腹腔镜袖状胃切除结合十二指肠空肠吻合术治疗肥胖并非酒精性脂肪性肝病的可行性及安全性分析

目的探讨腹腔镜袖状胃切除结合十二指肠空肠吻合术(SADJB-SG)治疗肥胖并非酒精性脂肪性肝病(NAFLD)的可行性及安全性。 方法回顾性分析2017年8月至2019年10月97例肥胖并NAFLD患者病例资料。根据手术方式分为SADJB-SG组(45例)和LSG组(腹腔镜袖状胃切除,52例)。采用SPSS 24.0软件进行数据处理,手术相关指标、LSM、CAP等计量资料以( ±s)表示,采用独立t检验;并发症等计数资料采用χ²检验,P<0.05为差异具有统计学意义。 结果SADJB-SG组手术时间、术中出血量长于LSG组(P<0.05);SADJB-SG组住院时间略高于LSG组,术后并发症总发生率略高于LSG组(20.0% vs. 13.5%),但差异无统计学意义(P>0.05);两组术后3个月体重、BMI均比术前明显降低(P<0.05),但两组差异无统计学意义(P>0.05);术后3个月SADJB-SG组LSM、CAP均比LSG组低(P<0.05)。 结论SADJB-SG治疗肥胖并NAFLD的临床疗效显著,可有效减轻体重,改善肝功能,且未增加并发症发生率。     

重度肥胖患者应用腹腔镜下袖状胃切除术与胃旁路术治疗前后肺功能及血脂水平变化分析

目的对比腹腔镜下袖状胃切除术(LSG)与胃旁路术(LRYGB)对重度肥胖患者肺功能及血脂水平的影响。 方法回顾性分析2014年11月至2017年11月2个医院收治的重度肥胖(BMI≥35kg/m²)患者90例,患者接受LSG(n＝48)或LRYGB(n＝42)治疗。采用SPSS 19.0进行统计学分析,一般资料、肺功能指标、生理指标、血脂水平的比较采用( ±s),组间比较采用独立t检验或单因素方差分析;计数资料采用χ²检验。P<0.05表示统计学差异显著。 结果LSG组手术时间与麻醉时间均低于LRYGB组,差异有统计学意义(P<0.05),两组术中出血量比较无明显统计学意义(P>0.05);术前两组肺功能的比较差异无统计学意义。术后两组PaO₂、FVC、FEV1和MMF均较术前明显下降(P<0.05)。术后48 h,上述指标均较术后24 h改善(P<0.05),但仍较术前水平低(P<0.05); LSG组术后24 h、48 h的上述指标均较LRYGB组高,差异有统计学意义(P<0.05)。与术前比较,两组术后6个月体重、BMI、腰围、臀围、空腹血糖和餐后2 h血糖均明显下降(P<0.05);与术前比较,两组术后6个月TG、CH、LDL水平均明显下降,而HDL水平明显升高(P<0.05),组间比较差异均无统计学意义(P>0.05)。(P>0.05)。 结论LRYGB和LSG减肥疗效相当,对血脂的改善无明显差异,但是LSG对患者短期肺功能和氧合的影响较LRYGB小。     

