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ISSN 1665-2576 (Impreso)

2010, Número 3

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Rev Mex Cir Endoscop 2010; 11 (3)


Diabetes mellitus. ¿Curación permanente por una cirugía gastrointestinal?

Correa BG

Idioma: Español
Referencias bibliográficas: 100
Paginas: 150-160
Archivo PDF: 644.34 Kb.


RESUMEN

La diabetes mellitus no insulinodependiente es una enfermedad notoriamente resistente al tratamiento, el cual incluye: insulina, dieta, ejercicio, modificaciones al estilo de vida e hipoglucemiantes orales, y rara vez por sí sola el paciente logra un control de la glicemia a largo plazo, y más que eso, si el tratamiento médico es suspendido, invariablemente, la glucosa plasmática se eleva y la enfermedad progresa. Desafortunadamente estas medidas no se ha visto que ayuden a la reducción de las complicaciones, como son insuficiencia renal, pérdida de la visión (mieloproliferativas), amputaciones, neuropatías, infartos y accidentes cerebrovasculares. Se ha visto la resolución de la diabetes mellitus, como un resultado adicional al tratamiento quirúrgico de la obesidad mórbida, en dos de los procedimientos más usados como son el bypass gástrico y la derivación biliopancreática, produciendo concentraciones normales de glucosa, insulina y hemoglobina glucosilada en 80 a 90% de estos pacientes. Sin embargo, lo más importante es que el control de la glucosa frecuentemente ocurre dentro de días, mucho antes que haya una pérdida significativa de peso, sugiriendo que el control de la diabetes mellitus puede ser a un efecto directo de la cirugía (incretinas, anti-incretinas), más que secundaria al resultado de la disminución de las anormalidades relacionadas a la obesidad. El objetivo de este estudio es evaluar los resultados clínicos de la cirugía de exclusión duodenal, en orden de tratar pacientes con diabetes tipo 2, y con IMC menor de 35 kg/m2, sin el uso más de medicamentos o insulina, y sin los efectos colaterales y agresivos de la cirugía bariátrica; el bypass gástrico (BG) o de la derivación biliopancreática (DBP), ya que lo anterior llevaría a un control de la hiperglucemia y una reducción de las complicaciones y mortalidad de la diabetes tipo 2.


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