For patients with persistent or relapsed diabetes following bariatric surgery, revisional bariatric surgery led to improvements and even remission of their residual disease, according to new research presented at the Society of American Gastrointestinal and Endoscopic Surgeons 2018 Annual Meeting and World Congress of Endoscopic Surgery.
Ali Aminian, MD, of the department of general surgery at the Cleveland Clinic, and colleagues compared metabolic parameters and clinical outcomes of 123 patients with persistent or relapsed diabetes who underwent revisional surgery at their academic center between 2008 and 2014. They found that reversions or conversion from restrictive surgeries, like gastric band, to diversionary ones, like gastric bypass, can help patients with persistent diabetes.
“Diabetes is a chronic progressive disease,” Aminian told Healio Gastroenterology and Liver Disease. “If one surgery failed to improve diabetes, we can escalate the care and convert to another surgery or do a corrective procedure to improve diabetes.”
The researchers found that revision of the gastric pouch and/or stoma in Roux-en-Y gastric bypass led to improvements in 69% of patients and remission in 25%.
The data showed disease improvement of 70% for patients who previously underwent vertical band gastroplasty and later underwent conversion to Roux-en-Y gastric bypass, 28% for sleeve gastrectomy and 58% for adjustable gastric bandings procedures. Conversion to Roux-en-Y gastric bypass from vertical band gastroplasty also correlated with a remission rate of 6%, and the rate was 27% for both sleeve gastrectomy and adjustable gastric bandings.
“The result of this study showed that persistent type 2 diabetes with inadequate weight control can be an indication for revisional bariatric surgery,” Aminian said. “Unfortunately, many patients and physicians do not consider the option of reoperation to improve metabolic outcomes. Furthermore, many insurance providers do not cover reoperative bariatric surgery.” – by Alex Young
Aleassa EM, et al. Abstract S043. Presented at: Society of American Gastrointestinal and Endoscopic Surgeons 2018 Annual Meeting and World Congress of Endoscopic Surgery; April 11-14; Seattle, WA.
Disclosures: The authors reported no relevant financial disclosures.