| International Session（Symposium）5(JSGS・JSGE) |
| Fri. November 22nd 14:30 - 16:30 Room 11: Portopia Hotel South Wing Topaz |
| The significance of bypass surgery in metabolic surgery for Japanese patient | |||
| Hirofumi Imoto1, Michiaki Unno1, Takeshi Naitoh1 | |||
| 1Department of Surgery, Tohoku University Graduate School of Medicine | |||
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| Bariatric or metabolic surgery has done widely in the world and the dramatic effect is reported. In Japan, the main procedures are laparoscopic sleeve gastrectomy (LSG) and LSG with duodenal-jejunal bypasss (LSG/DJB). Generally, the bypass procedures were considered more effective for T2DM than restrictive surgery alone. However, the mechanism of metabolic improvement effect remains unclear. A basic research using T2DM obese rat DJB model was performed in our institution for investigation of the mechanism of metabolic surgery. We found that the long bilio-pancreatic limb (BPL) model was effective and this improvement effect was cancelled after BPL resection. Further, the serum bile acid level was elevated in the long BPL model. Therefore, a long BPL and elevation of bile acids are thought to be the key mechanism in metabolic improvement effects. In clinical stage, we conducted the multi-central study to compare the DM improvement effect between LSG and LSG/DJB in Japanese DM patients (298 cases). DM remission rate at 12 months was 80.8% for LSG and 86.0% for LSG/DJB. In cases with ABCD score ≤5 and insulin use, DM remission rate was 70.3% and 60.3% respectively, and there was a statistical difference between procedures. Accordingly, we conclude that both procedures is effective, however, LSG/DJB is more effective for severe DM (ABCD score ≤5 or insulin user) patients. |
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Index Term 1: Metabolic surgery Index Term 2: Duodenal-jejunal bypass |
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