WHO WOULD HAVE THOUGHT IT - AN OPERATION PROVES TO BE THE MOST EFFECTIVE THERAPY FOR ADULT-ONSET DIABETES-MELLITUS

Objective This report documents that the gastric bypass operation prov ides long-term control for obesity and diabetes. Summary Background Da ta Obesity and diabetes, both notoriously resistant to medical therapy , continue to be two of our most common and serious diseases. Methods Over the last 14 years, 608 morbidly obese patients underwent gastric bypass, an operation that restricts caloric intake by (1) reducing the functional stomach to approximately 30 mt, (2) delaying gastric empty ing with a c. 0.8 to 1.0 cm gastric outlet, and (3) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy. Even though many of th e patients were seriously ill, the operation was performed with a peri operative mortality and complication rate of 1.5% and 8.5%, respective ly. Seventeen of the 608 patients (<3%) were lost to follow-up. Result s Gastric bypass provides durable weight control. Weights fell from a preoperative mean of 304.4 lb (range, 198 to 615 lb) to 192.2 lb (rang e, 104 to 466) by 1 year and were maintained at 205.4 lb (range, 107 t o 512 lb) at 5 years, 206.5 lb (130 to 388 lb) at 10 years, and 204.7 lb (158 to 270 lb) at 14 years. The operation provides long-term contr ol of non-insulin-dependent diabetes mellitus (NIDDM). In those patien ts with adequate follow-up, 121 of 146 patients (82.9%) with NIDDM and 150 of 152 patients (98.7%) with glucose impairment maintained normal levels of plasma glucose, glycosylated hemoglobin, and insulin. These antidiabetic effects appear to be due primarily to a reduction in cal oric intake, suggesting that insulin resistance is a secondary protect ive effect rather than the initial lesion. In addition to the control of weight and NIDDM, gastric bypass also corrected or alleviated a num ber of other comorbidities of obesity, including hypertension, sleep a pnea, cardiopulmonary failure, arthritis, and infertility. Conclusions Gastric bypass is now established as an effective and safe therapy fo r morbid obesity and its associated morbidities. No other therapy has produced such durable and complete control of diabetes mellitus.