Laparoscopic gastric bypass for type II diabetes mellitus

　　The so-called gastric bypass surgery originated in developed countries in Europe and the United States in the 1950s, when many obese patients influenced by fashion and aesthetics requested surgery to lose weight, and many bariatric surgeries came into being. It was not until 1998 that a medical school in the United States reported the results of a 30-year follow-up study of gastric bypass bariatric surgery in a world-renowned medical journal, which once again proved the fact that diabetes improved in obese patients after gastric bypass bariatric surgery, and only then did it attract great attention from the academic community. The International Diabetes Center, in conjunction with experts from many countries, conducted in-depth studies on gastric bypass surgery for diabetes and gradually improved the procedure, and the main beneficiaries of gastric bypass surgery have since shifted from obese patients to type II diabetic patients. After more than 20 years of dedicated research and clinical practice by scholars from many countries around the world, the technique has become fully mature.　　In January 2009, the American Diabetes Association published the 2009 American Diabetes Prevention and Control Guidelines, which formally listed gastric bypass surgery as a routine treatment for diabetes mellitus. Consensus”. By the end of last year, more than 10,000 cases of gastric bypass surgery had been performed in China, including more than 2,000 cases of laparoscopic gastric bypass surgery, with a total efficiency of more than 93%. The mechanism is that before surgery, the upper gastrointestinal tract is stimulated by food to produce “insulin resistance factor”, which causes insulin resistance in the body and is considered to be the main cause of type II diabetes. After surgery, the stimulation of the upper gastrointestinal tract by food disappears or is reduced, and these stimulating factors are no longer produced. The bypass surgery allows undigested or incompletely digested food to enter the ileum earlier, which can cause the body to produce factors that increase insulin action, thus achieving a therapeutic effect on diabetes.　　Patients with type II diabetes who have experienced poor results or are intolerant to long-term non-surgical treatment may consider surgery as long as there are no obvious contraindications to surgery. Better outcomes can be expected in those who meet the following conditions: 1, patient age <65 years; 2, duration of type II diabetes <15 years; 3, fasting C-peptide above 1/2 of the lower limit of normal, and 2-hour postprandial C-peptide more than 2-fold more responsive than preprandial.　　Laparoscopic gastric bypass surgery has been introduced, it is popular among patients, the specific method is to punch several small holes of 0.5 to 1.0 cm in the patient’s abdomen, one of the small holes is inserted into the laparoscope, the image in the abdomen is displayed on the screen through the camera, the doctor watches the image on the screen, and the stomach is slimmed down through several other small holes inserted into the abdomen, turning into a small stomach and then the digestive tract The digestive tract is then rerouted so that the food no longer passes through the distal stomach, duodenum, and part of the upper jejunum. Since the surgeon’s hand does not enter the abdominal cavity directly, the abdominal cavity is less disturbed, the patient can get out of bed early after surgery, the intestinal function recovers quickly, and intestinal adhesions can be effectively avoided, so minimally invasive surgery has very obvious advantages. The timely introduction of the new technology in our department has undoubtedly brought a blessing to the majority of diabetic patients in Nanyang.