Gastrectomia vertical associada à interposição ileal laparoscópicas no tratamento do Diabetes mellitus do Tipo 2: resultados iniciais

Abstract

The epidemiological impact produced by type 2 diabetes mellitus (T2DM) is expressed in rising rates of morbidity and mortality and consequent permanent disabilities such as blindness, end-stage renal disease and amputations of lower extremities. The current treatment of T2DM should establish strict glycemic control, with low-calorie diet, increased physical exercise and medication. It is demonstrated progressive deterioration of pancreatic beta cell function, regardless of treatment type, and failure of 75.0% of diabetics to respond to monotherapy after nine years of treatment, making it necessary association of multiple resources to improve glycemic control. This study is evaluate the initial results obtained in short and medium term, in 30 patients with T2DM undergoing laparoscopic sleeve gastrectomy associated with ileal interposition (II+SG), for the following variables: feasibility, hospital stay, operative time, conversion, intraoperative complications, immediate postoperative complications, late postoperative complications (after discharge), mortality, weight loss, remission/improvement of diabetes control. Patients were followed for time ranging from six to 18 months. There were no intraoperative complications or conversion to open surgery. There was weight loss with statistically significant difference in body mass index pre-and postoperatively. The complete and / or partial remission (with no hypoglycemic therapy) was found in 80.0% of cases. In 20.0% of patients there were markedly improvement with the use of oral hypoglycemic agents. We conclude that the II+SG laparoscopic procedures is feasible, with reduced hospital stay and operative time, considering the high complexity of disease and operation, low rate of postoperative complications and weight loss adjusted for initial weight.