Ileal Interposition With Sleeve Gastrectomy for Control of Diabetes

Interventional Study of Effects of Ileal Interposition With Sleeve Gastrectomy for Control of Type 2 Diabetes

Ileal interposition shifts a segment of ileum proximally to achieve maximal meal stimulated Glucagon-Like Peptide-1 secretion and coupled with a limited/complete sleeve gastrectomy (depending on the Body Mass Index), for Ghrelin reduction, helps in achieving good glycemic control in Type 2 Diabetes patients.

Laparoscopically, using 6 ports, the ileum is tarnsected at 30 cms proximal to ileo-caecal junction and at 200 cms proximal to Ileo-Caecal junction;this ileal segment of 170 cms is interposed into proximal jejunum between 20-50 cms distal to Ligament of Treitz. Endo-GIA staplers and hand-sown closure was used for the 3 anastomoses. The mesenteric gaps defects were closed with 3/0 prolene sutures. Sleeve gastrectomy was done starting from antrum/body upto angle of His with a sizing bougie ranging from size 32--58 Fr.

Inclusion Criteria:

• Type 2 Diabetes (as defined by American Diabetes Association criteria)of more than 1 year duration
• Body Mass Index 21 - 55 kg/m^2
• Poor glycemic control (HbA1c > 8%) despite maximal use of Oral Hypoglycemic Agents and Insulin; or good control(lower HbA1c) but requiring progressively higher drug doses.
• Gives Informed Consent for the surgery
• Postmeal C peptide > 1.0 ng/mL
• Age 25 - 75 years
• Stable weight for more than 3 months

Exclusion Criteria:

• Type 1 Diabetes
• Postmeal C peptide < 1 ng/mL
• Pregnancy
• Significant nephropathy requiring dialysis
• Coexisting systemic disease
• Previous gastric or intestinal resection surgery
• Obesity due to organic illness