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Laparoscopic revisional bariatric surgery is safe and effective. However, it should be performed only by experienced bariatric and laparoscopic surgeons.

Gastric bypass surgery causes resolution of type 2 diabetes (T2DM), which has led to the hypothesis that upper gastrointestinal (UGI) tract diversion, itself, improves glycemic control. The purpose of this study was to determine whether UGI tract bypass without gastric exclusion has therapeutic effects in patients with T2DM. We performed a prospective trial to assess glucose and β-cell response to an oral glucose load before and at 6, 9, and 12 months after duodenal-jejunal bypass (DJB) surgery. Thirty-five overweight or obese adults (BMI:27.0±4.0 kg/m2) with T2DM and 35 sex-, age-, race-, and BMI-matched subjects with normal glucose tolerance (NGT) were studied. Subjects lost weight after surgery, which was greatest at 3 months (6.9±4.9%) with subsequent regain to 4.2±5.3% weight loss at 12 months after surgery. HbA1C decreased from 9.3±1.6% before to 7.7±2.0% at 12 months after surgery (P<0.001), in conjunction with a 20% decrease in the use of diabetes medications (P<0.05); 7 (20%) subjects achieved remission of diabetes (no medications and HbA1C <6.5%). The area under the curve after glucose ingestion was ~20% lower for glucose but doubled for insulin and c-peptide at 12 months, compared with pre-surgery values (all P<0.01). However, the β-cell response was still 70% lower than subjects with NGT (P<0.001). DJB surgery improves glycemic control and increases, but does not normalize the β-cell response to glucose ingestion. These findings suggest that altering the intestinal site of delivery of ingested nutrients has moderate therapeutic effects by improving β-cell function and glycemic control.

The duodenal-jejunal bypass liner improves glycaemia in overweight and obese patients with Type 2 diabetes by rapidly improving insulin sensitivity. A reduction in hepatic glucose output is the most likely explanation for this improvement.

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ObjectiveTo determine whether upper gastrointestinal tract (UGI) bypass itself has beneficial effects on the factors involved in regulating glucose homeostasis in patients with type 2 diabetes (T2D).MethodsA 12-month randomized controlled trial was conducted in 17 overweight/obese subjects with T2D, who received standard medical care (SC, n=7, BMI=31.7±3.5 kg/m2) or duodenal-jejunal bypass surgery with minimal gastric resection (DJBm) (n=10; BMI=29.7±1.9 kg/m2). A 5-h modified oral glucose tolerance test (OGTT) was performed at baseline and at 1, 6 and 12 months after surgery or starting SC.ResultsBody weight decreased progressively after DJBm (7.9±4.1%, 9.6±4.2%, and 10.2±4.3% at 1, 6, and 12 months, respectively), but remained stable in the SC group (P<0.001). DJBm, but not SC, improved: 1) oral glucose tolerance (decreased 2-hr glucose concentration, P=0.039), 2) insulin sensitivity (decreased Homeostatic Model Assessment of Insulin Resistance, P=0.013), 3) early insulin response to a glucose load (increased insulinogenic index, P=0.022), and 4) overall glycemic control (reduction in HbA1c with less diabetes medications).ConclusionsDJBm causes moderate weight loss and improves metabolic function in T2D. However, our study cannot separate the benefits of moderate weight loss from the potential therapeutic effect of UGI tract bypass itself on the observed metabolic improvements.