Diabetes control and lessened cerebral cardiovascular risks after gastric bypass surgery in Asian
Taiwanese with a body mass index <35 kg/m2

1

Cardiovascular Department of internal Medicine, Min-Sheng Hospital, Taoyuan, Taiwan, ROC 2Departmentof surgery, Min-Sheng Hospital, Taoyuan, Taiwan, ROC
Jih-Hua

Wei1,Wei-Jei Lee2,Shu-Chu Chen2,Yi-Chih Lee2,Yen-How Su2

Background: Morbid obese patients with type 2 diabetes mellitus (T2DM) and a body mass index(BMI) >35kg/m2 benefit greatly from Roux-en-Y gastric bypass surgery (RYGB). Whether the patients with T2DM anda body mass index (BMI)<35kg/m2 also profit from this surgical procedure is not known. In Asian Taiwanese,the risks associated with T2DM and cardiovascular diseases occur at a relatively lower BMI levels. We
examined the safety and efficacy of RYGB in Asian Taiwanese patients with T2DM and a BMI of 22-35 kg/m2
in a referral medical center.Methods: A total 62 consecutive patients with T2DM and a BMI of 22-35kg/m2
underwent RYGB between 2003 and 2009. The data were prospectively collective before surgery and at 3,
6 and 12 months after operation. Results: Of the 62 patients, 15 were men and 47 were women (age 40.1± 10.1 years). Their preoperative characteristics were BMI 30.2 ± 3.2 kg/m2, body weight 81.8 ± 11.8kg, waist circumference 100.6 ± 10.4 cm, and duration of T2DM 5.9 ± 6.0 years. There was no mortality,major surgical morbidity, or excessive weight loss experienced. The BMI decreased postoperatively by20%, from 30.2 ± 3.2 kg/m2 to 24.0 ± 2.8 kg/m2 (P <.001). The fasting blood glucose level decreased
from 194.7 ± 70.4 mg/dL to 99.8 ± 28.4 mg/dL (P <.001), and the hemoglobin A1c decreased from 9.1%
± 1.7% to 6.0% ± 0.9% (P <.001). The 10-year cerebral and cardiovascular disease risk was estimatedwith UKPDS risk engine before and after RYGB. The risk for fatal and nonfatal stroke and coronary heartdisease decreased essentially. Conclusion: RYGB safely and effectively remits T2DM in Asian Taiwanesewith a BMI <35 kg/m2. It also lessens the 10-year cardiovascular cerebral disease risks. More larger,
longer term, prospective and randomized studies are needed to confirm these effects.

Prevalence of nonalcoholic steatohepatitis (NASH) in morbidly obese Japanese patients who underwent
bariatric surgery

Yosuke Seki
Yotsuya Medical Cube

1) Division of weight loss surgery, Department of minimally invasive surgery, Yotsuya Medical Cube, Tokyo,
Japan2) Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Gunma,Japan

Yosuke Seki1), Kazunori Kasama1), Satoru Kakizaki2), Hideharu Shimizu1)

Background:Non-alcoholic fatty liver disease (NAFLD) is increasingly being recognized to occur more commonly inthe obese with a clinicopathologic entity that extends beyond uncomplicated steatosis to steatohepatitis(NASH), advanced fibrosis, liver failure and hepatocellular carcinoma. In our previous report, we showedthat racial difference between Japanese and Western people in terms of NAFLD and related liver
dysfunction. There are few reports investigating the prevalence of NASH in morbidly obese Japanese.
Methods:
Twenty-eight consecutive morbidly obese Japanese who underwent bariatric surgery in Yotsuya Medical Cubefrom October 2009 to July 2010 were enrolled. There were 16 females and 12 males (mean age: 40.3±11.2).
Mean pre-operative weight was 114.4±22.3kg and mean BMI was 41.9±6.9kg/m2. A trucut liver biopsy wasperformed from left lobe of the liver at the time of surgery and analysed by a single pathologist. Theliver biopsies were assessed by applying histopathological criteria that are accepted in the pathology
literature.
Results:
Eighty-nine percent (25 in 28) of the patients undergoing bariatric surgery were found to have steatosis.
And 71.4% (20 in 28) were found to have NASH. One patient was found to have established cirrhosis.
Conclusion:
Hepatic steatosis was very prevalent in our cohort of patients presenting for bariatric surgery. The
prevalence of NASH was much higher in Japanese morbidly obese patients than the reported prevalence ofNASH in Western individuals. These findings support that Asian are more prone to central obesity and,thus, have increased risk for obesity-related comorbidities.

