Pyrrhic victory? Long-term results of biliopancreatic diversion on patients with type 2 diabetes and severe obesity.

Autor:	Papadia F; Department of Surgery, University of Genoa, Genoa, Italy., Carlini F; Department of Surgery, University of Genoa, Genoa, Italy., Longo G; Department of Surgery, University of Genoa, Genoa, Italy., Rubartelli A; Department of Surgery, University of Genoa, Genoa, Italy., Battistini M; Department of Surgery, University of Genoa, Genoa, Italy; Department of Internal Medicine, University of Genoa, Genoa, Italy., Drago B; Department of Surgery, University of Genoa, Genoa, Italy., Adami GF; Department of Surgery, University of Genoa, Genoa, Italy; Department of Internal Medicine, University of Genoa, Genoa, Italy. Electronic address: adami@unige.it., Marinari G; Bariatric Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy., Camerini G; Department of Surgery, University of Genoa, Genoa, Italy.
Jazyk:	angličtina
Zdroj:	Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery [Surg Obes Relat Dis] 2023 Oct; Vol. 19 (10), pp. 1110-1117. Date of Electronic Publication: 2023 Apr 11.
DOI:	10.1016/j.soard.2023.04.300
Abstrakt:	Background: The long-term results after biliopancreatic diversion (BPD) in patients with type 2 diabetes (T2D) and severe obesity is still being debated. Objective: Retrospective evaluation of the long-term metabolic and clinical conditions of patients with T2D following BPD. Setting: University hospital. Methods: A total of 173 patients with T2D and severe obesity were investigated prior to and at 3-5 and 10-20 years after BPD. Anthropometric, biochemical, and clinical findings preoperatively and throughout follow-up were considered. The long-term data were compared with those of a cohort of 173 T2D patients with obesity treated with conventional therapy. Results: T2D resolved within the first postoperative phases in most patients, and in the long and very long term, the fasting blood glucose level remained above the normal range in only 8% of patients. Likewise, a stable improvement of blood lipid pattern was observed (follow-up rate 63%). In contrast, in nonsurgical patients in the long term, the glucose and lipid metabolic parameters remained in the pathologic range in all cases. In the BPD group, a very high number of severe BPD-related complications was recorded, and 27% of the BPD patients died, whereas in the control group, 87% of patients were still alive at the end of the follow-up period (P < .02). Conclusion: Despite the high T2D stable resolution rate and the normalization of most metabolic data at 10-20 years following surgery, these results indicate that BPD should be indicated with caution in the surgical treatment of T2D in patients with severe obesity. (Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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