两种代谢手术治疗肥胖型2型糖尿病的对比分析

目的评价两种手术方式对治疗肥胖伴有2型糖尿病(T2DM)的优势。 方法回顾分析2012年1月至2019年2月两家医院收治的64例肥胖伴有T2DM的临床资料,根据手术干预情况分为两组,腹腔镜下SG(LSG组) 30例和腹腔镜下胃旁路手术(L-RYGB组) 34例,采用SPSS 17软件进行统计分析。生化指标等计量资料以( ±s)表示,采用独立t检验。术后并发症等计数资料采用χ²检验,采用logistic回归(逐步)模型,分析T2DM缓解与否的危险因素,P<0.05为差异有统计学意义。 结果两组患者术后1年血脂相关指标除甘油三酯外,两种手术方法均未获得明显改善。两组间BMI和血糖比较差异无统计学意义(P>0.05);L-RYGB对血糖的缓解率(88.2%)优于LSG(76.7%)P<0.05。而术后1年,两组接受治疗的患者的HbA1c、收缩压和舒张压减少值均明显降低(P＝0.016; P＝0.029和P＝0.017),多因素logistic回归分析,BMI、空腹血糖、HbA1c可作为1年时T2DM缓解的独立危险因素(P＝0.001; P＝0.001; P＝0.008)。L-RYGB显示出T2DM缓解率明显高于LSG (OR＝1.79, 95%CI: 1.133～2.829, P＝0.013)。两组患者均未发生30d内死亡和胃肠瘘。在深静脉血栓形成的并发症中,L-RYGB的发生率较高(11.8% vs.3.3%, P＝0.022)。 结论在T2DM缓解方面,术后1年的结论,L-RYGB优于LSG。远期持久缓解的结果,仍需更长时间的随访研究。     

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目的探讨行腹腔镜袖状胃切除术治疗合并2型糖尿病(type 2 diabetes mellitus,T2DM)肥胖症病人的效果。方法回顾性分析第二军医大学附属长海医院微创外科2010年7月至2011年6月行腹腔镜袖状胃切除术治疗合并T2DM的肥胖症19例病人的术前资料和术后6个月的随访资料。结果均在腹腔镜下完成手术。术后均无严重并发症发生。在术后6个月的随访过程中,病人体重、腰围、体重指数均呈下降趋势,与术前相比,术后1周开始差异即有统计学意义(P<0.01)。病人术后1周、1个月、3个月、6个月额外体重减轻百分率分别为(11.68±4.07)%、(32.33±9.12)%、(55.83±14.11)%、(74.55±20.39)%。术后6个月T2DM临床完全缓解15例(78.9%),临床部分缓解4例(21.1%)。所有病人术后糖化血红蛋白、空腹血糖、胰岛素抵抗指数均呈下降趋势,从术后1个月开始,糖化血红蛋白与术前相比差异有统计学意义(P<0.01),术后3个月复查15例(78.9%)已恢复正常水平;空腹血糖和胰岛素抵抗指数自术后1周开始与术前相比差异即有统计学意义(P<0.01)。病人术后血脂代谢及肥胖相关合并症如高血压病、脂肪肝、关节退行性变、睡眠呼吸暂停综合征等亦有不同程度的改善。结论腹腔镜袖状胃切除术是一种安全、有效的治疗肥胖症合并T2DM的手术方式。     

两种腹腔镜代谢手术方法治疗超级肥胖患者30例分析

目的探讨两种代谢手术治疗超级肥胖的疗效及安全性。 方法回顾性分析2011年3月至2017年11月30例超级肥胖患者的临床资料和随访资料。根据手术方式不同,分为腹腔镜袖状胃切除术组(LSG,9例)和腹腔镜Roux－en－Y胃旁路术组(LRYGB,21例)。数据采用SPSS21.0统计分析,术前术后各项指标、额外体重减轻百分比(%EWL)用( ±s)表示,独立t检验;术后早期及远期并发症、代谢合并症的改善情况使用χ²检验;P<0.05差异有统计学意义。 结果30例患者均成功完成腹腔镜手术,无中转开腹。两组患者在术后6个月内%EWL上升明显,之后上升缓慢。LSG组少于LRYGB组(P<0.01),提示LRYGB组的短期减重疗效优于LSG组。LSG组1例患者术后第2天出现胃切缘出血,再次手术修补。LRYGB组1例患者术后6个月出现脱发和骨质疏松,两组术后早期及远期并发症差异无统计学意义(P>0.05)。 结论两种代谢手术治疗超级肥胖及其合并症短期内安全有效。     

