From PubMed (this seems VERY conservatively stated, by the way):

Obes Surg. 2004 Nov-Dec;14(10):1354-9

Duodenal switch without gastric resection: results and observations
after 6 years.

Cossu ML, Noya G, Tonolo GC, Profili S, Meloni GB, Ruggiu M, Brizzi P,
Cossu F, Pilo L, Tilocca PL.

Centro di Chirurgia Generale e Della Grande Obesita', Policlinico
Universitario, Italy. Urgenza@...

BACKGROUND: The results on metabolic effects of the classical
biliopancreatic diversion (BPD) have led us to investigate the
operation without gastric resection, thus preserving stomach and
pylorus, in patients who are not seriously obese but suffer from
hypercholesterolemia, often associated with type 2 diabetes and
hypertriglyceridemia. METHODS: Between 1996 and 1999, we performed the
duodenal switch (DS) without gastric resection on 24 mildly obese
patients. Mean preoperative BMI was 36.2 kg/m(2). 17 patients (70.8%)
suffered from type 1 diabetes, 4 (16.6%) had impaired glucose
tolerance, while the remainder had fasting hyperglycemia. In 20
patients (83.3%), hypercholesterolemia and alterations in lipid
profile were present. Another 20 patients were taking drugs for
arterial hypertension. The pluri-metabolic syndrome was present in
41.6% of patients. RESULTS: Mean follow-up was 4 years. BMI reduction
and weight loss were not large. 2 patients who had severe longstanding
diabetes type 2 needed a second operation of the classical BPD because
of failure in improving diabetes. Another 2 patients were changed to
classical BPD because of a relapsing chronic duodeno-ileal ulcer. The
incidence of ileal ulcer was 29.1%. Regarding hypercholesterolemia,
hypertrigliceridemia, and type 2 diabetes when there is a good
pancreatic "reservoir", the operation seems effective in the
long-term. Protein absorption is better than that obtained with the
classical BPD. CONCLUSIONS: Our long-term results suggest that in
carefully selected patients suffering from serious
hypercholesterolemia or type 2 diabetes with insulin reserves still at
an acceptable level, and with BMI 30-40, DS without gastric resection
can be proposed as a surgical treatment for metabolic diseases but not
for obesity.

*******************************************
Obes Surg. 2001 Oct;11(5):635-9

Improvement of weight loss and metabolic effects of vertical banded
gastroplasty by an added duodenal switch procedure.

Yashkov YI, Oppel TA, Shishlo LA, Vinnitsky LI.

Dept. of Liver, Bile Ducts and Pancreatic Surgery, Russian Research
Center of Surgery RAMS, Moscow, Russia. yu.yashkov@...

BACKGROUND: Some patients who underwent vertical banded gastroplasty
(VBG) need revisional operations because of poor weight loss and
remaining comorbidities. The duodenal switch (DS) procedure with
partial gastrectomy is known as an effective method for treatment of
severe obesity and related dyslipoproteinemias and diabetes mellitus
type 2 (DM2). Other investigations have shown that DS without gastric
resection similarly corrects hypercholesterolemia and DM2 in the "less
than" morbidly obese patients. METHODS: Based on this knowledge, we
performed a DS simultaneously with hernioplasty and panniculectomy in
a 63-year-old woman with a fair EWL (36.4%), with remaining
hypercholesterolemia and DM2 4 years after VBG. The pouch stoma
diameter was 13 mm, and there was no pouch dilation nor staple-line
disruption. The previously partitioned stomach was left in place.
H2-blockers and polyvitamins were prescribed after operation. RESULTS:
1 year after DS there were no postoperative complications and
undesirable effects except slight anemia. DS allowed improvement in
weight loss, improved carbohydrate handling without need for insulin
or other hypoglycemic agents, and corrected severe
hypercholesterolemia. CONCLUSION: DS per se in the case presented had
a decisive effect on DM2 and hypercholesterolemia. DS should be kept
in mind as a second-step malabsorptive procedure after a failed purely
restrictive operation.
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RE: Diabetes Cured, Patty, Denise, Others?
Response from Black Thorne at 8:19 PM PST on 10/26/2005
Pensacola, FL – DS (09/15/2005)


Photo of Black Thorne
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1\
2409659&dopt=Abstract

Potential of surgery for curing type 2 diabetes mellitus.

Rubino F, Gagner M.

