Essa M Aleassa1,2, Monique Hassan1, Kellen Hayes1, Stacy A Brethauer1, Philip R Schauer1, Ali Aminian3. 1. Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Ave, M61, Cleveland, OH, 44195, USA. 2. Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates. 3. Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Ave, M61, Cleveland, OH, 44195, USA. aminiaa@ccf.org.
Abstract
INTRODUCTION: Bariatric 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. METHODS: Metabolic 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. RESULTS: The 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. CONCLUSION: Findings 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.
INTRODUCTION: Bariatric 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. METHODS: Metabolic 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. RESULTS: The 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. CONCLUSION: Findings 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.
Authors: Ali Aminian; Stacy A Brethauer; Amin Andalib; Suriya Punchai; Jennifer Mackey; John Rodriguez; Tomasz Rogula; Matthew Kroh; Philip R Schauer Journal: Ann Surg Date: 2016-10 Impact factor: 12.969
Authors: Philip R Schauer; Deepak L Bhatt; John P Kirwan; Kathy Wolski; Ali Aminian; Stacy A Brethauer; Sankar D Navaneethan; Rishi P Singh; Claire E Pothier; Steven E Nissen; Sangeeta R Kashyap Journal: N Engl J Med Date: 2017-02-16 Impact factor: 91.245
Authors: Ali Aminian; Stacy A Brethauer; Christopher R Daigle; John P Kirwan; Bartolome Burguera; Sangeeta R Kashyap; Philip R Schauer Journal: Acta Diabetol Date: 2014-09-27 Impact factor: 4.280
Authors: Geltrude Mingrone; Simona Panunzi; Andrea De Gaetano; Caterina Guidone; Amerigo Iaconelli; Giuseppe Nanni; Marco Castagneto; Stefan Bornstein; Francesco Rubino Journal: Lancet Date: 2015-09-05 Impact factor: 79.321
Authors: Christopher R Daigle; Ali Aminian; Héctor Romero-Talamás; Ricard Corcelles; Jennifer Mackey; Tomasz Rogula; Stacy A Brethauer; Philip R Schauer Journal: JSLS Date: 2014 Jul-Sep Impact factor: 2.172