腹腔镜袖状胃切除术36例近期疗效分析

目的探讨行腹腔镜袖状胃切除术治疗肥胖症的临床疗效和可行性。方法回顾性分析2010年4月至2013年12月行腹腔镜袖状胃切除术治疗肥胖症36例患者的资料和术后12个月随访资料。应用SPSS 17.0统计软件进行分析,患者术后1、3、6、12个月体重、BMI(术后各时间点与术前)比较采用配对t检验,以P<0.05为差异有统计学意义。结果所有患者均在腹腔镜下完成手术,无中转开腹。术中术后均无严重并发症发生。在术后12个月的随访过程中,患者体重、体质指数均呈下降趋势,与术前(104.3±22.4)kg、(37.4±5.8)kg/m2相比,术后1个月、3个月、6个月、12个月体重及体质指数分别为(95.1±16.1)kg、(34.6±5.2)kg/m2;(89.3±15.2)kg、(32.1±4.6)kg/m2;(82.1±12.3)kg、(30.3±4.2)kg/m2;(78.3±10.1)kg、(28.5±3.8)kg/m2,差异均有统计学意义(P<0.05或P<0.01)。结论腹腔镜袖状胃切除术是一种安全、有效的治疗肥胖症的手术方式。     

腹腔镜袖状胃切除术治疗超级肥胖症的疗效与评价

目的:探讨腹腔镜袖状胃切除术(LSG)治疗超级肥胖症(体重指数≥50 kg/m²)的临床疗效。方法:回顾分析2013年5月至2019年5月采用LSG治疗并完成随访12个月的66例超级肥胖症患者的临床资料,记录并分析术前及术后1、3、6、12个月的体重、体重指数、腰围、臀围、肥胖相关代谢指标的变化情况,以及合并症的改善、术后各阶段额外体重减少百分比的变化情况。结果:66例超级肥胖症患者均顺利完成LSG,无一例中转开腹,无术后死亡及其他严重并发症发生,术后住院8～17 d,平均(11.35±2.92)d。术后1、3、6、12个月,患者体重、体重指数、腰围、臀围均低于术前,且随时间呈不断降低趋势,额外体重减少百分比呈升高趋势,差异有统计学意义(P<0.05);患者糖化血红蛋白、总胆固醇、低密度脂蛋白胆固醇呈不断降低趋势(P<0.05);术后1个月患者血尿酸较术前升高后逐渐下降(P<0.05);术后12个月患者总胆固醇较术前下降(P<0.05),术后12个月高密度脂蛋白胆固醇较术前升高(P<0.05);术后12个月复查相关指标发现,患者肥胖相...     

腹腔镜辅助全胃切除术在不同年龄段进展期胃癌的对比研究

目的探讨腹腔镜辅助全胃切除术应用于不同年龄段进展期胃癌患者治疗中的临床价值。 方法回顾性分析2010年1月至2013年12月93例进展期胃癌患者资料,根据年龄差异将其分为A、B、C三组,每组31例,所有患者均行腹腔镜辅助全胃切除术治疗。A组平均年龄(48.6±7.6)岁;B组平均年龄(72.3±5.1)岁;C组平均年龄(83.2±2.2)岁。采用统计学软件SPSS19.0处理数据,围手术指标等用( ±s)表示,F检验;术后并发症等采用χ²检验;Kapln－Meier法绘制三组患者术后无病生存曲线图和总生存率曲线图;P<0.05为差异有统计学意义。 结果三组患者在围术期手术时间、出血量、淋巴结清扫、恢复排气时间、住院时间等方面差异无统计学意义(P>0.05);A、B、C三组患者术后总并发症发生率(22.6% vs. 25.8% vs. 29.0%)比较,组间差异无统计学意义(P>0.05),但肺部感染率C组>B组>A组(P<0.05);三组患者术后5年内的无病生存率和总生存率差异无统计学意义(P>0.05)。 结论不同年龄段进展期胃癌患者行腹腔镜辅助全胃切除术治疗术中安全,疗效近似,可适用于老年尤其是高龄患者。     

