[Insulin or surgery? : the perspective of a diabetologist]

NEW TECHNIQUE FOR OBESITY SURGERY: INTERNAL GASTRIC PLICATION TECHNIQUE USING INTRAGASTRIC SINGLE-PORT (IGS-IGP) IN EXPERIMENTAL MODEL

Background:

Bariatric surgery is currently the most effective method to ameliorate co-morbidities as consequence of morbidly obese patients with BMI over 35 kg/m². Endoscopic techniques have been developed to treat patients with mild obesity and ameliorate comorbidities, but endoscopic skills are needed, beside the costs of the devices.

Aim:

To report a new technique for internal gastric plication using an intragastric single port device in an experimental swine model.

Methods:

Twenty experiments using fresh pig cadaver stomachs in a laparoscopic trainer were performed. The procedure was performed as follow in ten pigs: 1) volume measure; 2) insufflation of the stomach with CO2; 3) extroversion of the stomach through the simulator and installation of the single port device (Gelpoint Applied Mini) through a gastrotomy close to the pylorus; 4) performance of four intragastric handsewn 4-point sutures with Prolene 2-0, from the gastric fundus to the antrum; 5) after the performance, the residual volume was measured. Sleeve gastrectomy was also performed in further ten pigs and pre- and post-procedure gastric volume were measured.

Results:

The internal gastric plication technique was performed successfully in the ten swine experiments. The mean procedure time was 27±4 min. It produced a reduction of gastric volume of a mean of 51%, and sleeve gastrectomy, a mean of 90% in this swine model.

Conclusion:

The internal gastric plication technique using an intragastric single port device required few skills to perform, had low operative time and achieved good reduction (51%) of gastric volume in an in vitro experimental model.

[Pharmacological therapy versus bariatric surgery for patients with obesity and type 2 diabetes]

There is strong epidemiological evidence for an association between increased body weight and a higher incidence of type 2 diabetes. Moreover, reduction in body weight may delay the onset of type 2 diabetes. The basic therapy of type 2 diabetes includes lifestyle modifications, such as education, nutritional advice, increased physical activity, non-smoking and strategies to cope with stress. If lifestyle modifications are not successful, antidiabetic pharmacotherapy is stepwise intensified to achieve individual therapeutic targets; however, pharmacological treatment of type 2 diabetes frequently fails to prevent the progress of the disease and the manifestation of diabetes complications. Sustained weight reduction belongs to the individual treatment targets for patients with obesity and type 2 diabetes. Because conservative weight reduction strategies are frequently not successful, bariatric surgery has emerged as an effective treatment particularly for those patients with obesity-associated type 2 diabetes in whom a glycosylated hemoglobin (HbA1c) target < 7.5% could not be achieved with pharmacological therapy. Bariatric surgery should no longer be considered as the last option for patients with obesity-associated type 2 diabetes.