Page 21 - World Journal of Laparoscopic Surgery

WJOLS
WJOLS

10.5005/jp-journals-10033-1231
Remission of Type 2 Diabetes Mellitus after Laparoscopic Sleeve Gastrectomy
OriginaL articLe

Remission of Type 2 Diabetes Mellitus after

Laparoscopic Sleeve Gastrectomy

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1 Salman Al-Sabah, Sulaiman Almazeedi, Sameer Alosaimi, Ahmed Al-Mulla, Daliya Al-Mohammad Ali
6 Abdullah Al-Elewah, Ardavan Algooneh
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ABSTRACT associated with a high body mass index (BMI) have
Introduction: Type 2 diabetes mellitus (T2DM) comprises become evident. Over a span of 20 years, namely between
90% of diabetics and is largely the result of excess body 1980 and 2008, the recorded percentage of overweight
weight. There is rising evidence in the literature to suggest that adults has reached 1.4 billion people worldwide (35% of
laparoscopic sleeve gastrectomy (LSG) produces effective
weight loss and improves obesity-related comorbidities, such the world’s population), of those 200 million men and
as T2DM. The purpose of the study is to observe the effective- 300 million women are considered obese (11% of the
ness of LSG in the remission of T2DM. population). When in view of the health hazards linked
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Materials and methods: A retrospective study of 107 diabetic to obesity, these numbers are somber. They translate as
obese patients who underwent LSG at Alamiri Hospital, from health risks, such as diabetes mellitus type 2 (T2DM),
October 2008 to 2012 was conducted. The pre- and post-
operative diabetic status, body mass index, and percent excess insulin resistance, heart disease, dyslipidemia, hyper­
weight loss (%EWL) of the patients were retrieved and analyzed. tension, stroke, venous thrombus formation, osteo­
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Results: The mean age of the patients was 42 years ± 10.4 arthritis, and psychosocial effects. Furthermore, all­cause
and 68% were females. Median preoperative BMI was 46 kg/m 2 mortality and cardiovascular disease related mortality
(30-87) and median postoperative follow-up period was
18 (2-48) months. Pre- and postoperative fasting blood glucose are parti cularly increased in the overweight populace. 3
and HbA1C were measured. Resolution and improvement of As of 2011 bariatric surgery is formally considered a
T2DM was 53.3% (n = 57) and 38.3% (n = 41), respectively. component of the early management of T2DM to decele­
The %EWL was 72% at 1 year and 73% at 4 years and median
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postoperative BMI was 33 kg/m (20-61). Duration based rate the progression of the disease and, thereby reduce
analysis showed that most of the resolved patients had diabetes mortality, morbidity and cost of treatment, thereby
for less than 5 years. improving the quality of life. The exact influential
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Conclusion: LSG resulted in total remission of T2DM in more mechanism of bariatric surgery on glucose metabolism
than half of the patients and is more effective for the treatment
of patients with short-term duration of the disease. is uncertain; however, it is thought to be secondary to
Keywords: Bariatric surgery, Sleeve gastrectomy, Diabetes the effects of hormones, principally: ghrelin, peptide YY
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mellitus. (PYY3­36), and glucagon­like peptide 1 (GLP­1).
How to cite this article: Al-Sabah S, Almazeedi S, Alosaimi S, It remains to be said that despite this, bariatric
Al-Mulla A, Ali DA, Al-Elewah A, Algooneh A. Remission of Type surgery is usually only considered once medical therapy
2 Diabetes Mellitus after Laparoscopic Sleeve Gastrectomy. has failed or glycemic control cannot be achieved ade­
World J Lap Surg 2014;7(3):121-124.
Source of support: Nil quately. In this study, we aim to observe the effectiveness
of laparoscopic sleeve gastrectomy (LSG) in the manage­
Conflict of interest: None
ment and definite treatment of T2DM.
inTRoDuCTion
MATERiALS AnD METhoDS
Obesity has recently gained the attention of many A retrospective study was conducted of the patients
physicians over the world as the numerous morbidities
who underwent LSG at Al­Amiri Hospital, Kuwait
from October 2008 to December 2012. From those, the
diabetic patients were isolated and their files with
1,3,4 Consultant General/Bariatric Surgeon
2,5-7 Surgical Resident pre­ and postoperative laboratory investigations were
1,2,4-7 Department of Surgery, Amiri Hospital, Kuwait Ministry of retrieved. LSG was performed in a standard split­leg
Health, Kuwait City, Kuwait French position using five laparoscopic ports. Devascula­
3 Department of Surgery, Al-Sabah Hospital, Kuwait Ministry rization of the greater curvature of the stomach was
of Health, Kuwait City, Kuwait carried out starting from 4 to 6 cm from the pylorus and
Corresponding Author: Sulaiman Almazeedi, Surgical up to the angle of His. A 36­Fr calibrating bougie was then
Resident, Department of Surgery, Amiri Hospital, Kuwait passed through the stomach to the duodenum before crea­
Ministry of Health, Kuwait City, Kuwait, Phone: +965-99012478 ting the gastric sleeve. The sleeve was performed with a
e-mail: al_mazeedi@yahoo.com
linear laparoscopic stapler using green or black cartridges
World Journal of Laparoscopic Surgery, September-December 2014;7(3):121-124 121