Hypoabsorptive surgery is the best revisional strategy for metabolic and diabetes outcomes

Gautier, Michel

doi:10.1016/j.soard.2020.06.053

Cited by 7 publications

(2 citation statements)

References 7 publications

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“…For remission rates however, RYGB (62%) performed significantly better than r-SG (33%). Many postulate that the malabsorptive function of duodenal exclusion and benefits of gut hormones changes in small intestine bypasses are reason for that those should be chosen for RBS [ 41 ]. Another single center studies provide remission rates of T2D after RBS of SG as follows: 100% SASI, 85–100% after revisional OAGB, 60% after revisional RYGB, 88% after SADI [ 42 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

The analysis of factors increasing the odds for type 2 diabetes mellitus remission following re-do bariatric surgery after laparoscopic sleeve gastrectomy- cohort study

Wysocki,

Ciszek,

Rymarowicz

et al. 2023

Langenbecks Arch Surg

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Introduction Metabolic/bariatric surgery is the only proven treatment for type 2 diabetes mellitus (T2D) with curative intent. However, in a number of patients, the surgery is not effective or they may experience a relapse. Those patients can be offered re-do bariatric surgery (RBS). Purpose The study aimed to determine factors increasing the odds for T2D remission one year after RBS following primary laparoscopic sleeve gastrectomy. Methods A multicenter retrospective cohort study was conducted between January 2010 and January 2020, which included 12 bariatric centers in Poland. The study population was divided into groups: Group 1- patients with T2D remission after RBS (n = 28) and Group 2- patients without T2D remission after RBS (n = 49). T2D remission was defined as HBA1c < 6.0% without glucose-lowering pharmacotherapy and glycemia within normal range at time of follow-up that was completed 12 months after RBS. Results Fifty seven females and 20 males were included in the study. Patients who achieved BMI < 33 kg/m2 after RBS and those with %EBMIL > 60.7% had an increased chance of T2D remission (OR = 3.39, 95%CI = 1.28–8.95, p = 0.014 and OR = 12.48, 95%CI 2.67–58.42, p = 0.001, respectively). Time interval between primary LSG and RBS was significantly shorter in Group 1 than in Group 2 [1 (1–4) vs. 3 (2–4) years, p = 0.023]. Conclusions Shorter time interval between LSG and RBS may ease remission of T2D in case of lack of remission after primary procedure. Significant excess weight loss seems to be the most crucial factor for T2D remission.

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Section: Discussionmentioning

confidence: 99%

The analysis of factors increasing the odds for type 2 diabetes mellitus remission following re-do bariatric surgery after laparoscopic sleeve gastrectomy- cohort study

Wysocki,

Ciszek,

Rymarowicz

et al. 2023

Langenbecks Arch Surg

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“…Hence the Lewis et al study is too short and comes to the wrong conclusion, because sleeve gastrectomy patient can be offered a second stage, that is a duodenal switch (as biliopancreatic diversion are not done anymore) or a single anastomosis duodenal switch, which would result in a diabetes resolution twice as high as a gastric bypass 10 years later. 3…”

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confidence: 99%

Comment on ‘‘Comparative Effectiveness of Vertical Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass for Diabetes Treatment: A Claims-based Cohort Study’’ or Why Gastric Bypass Might Not be a Good Choice for Type-2 Diabetes Treatment

Gautier

2021

Annals of Surgery

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compared to 25% in the FOLFIRINOX arm.8 The impact of different neoadjuvant therapies on PNI status should be further highlighted because it could be extremely important for the selection of the best neoadjuvant treatment strategy as well as to evaluate new potential therapeutic strategies.As stated by the authors, further research is also required to determine the molecular mechanisms underlying PNI and the interactions between nerves and cancer cells. This knowledge could guide the development of new therapeutic strategies that inhibit both pain and cancer dissemination. Implementation of single-cell RNA-sequencing and laser-capture microdissection, or the combination of these techniques, as recently reported for optic nerve crush-related early mRNA alterations in retinal ganglion cells.9 This approach can aid to disentangle tumor from nerves signals and assist to uncover subtype-specific vulnerabilities in the PDAC/ nerves relationships that could be targeted by different drugs.It would also be worthwhile to perform prospective trials paralleled by preclinical experiments in emerging models such as organoids, that can be co-cultured with other cell types of the TME, including nerves.10 These models should allow to monitor the interactions among different cell type in physiological or pathological conditions as well as in response to drugs. In particular, single-cell omics of these models should unravel key factors in intercellular communication and their impact on cancer dissemination that could be exploited as prognostic biomarkers and therapeutic targets.In conclusion, we are indebted to Crippa et al for their research on the implications of PNI on disease recurrence and survival after pancreatectomy. We agree that observational studies can provide a strong rationale for future trials, but standardized techniques of sample collection/processing/analysis, larger and uniformly treated populations with appropriate annotation clinical outcome and pain relief, according to powered statistical analysis, and integration with functional data are essential to strengthen the value of PNI in clinics beyond already available PDAC bio-markers.

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Duodenal Bipartition or Side-to-Side Duodeno-Ileostomy: Rationale and Technical Details

Gautier¹,

Lapointe-Gagner²

2023

Duodenal Switch and Its Derivatives in Bariatric and Metabolic Surgery

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Hypoabsorptive surgery is the best revisional strategy for metabolic and diabetes outcomes

Cited by 7 publications

References 7 publications

The analysis of factors increasing the odds for type 2 diabetes mellitus remission following re-do bariatric surgery after laparoscopic sleeve gastrectomy- cohort study

The analysis of factors increasing the odds for type 2 diabetes mellitus remission following re-do bariatric surgery after laparoscopic sleeve gastrectomy- cohort study

Comment on ‘‘Comparative Effectiveness of Vertical Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass for Diabetes Treatment: A Claims-based Cohort Study’’ or Why Gastric Bypass Might Not be a Good Choice for Type-2 Diabetes Treatment

Duodenal Bipartition or Side-to-Side Duodeno-Ileostomy: Rationale and Technical Details

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