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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 6/2020

01-06-2020 | Bariatric Surgery | Original Article

Does Reconstruction Type After Gastric Resection Matters for Type 2 Diabetes Improvement?

Authors: Mariana Costa, Artur Trovão Lima, Tiago Morais, Rui F. Almeida, Mário Nora, Marta Guimarães, Mariana P. Monteiro

Published in: Journal of Gastrointestinal Surgery | Issue 6/2020

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Abstract

Background

Gastrointestinal (GI) surgery involving gastric resection and bypass of intestinal segments was reported to facilitate glucose control in obese patients with type 2 diabetes (T2D).

Aim

Our aim was to assess whether the type of post-gastrectomy GI reconstruction also influences glucose control in T2D patients with BMI below 35 kg/m2 submitted to gastrointestinal surgery without bariatric intention.

Methods

A cohort of T2D Caucasian patients (n = 40) with upper GI malignancy (n = 33) or complicated reflux disease (n = 7) were submitted to either a gastrectomy plus Billroth II (BII) gastrojejunal anastomosis (n = 17), a gastrectomy plus Roux-en-Y gastrojejunostomy (RY) reconstruction (n = 18; subtotal gastrectomy n = 7 and total gastrectomy n = 11), or atypical gastrectomy without reconstruction (no-R) (n = 5). Patients were evaluated before and 2 years after surgery for body weight, Hb1Ac, need of glucose lowering drugs, and presence of diabetes.

Results

Body mass index (BMI) decreased after every surgical procedure when compared to baseline (− 0.9 ± 0.8 kg/m2 for BII vs − 4.3 ± 2.6 kg/m2 for RY vs − 4.6 ± 2.5 kg/m2 for no-R, p < 0.05), which was only significantly different after RY surgeries. Diabetes remission occurred in 5.9% of BII patients, in 27.8% of RY patients, and 0% of no-R patients, while in patients with persistent T2D, the needs for glucose-lowering drugs were significantly also decreased after RY (31.3% BII vs 66.7% RY vs 25% no-R, p = 0.03).

Conclusions

T2D Caucasian patients undergoing post-gastrectomy GI reconstructions without a bariatric intention experience a significant improvement of T2D, in a magnitude that could be influenced by the technical procedure performed in favor of RY reconstruction. Thus, presence of T2D should be taken into consideration when deciding for the type of post-gastrectomy GI reconstruction.
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Metadata
Title
Does Reconstruction Type After Gastric Resection Matters for Type 2 Diabetes Improvement?
Authors
Mariana Costa
Artur Trovão Lima
Tiago Morais
Rui F. Almeida
Mário Nora
Marta Guimarães
Mariana P. Monteiro
Publication date
01-06-2020
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 6/2020
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-019-04255-4

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