Laparoscopic Duodenal-Jejunal Exclusion in the Treatment of Type 2 Diabetes Mellitus in Patients with BMI < 30 kg/m2 (LBMI)

The association between medical and dietetic-behavioral treatments of type 2 diabetes mellitus (T2DM) has demonstrated to have variable results. The surgical treatment of T2DM is justifiable after the observation of a successful glycemic control in patients submitted to Roux-en-Y gastric bypass and biliopancreatic diversion. Experiments have shown an important role of the proximal intestine in glycemia decrease and diabetes control. Twenty diabetic patients underwent laparoscopic duodenal-jejunal exclusion. The variables studied were body mass index (BMI), fasting glycemia, glycosylated hemoglobin (HbA(1)c), and C-peptide, in the preoperative period and after 3 and 6 months. There was a BMI decrease up to the third month and a weight stabilization between the third and sixth months. There was a significant reduction in fasting glycemia (43.8%) and HbA(1)c (22.8%) up to the sixth month (p < 0.001). C-peptide did not show any significant alteration until the third month, although there was a considerable increase (25%) between the third and the sixth months (p < 0.001). Only two patients were on oral medication after the sixth month. Preliminary results have shown an important effect of the laparoscopic duodenal-jejunal exclusion in the treatment of T2DM. Studies with longer follow-up and a larger number of patients are necessary to better define the role of this new and promising procedure.