J Korean Surg Soc.  2011 Feb;80(2):103-110. 10.4174/jkss.2011.80.2.103.

The Effect of Duodenojejunal Bypass for T2DM Patients Below BMI 25 kg/m2 in Early Postoperative Period

• Hong IK
• Kim JY
• Lee YJ
• Choe YM
• Choi SK
• Lee KY
• Kim SJ
• Cho YU
• Ahn SI
• Hong KC
• Shin SH
• Kim KR
• Heo YS

• KMID: 2117117
• DOI: http://doi.org/10.4174/jkss.2011.80.2.103

Abstract

PURPOSE
Diabetes mellitus refers to one of several risk factors for cardiovascular diseases, renal failure and so on. Medical treatments of T2DM cannot suggest a perfect cure. But gastric bypass resulting in the exclusion of the duodenum and proximal jejunum has been shown to improve or resolve T2DM. The goal of this study is to evaluate the effect of duodenojejunal bypass for T2DM patients below BMI 25 kg/m2 in early postoperative period.
METHODS
Duodenojejunal bypass was performed on 25 patients at Inha University Hospital from July 2009 to April 2010. We compared 75 g OGTT, insulin, C peptide to those 7 days postoperative. The definitions for improvement are serum glucose level below 200 mg/dl of 75 g OGTT at 120 min or below 200 mg/dl at every other time in spite of over 200 mg/dl at 120 min.
RESULTS
A total of 25 patients (15 men and 10 women) were included. Median value BMI was 23.17 kg/m2 and the mean duration of T2DM was 8.3 years. There was a significant decrease of postoperative 75 g OGTT levels from 176, 268, 345, 373, 371 mg/dl to 125, 170, 200, 225 and 241 mg/dl, respectively (P<0.001). Only patients' age was an independent factor resolution of T2DM based on this study.
CONCLUSION
Duodenojejunal bypass could be one viable treatment modality for improving or resolving of T2DM although these are early results. This study has preliminary meanings only and the results of longer follow-up and a larger number of patients are necessary, by which we should be able to determine the effect and indications for surgical treatment of T2DM.

Keyword

T2DM; Duodenojejunal bypass; Metabolic surgery

MeSH Terms

C-Peptide
Cardiovascular Diseases
Diabetes Mellitus
Duodenum
Follow-Up Studies
Gastric Bypass
Glucose
Glucose Tolerance Test
Humans
Insulin
Jejunum
Male
Postoperative Period
Renal Insufficiency
Risk Factors
C-Peptide
Glucose
Insulin

Figure

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  Fig. 1 Duodenojejunal bypass. After transecting jejunum 80 cm from the Treitz ligament, end-to-end anastomosis of distal jejunum and duodenum was made. About 80 cm from this anastomosis, end-to-side jejunostomy was made.

• 

  Fig. 2 Comparison of OGTT between pre- and post-operation.

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