Effect of revisional bariatric surgery on type 2 diabetes mellitus

Essa M. Aleassa, Monique Hassan, Kellen Hayes, Stacy A. Brethauer, Philip R. Schauer, Ali Aminian

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

Abstract

Introduction: Bariatric and metabolic surgery significantly improves type 2 diabetes mellitus (T2DM). However, a small percentage of patients after bariatric surgery either have persistent hyperglycemia or relapse of their T2DM. These patients are usually medically managed. The aim of this study was to evaluate the effect of revisional surgery on the glycemic status of patients with T2DM who either failed to remit or relapsed after an initial remission following bariatric surgery. Methods: Metabolic parameters and clinical outcomes of 81 patients with persistent or relapsed T2DM after revisional bariatric surgery at an academic center between 2008 and 2017 were studied. Results: The most common types of revisional surgery were pouch and/or stoma revision of Roux-en-Y gastric bypass (RYGB) (n = 22, 27.2%), conversion of vertical banded gastroplasty (VBG) to RYGB (n = 20, 24.7%), conversion of adjustable gastric banding (AGB) to RYGB (n = 14, 17.3%), and conversion of sleeve gastrectomy (SG) to RYGB (n = 13, 16%). Revision of pouch/stoma after RYGB yielded improvement of T2DM in 50% of patients and remission in 22.7%. Conversion to RYGB yielded improvement of T2DM in 55%, 35.7%, and 30.8% of patients who previously had VBG, AGB, or SG, respectively. Furthermore, conversion of VBG, AGB, and SG to RYGB was associated with diabetes remission rates of 35%, 35.7%, and 23.1%, respectively. Conclusion: Findings of this study, which is the largest series to date, indicate that revisional surgery in patients with persistent or relapsed T2DM after bariatric surgery can significantly improve glucose control and use of diabetes medications. Further clinical and mechanistic studies are needed to better demonstrate the role of revisional bariatric surgery in patients with residual T2DM.

Original languageEnglish
Pages (from-to)2642-2648
Number of pages7
JournalSurgical Endoscopy
Volume33
Issue number8
DOIs
Publication statusPublished - Aug 15 2019

Keywords

  • Adjustable gastric banding
  • Diabetes
  • Revisional bariatric surgery
  • Roux-en-Y gastric bypass
  • Sleeve gastrectomy
  • Vertical band gastroplasty

ASJC Scopus subject areas

  • Surgery

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