Journal List > J Korean Surg Soc > v.80(2) > 1011237

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Hong, Kim, Lee, Choe, Choi, Lee, Kim, Cho, Ahn, Hong, Shin, Kim, and Heo: The Effect of Duodenojejunal Bypass for T2DM Patients Below BMI 25 kg/m2 in Early Postoperative Period
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2011; 80(2): 103-110.

Published online: 7 February 2011

DOI: https://doi.org/10.4174/jkss.2011.80.2.103

The Effect of Duodenojejunal Bypass for T2DM Patients Below BMI 25 kg/m2 in Early Postoperative Period

In Ki Hong, M.D., Jang Young Kim, M.D., Yeon Ji Lee, M.D.1, Yun-Mee Choe, M.D., Sun Keun Choi, M.D., Keon Young Lee, M.D., Sei-Joong Kim, M.D., Young Up Cho, M.D., Seung Ik Ahn, M.D., Kee Chun Hong, M.D., Seok Hwan Shin, M.D., Kyung Rae Kim, M.D., Yoon Seok Heo, M.D.

Department of Surgery, Inha University School of Medicine, Incheon, Korea.

1Department of Family Medicine, Inha University School of Medicine, Incheon, Korea.

Corresponding author (gshur@inha.ac.kr)

Received 25 October 2010       Accepted 17 December 2010

Copyright © 2011 The Korean Surgical Society

Abstract

Purpose

Diabetes mellitus refers to one of several risk factors for cardiovascular diseases, renal failure and so on. Medical treatments of T2DM cannot suggest a perfect cure. But gastric bypass resulting in the exclusion of the duodenum and proximal jejunum has been shown to improve or resolve T2DM. The goal of this study is to evaluate the effect of duodenojejunal bypass for T2DM patients below BMI 25 kg/m2 in early postoperative period.

Methods

Duodenojejunal bypass was performed on 25 patients at Inha University Hospital from July 2009 to April 2010. We compared 75 g OGTT, insulin, C peptide to those 7 days postoperative. The definitions for improvement are serum glucose level below 200 mg/dl of 75 g OGTT at 120 min or below 200 mg/dl at every other time in spite of over 200 mg/dl at 120 min.

Results

A total of 25 patients (15 men and 10 women) were included. Median value BMI was 23.17 kg/m2 and the mean duration of T2DM was 8.3 years. There was a significant decrease of postoperative 75 g OGTT levels from 176, 268, 345, 373, 371 mg/dl to 125, 170, 200, 225 and 241 mg/dl, respectively (P<0.001). Only patients' age was an independent factor resolution of T2DM based on this study.

Conclusion

Duodenojejunal bypass could be one viable treatment modality for improving or resolving of T2DM although these are early results. This study has preliminary meanings only and the results of longer follow-up and a larger number of patients are necessary, by which we should be able to determine the effect and indications for surgical treatment of T2DM.

Keywords: T2DM, Duodenojejunal bypass, Metabolic surgery

Figures and Tables

Fig. 1
Duodenojejunal bypass. After transecting jejunum 80 cm from the Treitz ligament, end-to-end anastomosis of distal jejunum and duodenum was made. About 80 cm from this anastomosis, end-to-side jejunostomy was made.
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Fig. 2
Comparison of OGTT between pre- and post-operation.
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Table 1
Demographics of patients (N=25)
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Mean±standard deviation.

Table 2
Comparison 75 g OGTT pre and post operation
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Table 3
Comparison between resolved and unresolved group
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P-value, compare the preoperative results of both groups. P-value<0.001, comparison between preoperative and postoperative in each group.

Table 4
Comparison of clinical values between the group of below and above 10 years
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