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Effect of revisional bariatric surgery on type 2 diabetes mellitus

机译：常规畜分手术对2型糖尿病的影响

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IntroductionBariatric and metabolic surgery significantly improves type 2 diabetes mellitus (T2DM). However, a small percentage of patients after bariatric surgery either have persistent hyperglycemia or relapse of their T2DM. These patients are usually medically managed. The aim of this study was to evaluate the effect of revisional surgery on the glycemic status of patients with T2DM who either failed to remit or relapsed after an initial remission following bariatric surgery.MethodsMetabolic parameters and clinical outcomes of 81 patients with persistent or relapsed T2DM after revisional bariatric surgery at an academic center between 2008 and 2017 were studied.ResultsThe most common types of revisional surgery were pouch and/or stoma revision of Roux-en-Y gastric bypass (RYGB) (n=22, 27.2%), conversion of vertical banded gastroplasty (VBG) to RYGB (n=20, 24.7%), conversion of adjustable gastric banding (AGB) to RYGB (n=14, 17.3%), and conversion of sleeve gastrectomy (SG) to RYGB (n=13, 16%). Revision of pouch/stoma after RYGB yielded improvement of T2DM in 50% of patients and remission in 22.7%. Conversion to RYGB yielded improvement of T2DM in 55%, 35.7%, and 30.8% of patients who previously had VBG, AGB, or SG, respectively. Furthermore, conversion of VBG, AGB, and SG to RYGB was associated with diabetes remission rates of 35%, 35.7%, and 23.1%, respectively.ConclusionFindings of this study, which is the largest series to date, indicate that revisional surgery in patients with persistent or relapsed T2DM after bariatric surgery can significantly improve glucose control and use of diabetes medications. Further clinical and mechanistic studies are needed to better demonstrate the role of revisional bariatric surgery in patients with residual T2DM.
机译：引进的bariatric和代谢手术显着改善2型糖尿病（T2DM）。然而，肥胖手术后的患者的一小部分患者患有持续的高血糖或复发的T2DM。这些患者通常是医学管理的。本研究的目的是评估常规手术对T2DM患者血糖地位的影响，在牛仔术后初次缓解后未能延长或复发。在持续或复发的81名患者的患者之后，2DMET代谢参数和临床结果研究了2008年至2017年之间学术中心的急性肥胖症手术。遗传最常见的常见手术类型是袋子和/或粗糙的ROUX-ZH-Y胃旁路（RYGB）的修改（N = 22,27.2％），转换垂直带状肉食术（VBG）至RygB（n = 20,24.7％），将可调节胃带（AGB）转化为RygB（n = 14,17.3％），并将套筒胃切除术（SG）转化为RygB（n = 13 ，16％）。 Rygb在50％的患者中提高T2DM后的袋/造口囊和22.7％。转化为RygB分别产生55％，35.7％和30.8％以前具有VBG，AGB或SG的患者的T2DM。此外，VBG，AGB和SG转化为RygB与糖尿病缓解率分别有关，分别为35％，35.7％和23.1％。本研究的组合件，这是迄今为止最大的系列，表明患者的常规手术在肥胖手术后持续或复发的T2DM可以显着改善葡萄糖控制和使用糖尿病药物。需要进一步的临床和机械研究，以更好地展示常规肥胖症手术在残留的T2DM患者中的作用。

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