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Wideochir Inne Tech Maloinwazyjne. 2013 Jun;8(2):130-8. doi: 10.5114/wiitm.2011.32925. Epub 2013 Jan 21.

Long segment ileal transposition leads to early amelioration of glucose control in the diabetic obese Zucker rat.

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1
Department of General and Visceral Surgery, Surgical Metabolic and Anastomosis Research Team SMART, Albert-Ludwigs-University, Freiburg, Germany.

Abstract

INTRODUCTION:

Fast delivery of food to the terminal ileum is thought to be pathophysiologically responsible for type 2 diabetes remission after obesity surgery. Imitating this effect, ileal transposition (IT) is designed as initiating diabetes remission for non-obese patients.

AIM:

To date, it is not clear which length of the transposed segment achieves the best glucose lowering results. As previous rodent data mostly rely on a 10 cm IT, the current study evaluated a long segment IT (20 cm) in the diabetic obese Zucker rat.

MATERIAL AND METHODS:

Twenty male diabetic obese Zucker rats (Crl:ZUC-Lepr(fa)) were randomly assigned to undergo either a long segment (20 cm; ∼ 50% of ileum) IT or sham surgery. Glucose control was determined by an oral glucose tolerance test (OGTT) on day -7, 0, 14 and 20. Analysis of the incretin hormones glucagon-like peptide 1 (GLP-1), peptide YY (PYY) and insulin was included in the first and third OGTT.

RESULTS:

Ileal transposition animals showed an early improvement of glucose control after 14 days (area under the curve: IT vs. baseline 314.7 ±229.0 mmol/l × min vs. 564.6 ±268.5 mmol/l × min; p < 0.05). Compared to sham animals, glucose-stimulated GLP-1 and PYY levels were raised (5.75 ±3.73 pmol/l vs. 18.52 ±14.22 pmol/l, p < 0.05; 129.7 ±64.62 pmol/l vs. 164.0 ±62.26 pmol/l, p < 0.05). Body weight gain from postoperative day 5 was greater for sham animals (50.22 ±20.93 γ vs. 16.4 ±25.93 g; p < 0.01).

CONCLUSIONS:

Long segment IT shows a rapid rise in GLP-1 and PYY levels, thus leading to early amelioration of glucose control.

KEYWORDS:

ileal transposition; metabolic surgery; obesity surgery; type 2 diabetes mellitus

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