INTRODUCTION: The effect of bariatric surgery on type 2 diabetes mellitus, which is usually seen with obesity, remains to be detailed.
METHODS: Patients with type 2 diabetes mellitus who underwent laparoscopic mini-gastric bypass surgery between April 2011 and April 2013 were included in the study retrospectively. Demographic variables [age, gender, body mass index (BMI, kg/m2)], and laboratory findings [fasting plasma glucose (mg/dL) and glycosylated hemoglobin (HbA1c, %)] were evaluated. Measurement of BMI and laboratory investigations were performed in preoperative period and at postoperative 1st, 3rd, 6th, and 12th months.
RESULTS: Type 2 diabetes mellitus was detected in 26 of 94 patients (27.7%) who underwent laparoscopic mini-gastric bypass surgery. There were 18 female patients (69.2%) and 8 male patients (30.8%), and mean age was 40.7±10 years. Preoperatively, 23 patients were under insulin therapy, and 3 were under oral anti-diabetic treatment. Mean BMI was calculated as 45±5.9 kg/m2. During evaluation of the patients at 1st (n=26), 3rd (n=26), 6th (n=23), and 12th months (n=14), mean BMI was 40±5.7, 33.7±5.1, 26.9±5.3, and 22.4±6.73 kg/m2, respectively. Mean fasting plasma glucose level changed from 217±70.2 mg/dL preoperatively to 134±28.8 mg/dL at 1st month, 137±45.4 mg/dL at 3rd month, 116±23.8 mg/dL at 6th month, and 100±28.8 mg/dL at 12th month. HbA1c level of less than 7% was achieved in 18 patients (69%) at 1st month, 23 patients (88%) at 3rd month, 21 patients (91%) at 6th month, and 11 patients (78%) at 12th month. At the end of 1 year, oral anti-diabetic use was required in only 3 of 14 patients who were followed-up.
DISCUSSION AND CONCLUSION: Remission in type 2 diabetes mellitus occurred in 78% of the patients based on laboratory values at end of first year after bariatric surgery, and none of the patients required parenteral use of insulin. In light of these data, laparoscopic mini-gastric bypass can be considered an effective method of treatment of type 2 diabetes mellitus and concurrent surgical treatment of morbid obesity.

Total of 484 bariatric procedures, predominantly (97.3%, 471 cases) Roux-en-Y gastric bypass, were performed between March 2006 and December 2014. Bariatric program at this facility began with open Roux-en-Y gastric bypass and, in time, progressed to routine laparoscopy. After several modifications, technique was mainly standardized, and education program for laparoscopic Roux-en-Y gastric bypass was launched in June 2013. Five surgeons were educated with full, hands-on experience during the last 18 months of the program. Aim of this report was to summarize daily practice in bariatric surgery, primarily focusing on this program. Preoperative/postoperative care, and some tips and tricks related to technique of laparoscopic Roux-en-Y gastric bypass were included.

Since Rutledge developed single anastomosis gastric bypass in 1990, it has been popularized by surgeons in Europe as procedure of choice in the morbidly obese. It involves creating gastric pouch of 12 cm and antecolic loop gastroenterostomy 200 cm distal to the ligament of Treitz. It has comparable excess body weight loss rate to Roux-en-Y gastric bypass, and safety profile is better. This review summarized technical details and key points in performing safe procedure and outlined results of key, high volume series in terms of outcome and technical feasibility.

Metabolic syndrome and 2 of its most important components, obesity and type 2 diabetes, have reached pandemic proportions threatening the entire world. Initial treatment options directed at life style changes, including diet and exercise, have failed to achieve desired results for an important portion of patients and status of considerable number of patients has eventually become worse than pre-treatment due to reactive weight regain. Currently, the most effective treatment for obesity and type 2 diabetes is, without doubt, surgical procedure. There is no treatment option that can achieve remission for all of the components of metabolic syndrome with over 90% efficiency. However, it should be known that there are numerous methods used for surgical treatment of metabolic syndrome, and all have advantages, disadvantages, and restrictions of their own. Also, each has its own rate of efficiency. Aim of this article was to provide a brief understanding of mechanisms of action and to analyze outcomes of diverted sleeve gastrectomy with ileal transposition as functional restrictive therapeutic option for obese and non-obese patients with type 2 diabetes.

Bariatric surgery is one of the fastest growing hospital procedures performed in the world and is also an important option for patients with extreme obesity and co-morbidities. Bariatric surgery, however, involves risks and complications. Complications following surgical treatment of severe obesity vary based upon the procedure performed, and rate can be as high as 40 percent. Due to high surgical volume, improving the safety of these operations has become a high priority, leading to development of strict criteria for center accreditation, guidelines for safe and effective bariatric surgery, and careful monitoring of surgical outcomes. This report is a review of major complications of bariatric surgery.

Bariatric surgeries can help resolve metabolic derangements concomitant to obesity; therefore, they are now referred to as metabolic surgeries. Duodenojejunal bypass (DJB) is a new procedure of metabolic surgery relying on foregut hypothesis. DJB has been described as standalone procedure to treat non-obese diabetic patients; however, loop DJB may also be performed in combination with sleeve gastrectomy (LDJB/SG) for obese patients. Literature review revealed 59 patients who underwent LDJB/SG in 3 clinical studies. Operation time, complication rate, improvements in preoperative comorbidities, and weight reduction in these patients were assessed. Effect of LDJB/SG on type 2 diabetes was observed to range from 70% to 92.9%, and it improved hypertension by 80% to 85.7% and hyperlipidemia by 100%. Obese patients lost nearly 80% of their excess weight. LDJB/SG is a safe and effective procedure to maintain weight loss in the long term and to achieve perfect outcomes in comorbidity improvement. However, there is a need for long-term follow-up studies.

Type 2 diabetes mellitus (T2D) develops in adulthood, and its exact etiology is still unknown. Obesity is major independent risk factor for T2D, as it is closely associated with insulin resistance. Bariatric surgery was initially used to induce weight loss in obese patients. However, it was observed that it also results in improvement in many comorbidities, including T2D. Curing diabetes cannot yet be considered a goal of bariatric surgery, but it is a serendipitous benefit. Mechanism of the effects of bariatric surgery on T2D was discussed in this review.

Long-term bariatric follow-up requires team approach and attention to several aspects of care. Active nutritional patient education and clinical management to prevent and detect nutritional deficiencies are recommended for all patients who undergo bariatric surgery. Patients who make dietary and lifestyle changes as an adjunct to their surgical procedure have better nutritional and weight loss outcomes than those who have limited follow-up. This article provides management and follow-up strategies for nutritional and dietary considerations of patients after bariatric surgery.