Biliopancreatic diversion in Hess-Marceau modification as a surgical treatment of type 2 diabetes associated with obesity

Abstract

Introduction. In the 21st century, diabetes mellitus is one of the most serious threats to the health of humanity on a global scale. Every year, more and more people in the world suffer from this disease, which can lead to serious complications that significantly reduce the duration and impair the quality of life. Aim of the study. Improvement of the results of surgical treatment of patients with type 2 diabetes associated with obesity, by assessing the results of the biliopancreatic diversion in Hess-Marceau modification. Methods. The results of surgical treatment of 100 patients with morbid obesity, who undergo biliopancreatic diversion in Hess-Marceau modification, were analyzed. 33 patients had type 2 diabetes mellitus (13 (39.4%) patients were in compensation, 20 (60.6%) patients – in decompensation of disease). Results. It has been observed that surgical intervention has led to complete stable remission of type 2 diabetes in all patients (without the need for the appointment or continuation of hypoglycemic therapy) in the postoperative period. No case of hypoglycemia in this category of patients after surgery was observed. Late postoperative complications of biliopancreatic diversion were observed in 9 (27.2%) patients with type 2 diabetes mellitus with mortality rate 3% – 1 patient died from protein-malnutrition syndrome. Significant improvement in the quality of life of patients with an increase in the quality of life index for Moorehead-Ardelt II from -1.5±0.73 before surgery to 1.7±0.49 in 2 years after the procedure and subsequent steady stabilization index during 5-year follow-up was documented. Conclusion. Biliopancreatic diversion in Hess-Marceau modification is high-effective surgical procedure for treatment of type 2 diabetes mellitus associated with obesity, which has led to complete stable remission of the disease in all patients with a significant improvement in their quality of life. However, the relatively high level of complications and the presence of a fatal case in the remote postoperative period indicate an inadequate "safety profile" of this bariatric procedure and the need for further research in determining the optimal strategy for surgical treatment of patients with type 2 diabetes.