الفهرس 
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Abstract
Diabetes mellitus represents an expanding pandemic that contributes markedly to worldwide morbidity and mortality. Currently, approximately 240 million people are afflicted, 90% to 95% with T2DM, and that number is expected to exceed 380 million by the year 2025. (2) Diabetes is responsible for reduced life expectancy and for lifelong disability such as blindness, amputation and renal dialysis. Tight glycemic control minimizes microvascular complications; however, macrovascular complications and cardiovascular mortality remain difficult to address even with intensive glucose-lowering therapy. Furthermore, despite substantial advances in pharmacotherapy and disease management, a large number of patients remain inadequately controlled, and complete remission of hyperglycemia and the associated metabolic alterations is rare.
Faced with the escalating global diabetes crisis, health care providers require as potent an armamentarium of therapeutic interventions as possible. Although numerous novel pharmaceutical agents have been introduced for diabetes remission, long-term success rates of glycemic control by lifestyle modification and medical therapy remain disappointing. Moreover, most diabetes medications promote weight gain, and using them to achieve tight glycemic control introduces a proportionate risk of hypoglycemia.
The first Diabetes Surgery Summit was held in Rome on March 2007 to develop guidelines to use GI surgery to treat T2DM. In 2009, the ADA first mentioned surgical therapy for treating T2DM. In 2011, the IDF released its position statement mentioning that bariatric surgery was an accepted option for T2DM patients with BMI ≥ 35 kg/m2, and might be considered an alternative therapy for patients with BMI < 35 kg/m2 who do not respond to standard medical therapy.
The aim of this work was to investigate the role of laparoscopic mini-gastric bypass in controlling type 2 diabetes mellitus in both obese and non-obese patients. This study was carried out on 30 consecutive adult patients with T2DM admitted to Head and Neck and Endocrine Unit, Department of Surgery, Faculty of medicine, Alexandria Main University Hospital.
The BMI of the 30 patients with T2DM included in this study was 49.76 ± 6.61. Twenty-six (86.7%) patients were female and four (13.3%) were male. Their ages ranged between 29-50 years with a mean of 40.70 ± 8.57 years. The mean duration of DM was 2.49 ± 2.75 years.
Before surgery, 26 (86.7%) patients were on oral hypoglycemic medications, 2 (6.7%) on insulin, and the remaining two patients on both. In addition, 18 patients (60%) were on anti-hypertensive medications and 11 (36.7%) on lipid-lowering agents.
The mean operation time was 114.63 ± 23.73 minutes (range 80-180 minutes). The most important complications were gastric leakage and bleeding, which occurred in two patients (6.67%) each.
The MGB procedure achieved significant improvement in glucose metabolism as compared to the pre-operative values. The mean level of FBG dropped significantly from 238.20 ± 55.57 mg/dL preoperatively to 106.03 ± 49.22 mg/dL post-operatively (p<0.001), and HbA1c from 7.86 ± 0.77 to 5.50 ± 0.85 (p<0.001). Also recorded was a significant increase in postprandial GLP-1 reaching a mean of 9.86 ± 0.84 pmol/L as compared to 2.21 ± 0.50pmol/l pmol/L pre-operatively (p<0.001).
Complete remission of T2DM was achieved in 26 patients (89.7 %) and partial improvement in one (3.3%), within the first 6 months.
Starting from the first month post-operatively and through 6 months, there was a statistically significant decrease of BMI (p<0.05). The mean patients’ percentage of excess weight loss (EWL%) significantly increased from 11.35 ± 2.29 at one month post-operatively to 49.86 ± 7.35 at 6 months (p<0.05). Moreover, there was an obvious amelioration of obesity-related comorbidities. Post-operatively, 14 patients (86.3%, 14/18) stopped their anti-hypertensive medications and 10 (90%, 10/11) ceased using lipid-lowering agents after the significant reduction of their cholesterol and triglycerides serum levels.
No mortality was encountered in the perioperative period; however, one patient (3.3%) passed away after 13 weeks due to myocardial infarction.
MGB is an effective surgical procedure in controlling T2DM with complete remission reaching nearly 90% within 6 months.