腹腔镜袖状胃切除术对肥胖型阻塞性睡眠呼吸暂停综合征中期疗效的临床研究

目的:探讨腹腔镜袖状胃切除术(LSG)对肥胖型阻塞性睡眠呼吸暂停综合征(OSAHS)的疗效,并分析其影响因素。方法:回顾分析2017年1月至2018年7月行腹腔镜袖状胃切除术的37例肥胖型阻塞性睡眠呼吸暂停综合征患者的临床资料及随访资料,分析此术式对患者体重及OSAHS的控制情况,并采用单因素与多因素Logistic回归分析影响体重及OSASH控制效果的相关因素。结果:共37例患者完成手术并定期随访至术后12个月,患者术后体重指数呈下降趋势,额外体重减轻百分率达73.2%;阻塞性睡眠呼吸暂停综合征治疗有效率达91.89%,呼吸暂停低通气指数、夜间最低血氧浓度较术前均呈现明显改善趋势;单因素分析显示,性别、体重、额外体重减轻百分率、吸烟可影响LSG对OSAHS的疗效(P<0.05),额外体重减轻百分率、吸烟是影响LSG治疗病态性肥胖疗效的独立因素之一。结论:LSG可有效降低肥胖患者多余体重,具有可靠的减重疗效,同时对OSAHS患者具有良好的中期疗效,吸烟及额外体重减轻百分率可能是影响手术疗效的因素。     

腹腔镜辅助进展期胃癌D2根治术的临床疗效及预后分析

目的探讨腹腔镜辅助进展期胃癌D2根治术的临床疗效及预后情况。 方法回顾性分析2011年至2013年确诊为进展期胃癌并行胃癌根治术的患者73例,根据患者手术方式不同将患者分为开腹组(34例)与腔镜组(39例),采用SPSS24.0进行统计分析,术中术后各个指标用( ±s)表示,采用独立t检验;术后并发症比较采用卡方检验,术后生存情况比较采用Kaplan－Meier法;以P<0.05为差异具有统计学意义。 结果与开腹组比较,腹腔镜组患者手术时间显著升高(P<0.05),术中出血量显著减少(P<0.05);腹腔镜组患者住院时间显著降低(P<0.05)。开腹组平均生存时间为(53.4±4.3)个月,1、3、5年生存率分别为94.0%,69.8%,63.7%;腔镜组平均生存时间为(50.9±4.6)个月,1,3,5年生存率92.3%,55.4%,50.2%;两组患者平均生存时间和累积生存率差异无统计学意义(F＝0.180,P＝0.672)。 结论腹腔镜D2胃癌根治术淋巴结清扫效果满意,术后5年生存率与开腹术相比较无显著差异,且术中出血量、术后住院时间短,安全可行,值得临床推广。     

腹腔镜袖带胃切除术治疗病态性肥胖合并2型糖尿病的疗效评价

目的评估腹腔镜袖带胃切除术（LSG）治疗病态性肥胖2型糖尿病的疗效。方法2007年1月至7月,对来自全美的30例体质量指数（BMD大于或等于35、且合并2型糖尿病的病态性肥胖志愿患者行LSG,术后所有病例随访6个月。分析患者手术前后血糖控制情况、BMI变化和超重体重下降百分比（EWL％）及血糖指标变化情况和Ghrelin激素。结果本组30例患者在接受LSG后6个月,糖尿病治愈率达63％（19／30）,缓解率达37％（11／30）,术后6个月总有效率为100％。结论LSG对病态性肥胖2型糖尿病有着良好的短期治疗效果。     

Impact of Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Bypass on HbA1c Blood Level and Pharmacological Treatment of Type 2 Diabetes Mellitus in Severe or Morbidly Obese Patients. Results of a Multicenter Prospective Study at 1 Year

