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Ileal Interposition with Diverted sleeve gastrectomy for treatment of Type 2 diabetes

Objective: The objective of the present study was to prospectively evaluate the results of laparoscopic ileal interposition (II) with diverted sleeve gastrectomy (DSG) for control of type 2 diabetes mellitus (T2DM) and related metabolic abnormalities. Materials and Methods: All patients underwent II +DSG. They had T2DM ≥5 years with poor glycemic control despite adequate dosage of oral hypoglycemic agents (OHAs) and/or insulin. The primary outcome was remission of diabetes (HbA1C <6.5% without OHAs/insulin), and secondary outcomes were reduction in antidiabetic agent requirement and components of metabolic syndrome. Results: We report the preliminary postoperative follow-up data of 13.1 ± 5.3 months (range: 3–26 months). There were 32 patients (Male: female = 21:11) with mean age of 48.7 ± 7.8 (range, 34-66 years), duration of diabetes of 13.1 ± 5.8 years (range, 5-30 years), and preoperative body mass index of 29.1 ± 6.9 kg/m2 (range: 22.4-39.5 kg/m2). Sixteen patients (50%) had hypertension, while dyslipidemia and microalbuminuria were present in 12 patients (39%) each. Twenty two patients (70.5%) had diabetes remission. Fifteen/sixteen (93%) patients had remission in hypertension. All participants had weight loss ranging between 15% and 25%. Postoperatively, statistically significant decline was observed in the glycemic and lipid parameters, microalbuminuria at all intervals (P<0.05). Patients with duration of follow up more than 6 months demonstrated to havebetter improvement in terms of reduction in glycemic, lipid parameters, and microalbuminuria. Three patients had vitamin B12 deficiency 1 year after surgery. Conclusion: Ileal interposition combined with DSG addresses both foregut and hindgut theories and brings about remissions in T2DM patients with reasonable safety. Our preliminary observations demonstrated the feasibility and efficacy of this novel surgical procedure as a promising option in T2DM.