[Severe obesity and insulin resistance. Result obtained by the bilio-pancreatic diversion independentely for an associated gastroresection or gastropreservation]. / Obesità grave e insulino resistenza. Risoluzione indotta dalla diversione biliopancreatica indipendentemente dalla gastroresezione o gastroconservazione associata.

INTRODUCTION: Type 2 diabetes is the paradigm of an obesity-related disease. In most cases it exists because of the obesity and will disappear with weight loss. AIM OF THIS STUDY: To evaluate the glicemic control in obese patients after two malabsorbitive procedure, the bilio-pancreatic diversion with ad hoc stomach resection (BPD-AHS) and the bilio-pancreatic diversion with transitory gastric restriction (BPD-TGR). MATERIAL AND METHODS: The effect of weight loss following malabsorbitive procedures was studied on 38 patients operated on between the May 1999 and July 2002. Ten patients were diabetes 2 type (group A, 4 patients with oral antidiabetic therapy and 6 with insulin therapy; mean BMI: 49.4 +/- 8.2 Kg/m2), 18 patients were glucose intolerance (group B; mean BMI: 48.2 +/- 6.4 Kg/m2) and 10 patients were in normal glicemic control (group C; mean BMI: 51.2 +/- 8.3 Kg/m2). Five patients in group A were operated on BPD-AHS and 5 patients on BPD-TGR. Ten patients in the group B were operated on BPD-AHS and 8 patients on BPD-TGR. After 3 months from the malabsorbitive procedure group A patients stopped antidiabetic (mean BMI was: 42.3) and group B patients had normal values of glucose and insuline (mean BMI: 41.8). No significant statistically differences were observed in terms of glicemic control, BMI and Excess Weight Loss (EWL%), comparing the two malabsorbitive procedure. RESULTS: Weight loss after both BPD-AHS and BPD-TGR had a beneficial and durable effect on the fasting plasma glucose and serum insuline levels in diabetic and non-diabetic obese patients. The gastric procedure did not change the glicemic control.

Duodenal switch without gastric resection after failed gastric restrictive surgery for morbid obesity.

BACKGROUND: Several surgical treatments have been proposed for patients in whom gastric restrictive operations have failed. The aim of this study was to analyze the effectiveness and safety of duodenal switch (DS) with restoration of normal gastric capacity in such patients. METHODS: Between May 2001 and May 2003, 11 DS with restoration of normal gastric capacity were performed without other gastric procedures in patients who had had previous gastric restrictive operations which had failed because of inadequate weight loss or weight regain. Data were collected and follow-up was 2 years for all patients. RESULTS: At the original operation, mean BMI was 47.3 (range 38-53) kg/m2, and mean age was 42 years. 7 of the 11 patients (63.6%) had previous vertical banded gastroplasty, and 4 of the 11 (36.4%) had previous laparoscopic adjustable gastric banding. Mean percentage weight regain and mean BMI at the time of DS were 92.1% and 44.6 (range 35-53) kg/m2 respectively. After the second operation, mean BMI at 6 months was 35.4 kg/m2, at 12 months 31.7 kg/m2 and at 24 months 28.6 kg/m2. The % excess weight loss was 41.1 after 6 months, 56.6 after 12 months and 69.6 after 2 years. There was minor morbidity and no mortality. CONCLUSION: After this experience, we suggest that patients with failed gastric restrictive operations (weight regain or inadequate weight loss) may undergo DS with restoration of normal gastric capacity. This second operation proved to be safe and effective.