Meister Katherine M, Schauer Philip R, Brethauer Stacy A, Aminian Ali
Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA.
Obes Surg. 2018 Apr;28(4):1086-1090. doi: 10.1007/s11695-017-2976-z.
Roux-en-Y gastric bypass (RYGB) has been shown to significantly improve glucose control in patients with type 2 diabetes (T2DM). The formation of a gastrogastric fistula (GGF) allows nutrients to pass through the native route, rather than bypassing the duodenum in typical RYGB configuration. We sought to evaluate the effect of revisional bariatric surgery for known GGF on control of diabetes.
A retrospective chart review of a single academic institution was performed to identify patients who had T2DM at the time of corrective surgery for a GGF. Baseline characteristics, and postoperative outcomes including changes in body mass index (BMI), glycated hemoglobin, fasting blood glucose (FBG), and diabetes medications were assessed.
Ten patients were identified with GGF who had T2DM at the time of corrective surgery. Patients had a male-to-female ratio of 2:3, a mean age of 59.2 ± 10 years, a mean baseline BMI of 38.1 ± 17.6 kg/m, and a median duration of 9 years (interquartile range 6-14) from initial RYGB to revision. At a mean follow-up of 14.9 ± 8.5 months, a mean reduction in BMI of 4.9 ± 6 kg/m was associated with a significant mean reduction in FBG (167.1 ± 88.2 vs. 106.1 ± 20.4 mg/dL, p = 0.04) and number of diabetes medications (1.4 ± 0.8 vs. 0.7 ± 0.7, p = 0.04).
In patients with diabetes and GGF, a corrective surgery for closure of fistula and restoration of bypass anatomy results in improvement of glucose control and status of diabetes medications. This finding can highlight the potential metabolic significance of duodenal exclusion.
Roux-en-Y胃旁路术（RYGB）已被证明能显著改善2型糖尿病（T2DM）患者的血糖控制。胃胃瘘（GGF）的形成使营养物质能够通过天然路径，而不是像典型的RYGB那样绕过十二指肠。我们试图评估针对已知GGF进行的减重手术修正对糖尿病控制的影响。
对一家学术机构进行回顾性病历审查，以确定在因GGF进行矫正手术时患有T2DM的患者。评估基线特征以及术后结果，包括体重指数（BMI）、糖化血红蛋白、空腹血糖（FBG）的变化以及糖尿病药物使用情况。
确定了10例在矫正手术时患有T2DM且伴有GGF的患者。患者男女比例为2:3，平均年龄为59.2±10岁，平均基线BMI为38.1±17.6kg/m²，从初次RYGB到修正手术的中位病程为9年（四分位间距6 - 14年）。平均随访14.9±8.5个月，BMI平均降低4.9±6kg/m²，同时FBG显著降低（167.1±88.2对106.1±20.4mg/dL，p = 0.04），糖尿病药物数量也显著减少（1.4±0.8对0.7±0.7，p = 0.04）。
对于患有糖尿病和GGF的患者，进行瘘管闭合和旁路解剖结构恢复的矫正手术可改善血糖控制及糖尿病药物使用状况。这一发现可凸显十二指肠旷置的潜在代谢意义。
