Diabetes Surgery
1 Study in a Diabetic Patient
GIP
· Produced by K cells at the level of duodenum.
· Potent stimulator of insulin secretion.
· Minimal effects on gastric emptying.
· Effects zero on the secretion of glucagon.
· Minimal effects on the regulation of appetite and body weight. Stimulates the proliferation of beta cells.
· Estimula la proliferación de las células Beta.
· Diabetic patients have elevated levels of GIP.
· Resistance to GIP.
· Diabetic patients present with a diminished response to the GIP1.
· Produced by T cells of ileum and colon level
· Potent stimulator of insulin secretion
· Inhibits gastric emptying.
· Inhibits glucagon secretion.
· Inhibits orexigenic pathways and body weight gain.
· Neoproliferación Stimulates the beta cells and the protection quote.
· Inhibits apoptosis by blocking caspase 3 system.
· Diabetic patients present with inadequate secretion of GLP-1
· Diabetic patients present with an adequate response to GLP-1.
GHRELIN
· Produce mainly at the level of gastric antrum and duodenum.
· Stimulates the secretion of growth hormone, cortisol and epinephrine which are three of the four classical hormones
contrarregulatorias.
· Although diabetogenie effects, suppresses ghrelin secretion and insulin action..
· Antagonizes the actions mediated by intracellular insulin.
· The chronic administration of agonists of ghrelin Rc results in the appearance of glucose intolerance in humans.
· Acting as an anti-incretin limiting peripheral glucose utilization.
2 Gastric By-Pass And ROUX (LRGB) O-D
· Edward Mason 1967
· 30cc Reservoir
· Biliary · Asa 30-75cm from Treitz
· Food Asa 75-100-150-250cm.
3 Biliopancreatic diversion with duodenal switch (BPD-DS)O-D
· Douglas Hess (Ohio-USA)
· Marceu Picard (Quebec-Canada) 1993
· Reservoir 120 – 200cc
· 2cm Post-Pylorus
· Common Asa 100cm
4 Sleeve Gastrectomy (LSG) O-D
· Michel Gagner (Canadá)
· Bpd-Ds
· Super-superobese
· Imc > 60
· Ghrelin · Gastric Fundus
· + Omentectomy
5 Ileal Interposition (IT) DB
· Dr. Aureo de Paula (Brasil)
· Ileal Transposition
· Koopmans & Sclafani
· Ileal Flap
· Exaggerated response of GLP-1 and PYY
· Reduces intake and weight
· Improves Glucose Homeostasis without restriction or malabsorption.
6 Spa Surgical O-D
· It’s the same technique Scopinaro.
· No partial gastrectomy.
7 Santoro Phase 2 O-D
· It’s the same Sleeve Gastrectomy.
· With partial enterectomy.
8 Santoro Phase 3 O-D
· Santoro is the same as Phase 2.
· With Gastro-jejunostomy.
9 Biliopancreatic diversion(BPD) Scopinaro O-D
· Nicola Scopinaro, Genova – Italia 1979
· Reservoir 500-800cc (Diabetes)
· Reservoir 200-500cc (Obesity)
· Food Asa 250cm
10 Duodenal Jejunal Bypass (DJB) DB
· Francesco Rubino (Italia)
· Pylorus Preservation D-J Anastomosis
· Pre-pyloric anastomosis with G-J.
