title: Effectiveness of Minimally Invasive Hybrid Surgery for Ileal Interposition (MIHSII) for the Resolution of Type 2 Diabetes.
abstract: OBJECTIVE
  To evaluate the effectiveness of minimally invasive hybrid surgery for ileal interposition (MIHSII), a novel procedure for type 2 diabetes (T2DM) in patients with a body mass index (BMI) <30 kg⁄m(2).
  
  
  METHODS
  MIHSII is an innovative technique in which sleeve gastrectomy is performed laparoscopically, followed by extracorporeal ileal interposition performed through a 5-cm midline incision. The procedure was performed on 31 T2DM patients, 17 males and 14 females. Their BMI values ranged from 21.8 kg/m(2) to 29.8 kg/m(2), with a mean BMI of 26.61 ± 2.61 kg/m(2). The average duration of diabetes 8.14 ± 4.89 (range = 1-20) years. Most of the patients exhibited poorly controlled diabetes despite the use of oral hypoglycemic agents (OHAs) and/or insulin.
  
  
  RESULTS
  The mean preoperative glycosylated hemoglobin (HbA1c) for the population was 8.86%. The mean HbA1c 1 year after surgery was 6.80%. The difference between the mean preoperative and 1-year postoperative HbA1c values was significant, at P < .05 (group 1: BMI = 18.5-24.99 kg/m(2), t = 2.83, and P = .022; group 2: BMI = 25-29.99 kg/m(2), t = 4.23, and P = .001). The resolution rate of diabetes was 80.48%; 48.57% experienced complete resolution, and 31.91% experienced partial resolution. The remaining 19.52% of patients exhibited a significant reduction in HbA1c, although the HbA1c levels did not fall below 6.5%, even with medications.
  
  
  CONCLUSIONS
  MIHSII is an innovative technique of metabolic surgery and is a cost-effective and minimal procedure for the resolution of T2DM in patients with BMI <30 kg/m(2).
authors.affiliation: Sunrise Hospital, Kakkanad, Kochi, India drrpadmakumar@gmail.com.
authors.forename: Padmakumar
authors.initials: P
authors.lastname: Ramakrishnapillai
authors.affiliation: Sunrise Hospital, Kakkanad, Kochi, India.
authors.forename: Madhukara
authors.initials: M
authors.lastname: Pai
authors.affiliation: Sunrise Hospital, Kakkanad, Kochi, India.
authors.forename: Farish
authors.initials: F
authors.lastname: Shams
authors.affiliation: Sunrise Hospital, Kakkanad, Kochi, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Sunrise Hospital, Kakkanad, Kochi, India.
authors.forename: P S
authors.initials: PS
authors.lastname: Shaji
authors.affiliation: Sunrise Hospital, Kakkanad, Kochi, India.
authors.forename: T S
authors.initials: TS
authors.lastname: Anithadevi
authors.affiliation: Sunrise Hospital, Kakkanad, Kochi, India.
authors.forename: P J
authors.initials: PJ
authors.lastname: Sulfia
authors.affiliation: Sunrise Hospital, Kakkanad, Kochi, India.
authors.forename: Vani
authors.initials: V
authors.lastname: Krishna
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin
keywords: gastric surgery; image-guided surgery; surgical education