively after ACE operation. MATERIAL AND METHOD: ACE is an "antegrade continent enema "operation carried out via a short laparotomy or laparoscopy creating appendicostomy. It serves as a port for enema delivery after catheter access. It is performed for constipation commonly in children and extremely rarely in adults. 46 years old lady has had a severe constipation (1x > 6 weeks) since her early childhood. The usage of laxatives had been progressively increased to achieve the best result. The patient experienced left iliac fossa pain, cramp, spurious diarrhea, anal seepage, spoilage of undergarments, tenesmus, urge incontinence, and social impairment as well. Other features included fibromyalgia and a very strong family history of colorectal cancer. She was examinated according to the guidelines for chronic constipation. Colonic transit study revealed a slow-colonic time and a global inertia of colon. ACE operation was performed in June 2006. RESULTS: The result at 3 months after surgery was frequency 2x/week within 10/30 minutes after self administrated ACE (PO4 + 100ml saline) with very occasional soilage. The progressive resistance in track at 8-10cm from skin level occurred 2 months after surgery. Contrast appendiculogram revealed an angulation and a very mild stenosis at appendico-caecal junction. Radiological balloon dilatation to 14F followed with effect. The quality of life assessment at pre-operative and 3 months post-ACE procedure revealed no difference. On specific questioning the predictability of bowel motion was found as a sole benefit. CONCLUSION: A non-resective appendicostomy for ACE for severe life-long constipation showed no improvement on QoL instrument. However, it resulted in improvement of the predictability of bowel action. ACE technique - Malon Operation can be used as a treatment method for selected adult patients with severe constipation.