Impact of the different biliopancreatic limb length on diabetes and incretin hormone secretion following distal gastrectomy in gastric cancer patients

The present study aimed to investigate changes in glucose metabolism and incretin hormone response following longer intestinal bypass reconstruction after distal gastrectomy (DG) in low BMI patients with gastric cancer and type 2 diabetes. A total of 20 patients were prospectively recruited and underwent either conventional Billroth I (BI), Billroth II with long-biliopancreatic limb (BII), or Roux-en-Y anastomosis with long-Roux limb (RY) after DG. A 75g-oral glucose tolerance test (OGTT) was given preoperatively; and at 5 days, 3 months, and 6 months postoperatively. Serum glucose, insulin, glucagon, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) were serially measured. At 6 months after surgery, complete diabetes remission was achieved in 57.1% of the BII group but in no patients in the other two groups (p = 0.018). BII group showed a significant reduction in glucose concentration during OGTT at 6 months in contrast to the other 2 groups. In the BII group, a significant increase in GLP-1 secretion was observed after surgery but not maintained at 6 months, while postoperative hyperglucagonemia was alleviated along with a reduction in GIP. BII gastrojejunostomy with long biliopancreatic limb achieved better diabetes control with favorable incretin response after DG compared to BI or RY reconstruction.

Sleeve-Plus Procedures in Asia: Duodenojejunal Bypass and Proximal Jejunal Bypass

Laparoscopic sleeve gastrectomy (SG) is the most commonly done bariatric procedure worldwide due to its technical ease. However, the physiologic effects of this procedure have limitations on glucose homeostasis for patients with type 2 Diabetes Mellitus (T2DM). This is due to the insufficient physiologic modulations from intestinal hormones. The Roux-en-Y gastric bypass (RYGB) has been proven to have better T2DM remission than SG due to more pronounced physiologic changes from foregut and hindgut hormone modulations. However, RYGB is technically challenging to perform and is accompanied by many potential postoperative complications, especially in terms of nutrition. The addition of an intestinal bypass to SG also induces said intestinal hormone changes to enhance diabetes remission. This chapter discusses the intestinal bypass that may be added to SG as surgical options for the treatment of obesity and T2DM with focus on duodenojejunal and proximal jejunal bypass.

The Effect of Standard versus Longer Intestinal Bypass on GLP-1 Regulation and Glucose Metabolism in Patients with Type 2 Diabetes Undergoing Roux-en-Y Gastric Bypass. The Long-Limb study

Objective <p>Roux-en-Y gastric bypass (RYGB) characteristically enhances post-prandial levels of Glucagon-like peptide 1 (GLP-1), a mechanism that contributes to its profound glucose-lowering effects. This enhancement is thought to be triggered by bypass of food to the distal small intestine with higher densities of neuroendocrine L-cells. We hypothesised that if this is the predominant mechanism behind the enhanced secretion of GLP-1, a longer intestinal bypass would potentiate the post-prandial peak in GLP-1, translating into higher insulin secretion and thus additional improvements in glucose tolerance. To investigate this, we conducted a mechanistic study comparing two variants of RYGB that differ in the length of intestinal bypass.</p> <p>Research Design and Methods</p> <p>Fifty-three patients with type 2 diabetes and obesity were randomised to either ‘standard limb’ RYGB (50cm biliopancreatic limb) or ‘long limb’ RYGB (150cm biliopancreatic limb). They underwent measurements of GLP-1 and insulin secretion following a mixed meal and insulin sensitivity using euglycaemic hyperinsulinaemic clamps at baseline, 2 weeks and at 20% weight loss after surgery.</p> <p>Results</p> <p>Both groups exhibited enhancement in post-prandial GLP-1 secretion and improvements in glycaemia compared to baseline. There were no significant differences in post-prandial peak concentrations of GLP-1, time to peak, insulin secretion, and insulin sensitivity. </p> <p>Conclusion</p> The findings of this study demonstrate that lengthening of the intestinal bypass in RYGB does not affect GLP-1 secretion. Thus, the characteristic enhancement of GLP-1 response after RYGB might not depend on delivery of nutrients to more distal intestinal segments.

