Residual Diabetes Improved in Most Revisional Bariatric Surgery Patients

Revisional bariatric surgery can improve residual type 2 diabetes in patients who undergo an initial bariatric intervention, according to a recent literature review.

Although previous studies have shown that bariatric surgery is effective for weight loss and the improvement of weight-related metabolic comorbidities, not all patients see these benefits. Persistent hyperglycemia or relapse of metabolic disease following bariatric surgery are still concerns for some patients. Despite the results of previous studies, evidence of the potential benefits of bariatric surgery on recurrent metabolic diseases, like diabetes, is limited.
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To explore this relationship further, the researchers reviewed 30 studies of patients with metabolic diseases that were not reversed by an initial bariatric intervention. A total of 14% to 38% of patients had residual diabetes prior to receiving revisional surgery.

Results indicated that revisional surgeries had resulted in additional excess weight loss of 20% to 80%, or an additional decrease of body mass index by 10% to 30%, depending on the index surgery and subsequent reconstruction.

Ultimately, an improvement of diabetes was observed in 65% to 100% of patients. Conversion to Roux-en-Y gastric bypass (RYGB) improved diabetes in 79% of patients who had previously received vertical banded gastroplasty (VBG), in 72% of patients who had received adjustable gastric banding (AGB), and in 62% of patients who had sleeve gastrectomy (SG).

Conversion from AGB to SG had improved diabetes in 65% of patients, and conversion from SG to duodenal switch had improved diabetes in 79% of patients. Additionally, revision of the gastric pouch or stoma in RYGB had improved diabetes in 79% of patients, according to the researchers.

“Further clinical and mechanistic research is needed to better delineate the role of revisional bariatric surgery in patients with residual metabolic disease,” the researchers concluded.”

—Christina Vogt

Reference:

Yan J, Cohen R, Aminian A. Reoperative bariatric surgery for treatment of type 2 diabetes mellitus. Surg Obes Related Dis. 2017;13(8):1412-1421. doi:10.1016/j.soard.2017.04.019.