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Anti-Diabetes Operations : The Foundation for New Procedures George S.Ferzli, M.D., Giancarlo Cires, M.D., Benjamin Chandler, Rosemarie E.Hardin, M.D. Metabolic Surgery Symposium New Mexico, 2007
Background ,[object Object],[object Object],[object Object],Problem???  None of these options offers a cure!!! Solution:  BARIATRIC SURGERY??
Francesco Rubino . Bariatric Surgery:Effects on Glucose Homeostasis. Curr Opin Clin Nutr Metab Care. 9:497-507 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Francesco Rubino . Bariatric Surgery:Effects on Glucose Homeostasis. Curr Opin Clin Nutr Metab Care. 9:497-507 ,[object Object],[object Object], 
Buchwald H, Avidor Y, Braunwald E. et al. Bariatric Surgery: A Systemic Review & Meta-analysis. JAMA 2004; 292:1724-1737 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Buchwald H, Avidor Y, Braunwald E. et al. Bariatric Surgery: A Systemic Review & Meta-analysis. JAMA 2004; 292:1724-1737 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anti-diabetic Effect of Bariatric Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Foregut vs. Hindgut ,[object Object],[object Object],[object Object],Rubino F. Bariatric Surgery:effects on glucose homeostasis. Curr Opin Clin Nutr Metab Care 9:497-507
Proposed Mechanism?
Rubino F.  Bariatric Surgery: Effects on Glucose Homeostasis. Curr Opin Clin Nutr Metab Care 9:497-507 ,[object Object],[object Object],[object Object],[object Object]
Rubino F. Bariatric Surgery: Effects on Glucose Homeostasis. Curr Opin Clin Nutr Metab Care 9:497-507 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pacheco D . The effects of duodenal-jejunal exclusion on hormonal  regulation of glucose metabolism in Goto-Kakazi rats. Am J Surgery; 194 (2007):221-224 ,[object Object],[object Object],[object Object],[object Object]
Diabetes Operations ,[object Object],[object Object],[object Object]
Restrictive Procedures ,[object Object],[object Object],[object Object],[object Object]
Roux-en-Y Gastric Bypass ,[object Object],[object Object],[object Object],[object Object],Rubino F. Bariatric Surgery: Effects on Glucose Homeostasis. Curr Opin Clin Nutr Metab Care 9:497-507
Malabsorptive Procedures ,[object Object],[object Object],[object Object],[object Object],Rubino F. Bariatric Surgery: Effects on Glucose Homeostasis. Curr Opin Clin Nutr Metab Care 9:497-507
Jejunoileal Bypass ,[object Object],[object Object],[object Object],[object Object],Rubino F. Bariatric Surgery: Effects on Glucose Homeostasis.  Curr Opin Clin Nutr Metab Care 9:497-507
Biliopancreatic Diversion ,[object Object],[object Object],[object Object],[object Object],[object Object],Rubino F. Bariatric Surgery: Effects on Glucose Homeostasis.  Curr Opin Clin Nutr Metab Care 9:497-507
Duodenal Switch Duodenal switch variant involves sleeve gastrectomy and preservation of pylorus and short segment of duodenum
Anti-diabetic Effect of Bariatric Surgery ,[object Object],[object Object],[object Object],[object Object]
Direct Effect or Secondary Gain? ,[object Object],[object Object],[object Object],[object Object],DM Type 2 is a potentially operable disease Rubino F. Bariatric Surgery: Effects on Glucose Homeostasis. Curr Opin Clin Nutr Metab Care 9:497-507
Bariatric Surgery for Control of DM in non-obese patients??? ,[object Object],[object Object],[object Object],[object Object]
DePaula AL . et al. Laparoscopic treatment of type 2 DM for patients with BMI less than 35. Surg Endosc.  In press ,[object Object],[object Object],[object Object]
DePaula AL . et al. Laparoscopic treatment of type 2 DM for patients with BMI less than 35. Surg Endosc.  In press ,[object Object],[object Object],[object Object],[object Object],[object Object]
DePaula AL . et al. Laparoscopic treatment of type 2 DM for patients with BMI less than 35. Surg Endosc.  In press
DePaula AL . et al. Laparoscopic treatment of type 2 DM for patients with BMI less than 35. Surg Endosc.  In press
DePaula AL .   et al. Laparoscopic treatment of type 2 DM for patients with BMI less than 35. Surg Endosc.  In press
DePaula AL . et al. Laparoscopic treatment of type 2 DM for patients with BMI less than 35. Surg Endosc.  In press
FUTURE?????

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Anti-Diabetes Surgery Procedures Cure Type 2 Diabetes

  • 1. Anti-Diabetes Operations : The Foundation for New Procedures George S.Ferzli, M.D., Giancarlo Cires, M.D., Benjamin Chandler, Rosemarie E.Hardin, M.D. Metabolic Surgery Symposium New Mexico, 2007
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  • 19. Duodenal Switch Duodenal switch variant involves sleeve gastrectomy and preservation of pylorus and short segment of duodenum
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  • 25. DePaula AL . et al. Laparoscopic treatment of type 2 DM for patients with BMI less than 35. Surg Endosc. In press
  • 26. DePaula AL . et al. Laparoscopic treatment of type 2 DM for patients with BMI less than 35. Surg Endosc. In press
  • 27. DePaula AL . et al. Laparoscopic treatment of type 2 DM for patients with BMI less than 35. Surg Endosc. In press
  • 28. DePaula AL . et al. Laparoscopic treatment of type 2 DM for patients with BMI less than 35. Surg Endosc. In press

Editor's Notes

  1. This is “KEY”reference that’s why the key symbol is on the slide
  2. This is “KEY”reference that’s why the key symbol is on the slide
  3. JIB ultimately abandonned secondary to complications
  4. as the DJB model leaves the stomach undisturbed
  5. This leads to the next important question….Should patients with Ype 2 DM be considered for surgical treatment regardless of their BMI? Mention that interestingly, sporadic observations of diabetes remission have also been reported before the advent of bariatric surgery as a serendipitous outcome of gastric resection for peptic ulcer in non obese patients; In 1955 Freidman reported 3 patients with uncontrolled DM for years who had sudden reduction in insulin requriement 3-4 days after subtotal gastrectomy, long before substantial weight loss.
  6. What about diabetic patients with normal BMI? Can surgery be considered for non-obese diabetic patients
  7. MUST CLICK TWICE TO GET TO NEXT AND FINAL SLIDE !!!!!!!