Resolution of Uncontrolled Type 2 Diabetes after Laparoscopic Truncal Vagotomy, Subtotal Gastrectomy, and Roux-en-Y Gastrojejunostomy for a Patient with Intractable Gastric Ulcers

Background. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been shown to be an effective treatment for type 2 diabetes mellitus (T2DM) in patients with morbid obesity. However, it is unclear just how effective the LRYGB procedure is on T2DM for patients with BMI less than 35？kg/m2. We report one obese patient with T2DM who did not meet the current NIH criteria for morbid obesity surgery. This patient underwent a laparoscopic truncal vagotomy, subtotal gastrectomy, and Roux-en-Y gastrojejunostomy for intractable gastric ulcers and subsequently had full resolution of her T2DM. Methods. A 48-year-old patient with a BMI of 34.6？kg/m2 underwent a laparoscopic truncal vagotomy, subtotal gastrectomy, and Roux-en-Y gastrojejunostomy for intractable gastric ulcers. The patient was seen 3 months preoperatively, followed for 24 months postoperatively, and evaluated for postoperative complications, weight loss, and improvement in comorbidities. Results. The patient had no postoperative surgical complications. Her BMI decreased from 34.6？kg/m2 to 22.3？kg/m2 by 24 months postoperatively. Significant improvements in her fasting blood glucose levels were seen 10 days postoperatively from a preoperative level of 147？mg/dl to 97？mg/dl. Conclusion. Patients with a BMI less than 35？kg/m2 and uncontrolled T2DM may benefit from a laparoscopic Roux-en-Y gastric bypass. 1. Introduction Obesity is a growing epidemic and is strongly associated with an increase in the prevalence of comorbid conditions, including type 2 diabetes mellitus (T2DM), cardiovascular disease, and cancer. In the United States, the development of T2DM has been strongly linked to obesity, with 50% of T2DM patients having a BMI >30？kg/m2 [1]. T2DM is now an epidemic, accounting for 90–95% of all cases of diabetes mellitus and affecting more than 246 million people worldwide. This number is expected to increase to 380 million people by the year 2025 [2, 3]. In the United States, the most common complications to long-standing, uncontrolled T2DM include heart disease, myocardial infarction, stroke, vision loss, renal failure, and peripheral artery disease often times resulting in amputations. While current medical therapies for T2DM can reduce the incidence of complications, they have not been effective in providing a definitive cure [4]. Bariatric surgery has been shown to be the most effective therapy in the resolution of comorbid conditions including T2DM in obese patients [5]. The role of surgical therapy as the primary management of T2DM is promising but controversial. The mechanism of action has been