Laparoscopic duodenal-jejunal exclusion in the treatment of type 2 diabetes mellitus in patients with BMI<30 kg/m2 (LBMI).
BACKGROUND
The association between medical and dietetic-behavioral treatments of type 2 diabetes mellitus (T2DM) has demonstrated to have variable results. The surgical treatment of T2DM is justifiable after the observation of a successful glycemic control in patients submitted to Roux-en-Y gastric bypass and biliopancreatic diversion. Experiments have shown an important role of the proximal intestine in glycemia decrease and diabetes control.


METHODS
Twenty diabetic patients underwent laparoscopic duodenal-jejunal exclusion. The variables studied were body mass index (BMI), fasting glycemia, glycosylated hemoglobin (HbA1c), and C-peptide, in the preoperative period and after 3 and 6 months.


RESULTS
There was a BMI decrease up to the third month and a weight stabilization between the third and sixth months. There was a significant reduction in fasting glycemia (43.8%) and HbA1c (22.8%) up to the sixth month (p<0.001). C-peptide did not show any significant alteration until the third month, although there was a considerable increase (25%) between the third and the sixth months (p<0.001). Only two patients were on oral medication after the sixth month.


CONCLUSIONS
Preliminary results have shown an important effect of the laparoscopic duodenal-jejunal exclusion in the treatment of T2DM. Studies with longer follow-up and a larger number of patients are necessary to better define the role of this new and promising procedure.
Ramos
Almino C
AC
Gastrointestinal, Bariatric and Metabolic Surgery, Gastro Obeso Center, São Paulo, Brazil.
Galvão Neto
Manoel P
MP
de Souza
Yglésio Moyses
YM
Galvão
Manoela
M
Murakami
Abel H
AH
Silva
Andrey C
AC
Canseco
Edwin G
EG
Santamaría
Raúl
R
Zambrano
Trino A
TA
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D004385:Duodenostomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007581:Jejunoileal Bypass / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications* / Q000601:surgery; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult