Yoshimochi Kurokawa

Metabolic surgery for inadequately controlled type 2 diabetes in nonseverely obese Japanese: a prospective, single-center study

BACKGROUND The beneficial effects of metabolic surgery on weight loss, glycemic control, and cardiovascular improvement for the morbidly obese patient has been vast and undeniable. It is also expected to be effective in diabetic patients with less severe obesity, but the evidence is yet to yield significant impact. OBJECTIVE In this study, we investigate the impact of metabolic surgery on inadequately controlled type 2 diabetes in Japanese patients with mild obesity. SETTING Private practice, Japan. METHODS Twenty-eight consecutively selected diabetic patients with body mass index 27.5 to 34.9 kg/m2, who had inadequately controlled diabetes despite intensive medical treatments, underwent laparoscopic sleeve gastrectomy with duodenojejunal bypass, and were prospectively followed up for 12 months. The primary endpoint was a composite of proposed parameters of optimal diabetes management of glycosylated hemoglobin (HbA1C)<7.0%, low-density lipoprotein cholesterol<100 mg/dL, and systolic blood pressure<130 mm Hg. RESULTS At enrollment, the HbA1C was 9.4 ± 1.3% and the duration of diabetes was 11.7 ± 7.4 years. After the short-term low-calorie diet intervention, the preoperative baseline body mass index and HbA1C were 31.0 ± 1.5 kg/m2 and 8.5 ± 1.3%, respectively. At 1 year, body mass index and HbA1C dropped to 24.7 ± 2.3 kg/m2 and 6.8 ± .8%, respectively. Those who achieved HbA1C<6.5% without diabetes medications, and those with HbA1C<7% were 23% and 54% compared with 0% and 3.6% at baseline (P = .007 and P<.001), respectively. Although the ratio of those who achieved the composite endpoint did not reach statistical significance, positive impacts were also observed on hypertension, dyslipidemia, medication usage, and quality of life. There were 3 major surgical morbidities and no mortalities. CONCLUSIONS Gastrointestinal metabolic surgery in nonmorbidly obese Japanese with inadequately controlled type 2 diabetes may have additional metabolic benefits.

Mid-term results of bariatric surgery in morbidly obese Japanese patients with slow progressive autoimmune diabetes: Bariatric surgery in autoimmune diabetes

Bariatric surgery is recognized as an effective treatment for type 2 diabetes mellitus, but data on its efficacy for type 1 diabetes mellitus, especially slowly progressive insulin‐dependent diabetes mellitus, are limited.

Early gastric cancer successfully treated by endoscopic submucosal resection 1 year after laparoscopic sleeve gastrectomy with duodenal-jejunal bypass: De novo early gastric ca. after LSG-DJB

This case involved a 64‐year‐old female patient with a BMI of 35.3 kg/m2 and poorly controlled type 2 diabetes mellitus. Preoperative upper gastrointestinal endoscopy revealed chronic, atrophic gastritis. Helicobacter pylori antibody was negative. The patient underwent laparoscopic sleeve gastrectomy with duodenal‐jejunal bypass as a metabolic surgery to treat obesity and type 2 diabetes mellitus. At 1 year postoperatively, routine endoscopy detected a flat elevated lesion at the distal gastric sleeve, near the posterior wall of the antrum; biopsy revealed adenocarcinoma. Endoscopic submucosal resection was performed without complication. This case shows the advantage of laparoscopic sleeve gastrectomy with duodenal‐jejunal bypass in screening the excluded stomach as compared to laparoscopic Roux‐en‐Y gastric bypass. Therefore, laparoscopic sleeve gastrectomy with duodenal‐jejunal bypass can be a viable alternative to laparoscopic Roux‐en‐Y gastric bypass for regions where gastric cancer is endemic.

Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy in patient with liver cirrhosis: PMVT after LSG

Laparoscopic sleeve gastrectomy (LSG) has become the dominant bariatric procedure because of its reliable weight loss and low complication rate. Portomesenteric vein thrombosis (PMVT) after LSG is an infrequent complication that can lead to serious consequences. Here, we report a patient who presented with abdominal pain 11 days after LSG for the treatment of morbid obesity. Contrast CT of the abdomen revealed PMVT. The patient had liver cirrhosis, which is a major risk factor for PMVT. When LSG is performed on an obese patient with liver cirrhosis, careful attention must be paid to the onset of PMVT.

Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease: A Retrospective Study of 50 Consecutive Cases

Background: Laparoscopic anti-reflux surgery has been proven to be an effective treatment for gastroesophageal reflux disease (GERD) in Western countries. On the other hand, the concept of surgical treatment of GERD has not widely spread in Japan, and the number of operations performed remains extremely low. Purpose: The aim of this study is to analyze our initial experience