The Feasibility: SILS port Roux-en-Y Gastric Bypass for Low BMI Diabetes Mellitus

1

Bariatric & Metabolic International Surgery Center,E-Da Hospital,Taiwan 2International MinimallyInvasive Surgery Training Center 3General Surgery
Chih-Kun Huang1,2,3,Chi-Hsien Lo1,3

Background: Single Incision Laparoscopic Surgery has been expanded to bariatric surgery. Laparoscopic
Roux-en-Y gastric bypass is already accepted as one of the most effective procedure for the treatmentof type 2 diabetes mellitus. Hereby, we described our experience using SILS Port to performed Roux-en-Y
gastric bypass in nine patients with type 2 diabetes mellitus patients.Methods: After getting approvalof E-Da Institutional Review Board, 9 cases with diagnosis of Type 2 Diabetes Mellitus patients withlow body mass index (BMIless than 30) underwent Roux-en-Y gastric bypass using the SILS Port from August2010 to November 2010. Standard Roux-en-Y gastric bypass was performed with 25ml of gastric pouch, 100cmof alimentary and biliopancreatic limb. Results: Four female and five male patients with mean BMI 27.15
and average of diabetes history of 10.2 years, underwent SILS Port Roux-en-Y gastric bypass. Novel liversuspension technique was performed in all patients. Mean operation time was 135 min. And two patientsneeded additional trocars intra-operatively, related to the difficulty in the dissection of gastric pouchand gastrojejunostomy suture. There was no surgical complication or mortality. At the first month
postoperatively, mean AC sugar dropped from 198mg/dL to 116.1mg/dL, and mean HbA1c decreased from 9.71%
to 8.18%. Conclusion: Laparoscopic Roux-en-Y Gastric Bypass with SILS Port is feasible and reproducible,
but should be performed under strict indication and by an experienced surgeon. Even in low BMI patients,
it showed high technical skill demands, increased operation time and high conversion rate.

Early Resolution of Type 2 Diabetes Mellitus by Laparoscopic Ileal Transposition with Sleeve Gastrectomy
Surgery in 23 to 35 BMI Patients

1Bombay Hospital 2Center of Metabolic Surgery, Levioza Clinic, Pushpanjali Building, Santacruz(W),Mumbai, India
Ramen Goel1,Pravin Amin1,Madhu

Goel2,Sanjeet Marik1

Introduction: Diabetes is considered a life style disease. 56% diabetic patients with BMI greater than
7 are at high risk of diabetes related complications. Bariatric surgery results in diabetes resolution
in over 84% patients. Based on hindgut hypothesis suggesting role of incretins like GLP-1, early trialsof ileal interposition surgery have displayed consistent HbA1c levels below 7 in over 80% patients withover 30 kg/m2 BMI. In developing countries majority of T2DM patients are not morbidly obese and surgicalprocedures are to be evaluated for their efficacy in this group. In this study we have assessed the efficacy
of ileal transposition with sleeve gastrectomy (SGIT) in 23 to 35 BMI T2DM patients.Method: Afterinstitutionalethicalcommittee

approval&IndianCouncilofMedicalResearchregistration(CTRI/2008/091/00206), selected T2DM patients [HbA1c over 7, C Peptide more than 1] underwent
Lap SGIT by a single surgeon. Data of first five patients with minimum 6 months follow up was analyzed
for glycemic control, reduction/ discontinuation of diabetes medication.Results: The study target (HbA1cless than 7) was achieved in 60 % patients within 1 month , and in 100% patients within 6 months. Requirementof medicines reduced significantly within 6 months and their HbA1c levels reduced from 9.65% to 6.22%.
Conclusion: Laparoscopic SGIT represents a new paradigm, for the treatment of T2DM even in non morbidly
obese patients. Conflict of Interest: None.Funding: Research related to this study was funded by Bombay
Hospital trust, Mumbai, India.

Is Laparoscopic Duodenojejunal bypass with Sleeve an effective alternative to Roux en Y gastric bypass:A Randomized Trial

1

Department of Bariatric and Metabolic Surgery,Gem Hospital and Research Centre,Coimbatore,India

Praveen Raj1,Palanivelu Chinnusamy1

Background:The incidence of Obesity and related metabolic disorders including Carcinoma Stomach in India
is one of the highest in the world .Hence one requires a procedure that allows postoperative surveillanceof the stomach with the best outcomes in terms of weight control and resolution of comorbidities .Here
we compare one such procedure,Duodenojejunal bypass with Sleeve against the standard Roux-en Y gastricbypass.Methods:52 patients were randomized into 2 groups of Laparoscopic Duodenojejunal bypass withSleeve (DJB) and Laparoscopic Roux en Y gastric bypass (RYGB) of 26 patients each. Results:The mean BMI
at the end of 6 months and 1 year was 35.16, 29.25 in RYGB and 34.51, 28.10 in DJB. The %excess BMI loss
at 6 months and 1 year were 52% ±19 and 77% ±24 in RYGB and 58% ±14 and 82% ±19 in DJB, which was
not statistically significant.14/26 patients in the RYGB and 19/26 in the DJB group had Type IIDiabetes .In RYGB

12 had complete resolution and 2 had improvement and 16 patients in the DJB had complete

resolution and remaining 3 had improvement . There was 100% resolution of Dyslipidemias in both groups.
There was 1 patient in the DJB group who presented with internal herniation 1 month post-op was managed
surgically. Conclusion:Laparoscopic Duodeno-jejunal bypass with Sleeve, which combines the principles
and advantages of Sleeve Gastrectomy and RYGB is a safe and effective alternative to gastric bypass inweight reduction and resolution of comorbidities.Also, with the possibility that the procedure can bemade less restrictive by altering the size of the sleeve, it can be employed as a procedure to treat
Metabolic Syndrome even in the lower BMI group. But, a long term follow up is necessary to establish
it as a standard procedure.