Preliminary Report Adaptive entero-omentectomy: Physiological and evolutionary bases of an auxiliary treatment to type 2 diabetes A report on the first two cases

Abstract

Objective: The objective of this article is to report on a new surgicalstrategy specifically designed to treat type 2 diabetes: adaptiveentero-omentectomy (AEO), and present its rationale andpreliminary results. Some techniques used in bariatric surgeryare capable of producing fast improvement in type 2 DiabetesMellitus, before significant loss of weight, due to metabolicchanges that are currently being explained. Methods: Two type 2diabetic patients were operated on. The technique included anenterectomy that left the first 40 cm of the jejunum and the last260 cm of the ileum, besides the resection of the greater omentum.Results: At five and seven-month follow-up, both patients had nosymptoms, reported early satiety and presented improvedmetabolic profile. Conclusions: This is the preliminary report of asurgical technique designed to help treating type 2 diabetes. It isbased on leaving the bowel in the lower limit of normal range,diminishing the highly permeable portions and taking more nutrientsto the distal bowel to enhance the secretion of enterohormones.The aim of omentectomy is to reduce visceral fat, contributing toa decreased production of plasminogen activator inhibitor-1 (PAI-1)and resistin. After surgery, the patients do not need nutritionalsupport. The procedure is simple to perform and its rationale andpreliminary results are encouraging. A protocol with more patientsand long-term observation is needed.

Keywords

• Type 2 Diabetes
• Small bowel/physiology
• Enterectomy/methods
• Peptide hormones
• Obesity
• morbid/surgery