The Effect of Standard versus Longer Intestinal Bypass on GLP-1 Regulation and Glucose Metabolism in Patients with Type 2 Diabetes Undergoing Roux-en-Y Gastric Bypass. The Long-Limb study

Objective <p>Roux-en-Y gastric bypass (RYGB) characteristically enhances post-prandial levels of Glucagon-like peptide 1 (GLP-1), a mechanism that contributes to its profound glucose-lowering effects. This enhancement is thought to be triggered by bypass of food to the distal small intestine with higher densities of neuroendocrine L-cells. We hypothesised that if this is the predominant mechanism behind the enhanced secretion of GLP-1, a longer intestinal bypass would potentiate the post-prandial peak in GLP-1, translating into higher insulin secretion and thus additional improvements in glucose tolerance. To investigate this, we conducted a mechanistic study comparing two variants of RYGB that differ in the length of intestinal bypass.</p> <p>Research Design and Methods</p> <p>Fifty-three patients with type 2 diabetes and obesity were randomised to either ‘standard limb’ RYGB (50cm biliopancreatic limb) or ‘long limb’ RYGB (150cm biliopancreatic limb). They underwent measurements of GLP-1 and insulin secretion following a mixed meal and insulin sensitivity using euglycaemic hyperinsulinaemic clamps at baseline, 2 weeks and at 20% weight loss after surgery.</p> <p>Results</p> <p>Both groups exhibited enhancement in post-prandial GLP-1 secretion and improvements in glycaemia compared to baseline. There were no significant differences in post-prandial peak concentrations of GLP-1, time to peak, insulin secretion, and insulin sensitivity. </p> <p>Conclusion</p> The findings of this study demonstrate that lengthening of the intestinal bypass in RYGB does not affect GLP-1 secretion. Thus, the characteristic enhancement of GLP-1 response after RYGB might not depend on delivery of nutrients to more distal intestinal segments.

Risk Assessment of Perioperative Infection about 263 Diabetic Patients Undergoing Small Bowel Lateral-lateral Anastomos(intestinal bypass)

Objective: Analyze and summarize the risk assessment of perioperative infection of 263 diabetic patients undergoing small bowel lateral-lateral anastomos(intestinal bypass )in the small intestine's side ,discuss the managerial methods of antimicrobial agents during the perioperative period. Methods: Retrospectively analyze the clinical data of patients who underwent laparoscopic small bowel lateral anastomosis (intestinal bypass) from January 2018 to December 2018. The patients with HBA1c ?9.0% were selected as the observation group and patients with HBA1c < 9.0% as the control group. Results: The decling range of the average value about blood glucose in the observation group was greater than that in the control group. The difference was statistically significant (P<0.05). The average postoperative neutrophil ratio of the observation group was higher than that of the control group; and the difference was statistically significant(P<0.05). The proportion of patients with postoperative body temperature over 37 degrees in the observation group was higher than that in the control group. Conclusion: Laparoscopic lateral anastomosis (intestinal bypass surgery) may cause intestinal fluid overflow and intestinal flora ectopic, for the diabetic patients with poor blood glucose control, perioperative risk of infection increased, we should consider strengthening the grade of antimicrobial agents in preventive application, better cover gram-negative bacteria and anaerobic bacteria.

Surgery Techniques for Urgent Intestinal Neostomy and Bypass

Introduction. Modern standards for the treatment of acute abdominal surgical diseases suggest a temporary exclusion of the impaired intestinal part from the digestion. This reduces the morbidity of the primary operation, but also results in specific postoperative complications.The aim of the study was to analyze current data on the technique and effectiveness of urgent intestinal neostomy and bypass surgery.Results. The authors analyzed 39 modern literature sources that deal with the problem of urgent intestinal neostomy and bypass surgery. Currently, there is a growing interest in developing techniques for early (before anastomosis) restoration of the chyme passage across the intestine bypassing the impaired intestinal area. It has been reported that a number of unresolved issues do not yet allow full implementation of the concept of intestinal bypass (shunt): a safe mechanism for performing an anastomosis between the small intestine and a synthetic prosthesis has not been developed, the problem of creating unidirectional pathway along a non-peristaltic intestinal prosthesis has not been solved.Conclusion. Solution of these problems can contribute to a significant improvement in the clinical outcomes of patients with acute ischemic or traumatic damage to the intestine.