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Dr. Robert RUTLEDGETitle of Paper: RESOLUTION OF DIABETES MELLITUS IN LOWER WEIGHT PATIENTS WITH MINI-GASTRIC BYPASS

Nationality: United States of AmericaPosition: Director

Department: SurgeryOrganization: Center For Laparoscopic Obesity Surgery

Tel: +1-702 714 0011E-mail: drr@clos.net

RESOLUTION OF DIABETES MELLITUS IN LOWER WEIGHT PATIENTS WITH MINI-GASTRIC

BYPASS

Robert RUTLEDGE11Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America

Introduction

• Bariatric procedures have been shown to improve the outcome of Diabetes Mellitus (DM).

Introduction

• The Mini-Gastric Bypass (MGB) • includes both a • Gastric component & • Bypass component • Which has been shown to be more

effective than either alone.

Introduction

• Studies have shown that the MGB leads to resolution of Type II DM in up to 95% of morbidly obese patients

• Because of the risks and danger of DM and the success of the MGB in obese diabetic the MGB was offered to lower weight patients.

Methods:

• 6,234 patients underwent MGB including

• 303 DM patients with BMI 21-35. • The MGB operations were

tailored for lower weight patients • Shorter bypass length and

Larger gastric pouch

Tailored MGB?

• Think as a General SurgeonNOT as a Bariatric Surgeon

• Antrectomy and Billroth IILarge pouch and 20-50 cm bypass

Tailored MGB

• Antrectomy and Billroth IILarge pouch and 20-50 cm bypass

• MGBSmall Pouch and Long (200 cm) Bypass

Tailored MGBFor THIN Diabetic

• Antrectomy and Billroth IILarge pouch and 20-50 cm bypass

• MGBSmall Pouch and Long (200 cm) Bypass

• Tailored MGB: For THIN DiabeticPouch << than AntrectomyPouch >> than “Bariatric” MGBBypass >> than AntrectomyBypass << than MGB

Tailored MGBFor THIN Diabetic

• Antrectomy and Billroth IIMinimal Weight Loss

• MGBMaximal Weight Loss

• Tailored MGBSelected for - Min Weight Loss+ Foregut Effect

Results

• 68.9% of patients were female. • Average age 48 + 11. • Follow up 6 to 48 months. • Mean preop weight

97 kg and post op was 69 kg • Mean weight loss of 27 kg.

Results

• DM resolved in 98% and improved in the remaining patients.

• 98% of patients were off all oral medications.

• 15.2% were taking insulin and all were taken off the insulin by their physicians.

Conclusions:

• The TAILORERD MGB particularly well suited for Rx of DM in low weight patients Gastric pouch = Larger & Bypass length = Shorter Weight loss can be customized

• Laparoscopic MGB has a beneficial effect on glucose metabolism and serum lipid composition in obese DM patients.

Conclusions

• The Mini-Gastric Bypass improves DM in 95% of obese patients and also leads to resolution or improvement of DM in lower weight patients.