Metabolic effects of an entero-omentectomy in mildly obese type 2 diabetes mellitus patients after three years

Abstract

BACKGROUND:Various digestive tract procedures effectively improve metabolic syndrome, especially the control of type 2 diabetes mellitus. Very good metabolic results have been shown with vertical gastrectomy and entero-omentectomy; however, the metabolic effects of an isolated entero-omentectomy have not been previously studied.METHODS: Nine patients with type 2 diabetes mellitus and a body mass index ranging from 29 to 34.8 kg/m2 underwent an entero-omentectomy procedure that consisted of an enterectomy of the middle jejunum and exeresis of the major part of the omentum performed through a mini-laparotomy. Glucagon-like peptide-1 and peptide YY were measured preoperatively and three months following the operation. Fasting and postprandial variations in glycemia, insulinemia, triglyceridemia, hemoglobin A1c, and body mass index were determined in the preoperative period and 3, 18 and, 36 months after the operation.RESULTS: All patients significantly improved the control of their type 2 diabetes mellitus. Postprandial secretion of peptide YY and Glucagon-like peptide-1 were enhanced, whereas hemoglobin A1c, fasting and postprandial glucose, insulin, and triglyceride levels were significantly reduced. Mean body mass index was reduced from 31.1 to 27.3 kg/m2. No major surgical or nutritional complications occurred.CONCLUSIONS: Entero-omentectomy is easy and safe to perform. A simple reduction in jejunal extension and visceral fat causes important improvements in the metabolic profile.

Metabolic (Bariatric and Nonbariatric) Surgery for Type 2 Diabetes: A Personal Perspective Review

“…Because visceral adiposity is a risk factor for the metabolic complications associated with obesity, omentectomy was an early proposed surgical intervention to influence type 2 diabetes. Study reports of omentectomy alone, or in addition to a standard bariatric operation, varied as to no benefit (69,70), possible benefit (71,72), and demonstrable benefit (73,74).…”

Metabolic alterations following visceral fat removal and expansion

“…More specifically, intra-abdominal lipectomy reverses insulin resistance and glucose intolerance in obese, aged and young rodents 76 - 81 . Though controversial in humans, 82 , 83 omental fat removal improves insulin action, 84 , 85 whereas removal of non-visceral fat has no effect 86 . Conflicting results among human omentectomy studies likely occur because outcome measurements are not consistent or sensitive enough to detect metabolic improvements.…”

Effects of omentectomy in addition to sleeve gastrectomy on the metabolic and inflammatory profiles of obese rats

“…These same authors also found the beneficial effects of the entero-omentectomy alone on the glycemic profile of patients with T2D and obesity degree I during a 3-year follow-up period [23]. Heap et al also presented favorable results regarding the improvement of co-morbidities associated to obesity when performing a technique similar to the Santoro group, which included a subtotal lateral gastrectomy, placement of a gastric ring, partial resection of the jejunum, and omentectomy [24].…”