Bariatric Times

Sleeve Gastrectomy 2015

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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April 2015 • Supplement A • Bariatric Times A15 5 th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY BACKGROUND We started laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) in 2007 as an alternative to laparoscopic Roux- en-Y gastric bypass (RYGB), mainly because the prevalence of gastric cancer is comparatively high and the anatomical difficulty of cancer screening in the remnant stomach by upper gastrointestinal (UGI) endoscopy is considered a non- negligible problem in Japan. 1 LSG- DJB is a modification of duodenal switch ("short-limb" DS) and has the following features: 1. The pylorus, a physiological valve, is preserved, leading to less occurrence of dumping syndrome and reactive hypoglycemia, which can often be problematic after RYGB. 2. Duodenojejunostomy is located at 1 to 2cm distal to the pylorus; thus the anastomotic stoma can be created widely compared to the one in RYGB, contributing to less occurrence of anastomotic stenosis. 3. Theoretically, the combination of LSG and DJB is expected to have a strong anti-diabetic effect. LITERATURE REVIEW Recent data on the effectiveness of bariatric surgery as a treatment for type 2 diabetes mellitus (T2DM) in patients with morbid obesity (body mass index [BMI] >35kg/m 2 ) suggest that it may have an important role for treatment of T2DM in non-morbidly obese patients (BMI<35kg/m 2 ) as well. In Japan, according to recent statistics, prevalence of diabetes in the adult population is 16.2 percent in men and 9.2 percent in women, which means 7.2 million people are diabetic, making Japan the 10th highest in the world for T2DM prevalence. 2 The majority of Japanese patients with T2DM are not obese. The average BMI of those who have diabetes is 23.1kg/m 2 in Japan and 34.2kg/m 2 in the United States. This may be because Japanese patients are prone to central obesity and their insulin secretion is genetically impaired. In this study, we investigated the clinical effect of LSG-DJB on diabetic Japanese patients with BMI less than 35kg/m 2 . METHODS Since 2011, we have conducted the clinical trial "LSG-DJB for Asian T2DM with BMI from 27.5 to 34.9kg/m 2 "(UMIN000005716). Thirty-seven patients (19 women, 18 men) who underwent LSG-DJB and presented for follow up for at least one year were included in the analysis. The average age, body weight, and BMI at surgery were 45.7±7.6 years (28–61 years), 88.4±11.6kg (68.4–109.2kg), and 31.7±2.3 kg/m 2 (26.3–34.9kg/m 2 ), respectively. The average hemoglobin A1c (HbA1c) at the first visit was 9.1±1.7 percent • LSG-DJB is a modification of duodenal switch ("short-DS") and has advantages in terms of less occurrence of dumping syndrome, anastomotic stenosis, and marginal ulcer, which are often problematic after RYGB. • The combination of sleeve gastrectomy and DJB is expected to have a strong anti-diabetic effect. • The clinical effect of LSG-DJB on non-morbidly obese Japanese patients with T2DM was investigated, and preliminary results indicate that LSG-DJB is an effective treatment for advanced diabetes associated with mild to moderate obesity in Japanese patients. KEY POINTS Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass (LSG-DJB) for Diabetic Japanese Patients with BMI Less than 35kg/m 2 YOSUKE SEKI, MD, PhD; KENKICHI HASHIMOTO, MD, PhD; and KAZUNORI KASAMA, MD, FACS Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan Bariatric Times. 2015;12(4 Suppl A):A15–A17. DISCLOSURE: Drs. Seki, Hashimoto, and Kasama report no conflicts of interest relevant to the content of this article. ADDRESS CORRESPONDENCE TO: Kazunori Kasama, MD, FACS, 7-7 Nibancho, Chiyoda-ku, Tokyo 102-0084, Japan; Phone: +81-3-3261-0401; Fax: +81-3-3261-0402; E-mail: kasama@mcube.jp

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