Gastric bypass (GBP) has proved its efficacy 30 years ago in the management of diabetes mellitus (T2DM) for severe obese patients. More recently, interesting results have been published after sleeve gastrectomy (SG) in the same indication. Between 2005 and 2008, three bariatric centers have prospectively collected the data of T2DM patients treated by laparoscopic gastric bypass (LGBP) or laparoscopic sleeve gastrectomy (LSG). Effects on hemoglobin A1c (HbA1c), pharmacological treatment and excess weight loss after 1 year of surgery have been analyzed. All patients (35 LGBP and 33 LSG) were treated with oral anti-diabetics (OAD) or insulin before surgery (32 OAD and three insulin in LGBP group and 27 OAD and six insulin in LSG group). The average body mass index (BMI) in the LGBP group was 47.9 and 50.6 kg/m2 in the LSG group. At 1 year after surgery, the average HbA1c lost was 2,537 in the GBP group and 2,175 in the SG group. T2DM had resolved (withdrawal of pharmacological treatment) in 60% of the LGBP group and 75.8% of the LSG group. Reduced use of pharmacological therapy was noted in 31.42% of the LGBP group and 15.15% of the LSG group. Percentage excess weight loss and BMI lost were 56.35% and 29.75% in the LGBP group and 60.11% and 29.80% in the LSG group, respectively. During short-term follow-up, the impact on regulation of HbA1c blood level of LGBP or LSG is important. At 1 year after surgery, LSG seems to be as effective as LGBP for the management of T2DM in severely obese patients.     

腹腔镜手术治疗219例肥胖症疗效分析

目的探讨腹腔镜下胃肠外科手术治疗单纯性肥胖症及其合并2型糖尿病（T2DM）患者的效果及安全性。方法上海第二军医大学附属长海医院微创外科2003年6月至2010年6月间对219例肥胖症患者进行了腹腔镜下胃肠外科手术,其中201例行腹腔镜下可调节胃绑带术（LAGB组）,13例行腹腔镜下改良简易型胃肠短路术（LMGB组）,5例行腹腔镜下管状胃胃切除术（LSG组）。总结分析该组患者的临床和随访资料。结果LAGB组患者体质量指数（BMI）平均37．9kg／m2,术后6个月及12个月BMI分别为平均32．4kg／mz和29．7kg／m2;43例术前合并T2DM者．11例（25．6％）术后临床部分缓解,16例（37．2％）完全缓解;有26例（12．9％）术后出现并发症。LMGB组患者BMI平均34．7kg／m2,术后6个月及12个月BMl分别为平均31．6kg／m2和26．9kg／m2：10例术前合并T2DM者,2例（20．0％）术后临床部分缓解,7例（70．0％）完全缓解;有2例（15．4％）术后出现并发症。LSG组患者BMI平均43．8kg／m2．术后6个月及12个月BMl分别为平均38．1kg／m2和34．3kg／m2;3例术前合并T2DM者,术后1例达到临床部分缓解,1例完全缓解：有1例术后出现并发症。所有术式组均无围手术期死亡。结论腹腔镜下胃肠外科手术对单纯性肥胖症有效．并能使合并的T2DM得到缓解．同时手术并发症较少。     

腹腔镜袖套状胃切除术治疗肥胖症

目的 探讨腹腔镜袖套状胃切除术治疗肥胖症的有效性及安全性.方法 自2006年12月至2010年4月,40例肥胖症患者接受了腹腔镜袖套状胃切除术,术前平均体质量、体质量指数、超重体质量分别为(104.2±3.3) kg、(36.9±1.0) kg/m2和(37.8±3.0) kg.前瞻性收集和评价实验数据.结果 所有腹腔镜袖套状胃切除术均顺利完成,无中转开腹手术.平均手术时间(80±18) min,无严重并发症发生.术后住院时间(5.5±1.5)d.术后1、3、6、12个月随访,体质量指数分别减少(4.3±1.7) kg/m2、(7.0±1.9) kg/m2、(9.3±3.1)kg/m2和( 10.1±3.8) kg/m2,超重体质量分别减少35.0％±13.5％、57.1％±17.7％、74.2％±27.2％和81.8％±29.4％.结论 腹腔镜袖套状胃切除术治疗体质量指数较小的肥胖患者是有效和安全的,但需要积累更多病例和长期随访观察研究来比较本手术与其他减肥手术的优缺点.     

