Baipás metabólico y control de la diabetes mellitus tipo 2 en pacientes con obesidad sometidos a cirugía bariátrica

Baipás metabólico y control de la diabetes mellitus tipo 2 en pacientes con obesidad sometidos a cirugía bariátrica

Metabolic bypass and control of type 2 diabetes mellitus in patients with obesity undergoing bariatric surgery

Rosa González Martín*, Ana Isabel Pérez Zapata*, Elías Rodríguez Cuéllar*, Cristina Alegre Torrado*, Pilar Gómez Rodríguez*,
Diego Hernández Gallardo*, Manuel Ortiz Aguilar*, Eduardo Ferrero Herrero*

* Hospital Universitario 12 de Octubre. Madrid, España

DOI: 10.14679/2326

Resumen: 

Introducción y objetivos. La cirugía bariátrica y metabólica puede resolver el problema sustancial de ecxceso de peso en pacientes obesos y también inducir la remisión o mejora de las complicaciones relacionadas con ella. Por diversos factores fisiopatológicos al margen de la pérdida de peso, el baipás intestinal tiene un efecto beneficioso sobre la resistencia a la insulina que presentan estos pacientes. Consideramos que la variación en al longitud del asa biliopancreática en el baipás gástrico en Y re Roux puede producir mayor tasa de remisión de la diabetes en pacientes obesos sometidos a cirugía bariátrica. Material y Métodos. Estudio de cohortes retrospectivo sobre pacientes obesos con diabetes tipo 2 sometidos a baipás gástrico (asa biliar 50 cm y alimentaria 150 cm) o baipás metabólico (asa biliar 150 cm y alimentaria 100cm). Resultados. El estudio incluyó 67 pacientes, 35 sometidos a baipás gástrico y 32 a baipás metabólico. Todas las cirugías se realizaron por vía laparoscópica. El exceso de peso perdido fue del 80% sin diferencias significativas entre ambos grupos. La normalización de la hemoglobina glicada a os dos años fue del 95% en el baipás metabólico y 87,5% en el gástrico. Tras dos años de seguimiento el 91% de los pacientes en el baipás metabólico y el 87,5% en el metabólico presentaron remisión completa de la DM2. Conclusión. El BPG y el BPM presentan similares resultados en cuanto a pérdida de peso y resolución de la DM2 en términos de tratamiento y normalización de le hemoglobina glicosilada. 
Palabras clave: Obesidad; Diabetes; Baipás gástrico; Cirugía metabólica.

Abstract: 

Introduction and objectives. Bariatric and metabolic surgery can solve the substantial problem of excess weight in obese patients and induce remission or improvement of related complications. Due to several pathophysiological factors apart from weight loss, intestinal bypass has a beneficial effect on insulin resistance in these patients. We consider that the variation in the length of the biliopancreatic loop Roux-en-Y gastric bypass can produce a higher remission rate of diabetes in obese patients undergoing bariatric surgery. Material and methods. Retrospective cohort study of obese patients with type 2 diabetes undergoing gastric bypass (bile limb 50 cm and alimentary limb 150 cm) or metabolic bypass (bile limb 150 cm and alimentary limb 100 cm). Results. The study included 67 patients, 35 who underwent gastric bypass and 32 who underwent metabolic bypass. All surgeries were performed laparoscopically. The excess weight lost was 80% with no significant differences between both groups. Normalization of glycated hemoglobin at two years was 95% in metabolic bypass and 87.5% in gastric bypass. After two years follow-up, 91% of the patients in the metabolic bypass and 87.5% in the metabolic bypass presented complete remission of DM2. Conclusion. BPG and BPM present similar results regarding weight loss and resolution of DM2 in terms of treatment and normalization of glycosylated hemoglobin.
Key words: Obesity; Diabetes; Gastric baypass; Metabolic surgery..

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