袖状胃切除+单吻合口十二指肠回肠旁路术作为超级肥胖病人首选术式的合理性探讨

目的探讨袖状胃切除+单吻合口十二指肠回肠旁路术(single-anastomosis duodenoileal bypass with sleeve gastrectomy,SADI-S)作为首选术式在治疗超级肥胖病人中的临床价值及合理性。方法解放军总医院第一医学中心于2016年1月至2018年1月期间收治20例超级肥胖病人,所有病人术前体质量指数(body mass index,BMI)均超过50 kg/m 2 ,经多学科评估及完善术前各项相关准备后,对所有病人均行3D腹腔镜下SADI-S,统计并分析手术时间、术中出血量、术后1年内多余体重减少百分比(percentage of excess weight loss,%EWL)及糖尿病缓解率。结果 20例病人均在3D腹腔镜下完成SADI-S,未出现中转开腹病人。手术时间为(110.4±12.8) min,范围为95~210 min;术中出血量为(32.3±4.7) ml,范围为20~100 ml;术后住院时间为(8.1±1.6) d,范围为5~14 d。术后1个月、3个月、6个月、1年%EWL分别为(21.35±8.12)%、(43.14±5.19)%、(64.50±10.39)%、(73.81±8.47)%。术后随访满1年,20例超级肥胖病人中合并2型糖尿病者17例,其中14例达到完全缓解,缓解率达82.3%。结论 SADI-S作为超级肥胖病人手术治疗的一种新术式探索,设计上兼顾了腹腔镜袖状胃切除术和腹腔镜Roux-en-Y胃旁路术二者优点,操作方式相对简便、并发症相对较少,短期效果较为显著,其远期效果、安全性及对其他肥胖合并症的诊治仍需大样本、多中心长期对照研究,并需要与目前主流减重术式做进一步对比。     

Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy

BackgroundThe aim of this study was to evaluate the long-term effects of laparoscopic sleeve gastrectomy (LSG) on type 2 diabetes mellitus (T2DM) and other related co-morbidities in severely obese patients.MethodsFrom May 2003 to July 2008, 33 morbidly obese diabetic patients (20 with body mass index [BMI]>50 kg/m²) underwent LSG. A total of 23 females and 10 males participated, with a mean age of 49.3±8 years, mean preoperative BMI of 52.1±8.5 kg/m², mean fasting plasma glucose (FPG) of 143.2±47.9 mg/dL, mean glycosylated hemoglobin (HbA_1c) of 7.3%±1.4%, and a mean T2DM duration of 7 years. All patients had a 36-month follow-up, and 13 had a 60-month follow-up.ResultsTwenty-nine patients (87.8%) discontinued antidiabetic medications 3 months after LSG, (mean BMI of 42.8±7.8 kg/m²; FPG of 104.5±22.1 mg/dL; HbA_1c of 5.3%±.4%). At 36 months, 22 of 26 LSG patients (84.6%) had normal FPG and HbA_1c values without antidiabetic therapy. At the 60-month follow-up, 10 of 13 patients (76.9%) had normal FPG and HbA_1c values without antidiabetic therapy. The Framingham risk score decreased significantly from 9.7% preoperatively to 4.7% postoperatively. No new diabetic retinopathy occurred during the whole period of observation.ConclusionsThis study confirms the efficacy of LSG in the treatment of T2DM and indicates that, at both 36- and 60-month follow-ups, LSG can provide a significant percentage of treated patients with a prolonged remission of T2DM, with diminished cardiac risk factors and no development of diabetic retinopathy. These results compare favorably with those reported after standard medical therapy.     

New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients

BACKGROUND It has been established that bariatric surgery, including laparoscopic sleeve gastrectomy(LSG), has a positive impact on type 2 diabetes mellitus(T2 DM).However, less frequently T2 DM is reported as a risk factor for complications with this type of surgery.AIM To evaluate the safety of LSG in T2 DM.METHODS A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015. Data was collected through digitized records. Any deviation from normal postoperative care within the first 60 d was defined as an early complication, and further categorized into mild or severe.RESULTS Nine hundred eighty-four patients underwent LSG, among these 143(14.5%)were diagnosed with T2 DM. There were 19 complications in the T2 DM group(13.3%) compared to 59 cases in the non-T2 DM(7.0%). Out of 19 complications in the T2 DM group, 12 were mild(8.4%) and 7 were severe(4.9%). Compared to the non-T2 DM group, patients had a higher risk for mild complications(Odds-ratio2.316, CI: 1.163-4.611, P = 0.017), but not for severe ones(P = 0.615). An increase of 1% in hemoglobin A1 c levels was associated with a 40.7% increased risk for severe complications(P = 0.013, CI: 1.074-1.843) but not for mild ones.CONCLUSION Our data suggest that LSG is relatively safe for patients with T2 DM. Whether preoperative control of hemoglobin A1 c level will lower the complications rate has to be prospectively studied.     

Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review

BackgroundExisting evidence has suggested that bariatric surgery produces sustainable weight loss and remission or cure of type 2 diabetes mellitus (DM). Laparoscopic sleeve gastrectomy (LSG) has garnered considerable interest as a low morbidity bariatric surgical procedure that leads to effective weight loss and control of co-morbid disease. The objective of the present study was to systematically review the effect of LSG on type 2 DM.MethodsAn electronic data search of MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, TRIP, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library database was completed. The search terms used included LSG, vertical gastrectomy, bariatric surgery, metabolic surgery, and diabetes (DM), type 2 DM, or co-morbidities. All human studies, not limited to those in the English language, that had been reported from 2000 to April 2010 were included.ResultsAfter an initial screen of 3621 titles, 289 abstracts were reviewed, and 28 studies met the inclusion criteria and the full report was assessed. One study was excluded after a careful assessment because the investigators had combined LSG with ileal interposition. A total of 27 studies and 673 patients were analyzed. The baseline mean body mass index for the 673 patients was 47.4 kg/m² (range 31.0–53.5). The mean percentage of excess weight loss was 47.3% (range 6.3–74.6%), with a mean follow-up of 13.1 months (range 3–36). DM had resolved in 66.2% of the patients, improved in 26.9%, and remained stable in 13.1%. The mean decrease in blood glucose and hemoglobin A1c after sleeve gastrectomy was ?88.2 mg/dL and ?1.7%, respectively.ConclusionMost patients with type 2 DM experienced resolution or improvement in DM markers after LSG. LSG might play an important role as a metabolic therapy for patients with type 2 DM.     

Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35

Background Type 2 diabetes mellitus (T2DM) is a common disease with numerous complications. Bariatric surgery is an efficient procedure for controlling T2DM in morbidly obese patients. In T2DM, the incretin effect is either greatly impaired or absent. This study aimed to evaluate the preliminary results from interposing a segment of ileum into the proximal jejunum associated with a sleeve or diverted sleeve gastrectomy to control T2DM in patients with a body mass index (BMI) less than 35 kg/m². Methods For this study, 39 patients (16 women and 23 men) underwent two laparoscopic procedures comprising different combinations of ileal interposition into the proximal jejunum via a sleeve or diverted sleeve gastrectomy. The mean age of these patients was 50.3 years (range, 36–66 years). The mean BMI was 30.1 kg/m² (range, 23.4–34.9 kg/m²). All the patients had a diagnosis of T2DM that had persisted for at least 3 years and evidence of stable treatment with oral hypoglycemic agents or insulin for at least 12 months. The mean duration of T2DM was 9.3 years (range, 3–22 years). Results The mean operative time was 185 min, and the median hospital stay was 4.3 days. Four major complications occurred in the short term (30-days), and the mortality rate was 2.6%. The mean postoperative follow-up period was 7 months (range, 4–16 months), and the mean percentage of weight loss was 22%. The mean postoperative BMI was 24.9 kg/m² (range, 18.9–31.7 kg/m²). An adequate glycemic control was achieved for 86.9% of the patients, and 13.1% had important improvement. The patients whose glycemia was not normalized were using a single oral hypoglycemic agent. No patient needed insulin therapy postoperatively. All the patients except experienced normalization of their cholesterol levels. Targeted triglycerides levels were achieved by 71% of the patients, and hypertension was controlled for 95.8%. Conclusions The laparoscopic ileal interposition via either a sleeve gastrectomy or diverted sleeve gastrectomy seems to be a promising procedure for the control of T2DM and the metabolic syndrome. A longer follow-up period is needed.