IRCAD-European Institute of Telesurgery, Strasbourg, France.
f.rubino@...

OBJECTIVE: To review the effect of morbid obesity surgery on type 2
diabetes mellitus, and to analyze data that might explain the
mechanisms of action of these surgeries and that could answer the
question of whether surgery for morbid obesity can represent a cure
for type 2 diabetes in nonobese patients as well. SUMMARY BACKGROUND
DATA: Diabetes mellitus type 2 affects more than 150 million people
worldwide. Although the incidence of complications of type 2 diabetes
can be reduced with tight control of hyperglycemia, current therapies
do not achieve a cure. Some operations for morbid obesity not only
induce significant and lasting weight loss but also lead to
improvements in or resolution of comorbid disease states, especially
type 2 diabetes. METHODS: The authors reviewed data from the
literature to address what is known about the effect of surgery for
obesity on glucose metabolism and the endocrine changes that follow
this surgery. RESULTS: Series with long-term follow-up show that
gastric bypass and biliopancreatic diversion achieve durable normal
levels of plasma glucose, plasma insulin, and glycosylated hemoglobin
in 80% to 100% of severely obese diabetic patients, usually within
days after surgery. Available data show a significant change in the
pattern of secretion of gastrointestinal hormones. Case reports have
also documented remission of type 2 diabetes in nonmorbidly obese
individuals undergoing biliopancreatic diversion for other
indications. CONCLUSIONS: Gastric bypass and biliopancreatic diversion
seem to achieve control of diabetes as a primary and independent
effect, not secondary to the treatment of overweight. Although
controlled trials are needed to verify the effectiveness on nonobese
individuals, gastric bypass surgery has the potential to change the
current concepts of the pathophysiology of type 2 diabetes and,
possibly, the management of this disease.

Publication Types:
Review

PMID: 12409659 [PubMed - indexed for MEDLINE]
___________________________________________________________

1: Treat Endocrinol. 2005;4(1):55-64. Related Articles, Links

Surgical management of obesity: a review of the evidence relating to
the health benefits and risks.

Lara MD, Kothari SN, Sugerman HJ.

Department of General and Vascular Surgery, Gundersen Lutheran Medical
Center, LaCrosse, Wisconsin 54601, USA.

Obesity continues to plague our society in epidemic proportions.
Surgery for morbid obesity is considered by many as the most effective
therapy for this complex disorder. Today, multiple surgical procedures
for the treatment of obesity are available. As with most procedures,
there are benefits and risks associated with open and laparoscopic
gastric bypass surgery, as well as with laparoscopic adjustable
gastric banding and partial biliopancreatic bypass with a duodenal
switch. The risks and complications associated with bariatric surgery
may be serious and in some cases life threatening. However, surgery
for obesity has shown remarkable results in helping patients to
achieve significant long-term weight control. In addition, it is
associated with improvement and often resolution of co-morbid
conditions, including type 2 diabetes mellitus, systemic hypertension,
obesity hypoventilation, sleep apnea, venous stasis disease,
pseudotumor cerebri, polycystic ovary syndrome, complications of
pregnancy and delivery, gastroesophageal reflux disease, stress
urinary incontinence, degenerative joint disease, and non-alcoholic
steatohepatitis.

Publication Types:

* Review
* Review, Tutorial


PMID: 15649101 [PubMed - indexed for MEDLINE]
_____________________________________________________________

1: Obes Surg. 2004 Nov-Dec;14(10):1354-9. Related Articles, Links
Click here to read
Duodenal switch without gastric resection: results and observations
after 6 years.

Cossu ML, Noya G, Tonolo GC, Profili S, Meloni GB, Ruggiu M, Brizzi P,
Cossu F, Pilo L, Tilocca PL.

Centro di Chirurgia Generale e Della Grande Obesita', Policlinico
Universitario, Italy. Urgenza@...

BACKGROUND: The results on metabolic effects of the classical
biliopancreatic diversion (BPD) have led us to investigate the
operation without gastric resection, thus preserving stomach and
pylorus, in patients who are not seriously obese but suffer from
hypercholesterolemia, often associated with type 2 diabetes and
hypertriglyceridemia. METHODS: Between 1996 and 1999, we performed the
duodenal switch (DS) without gastric resection on 24 mildly obese
patients. Mean preoperative BMI was 36.2 kg/m(2). 17 patients (70.8%)
suffered from type 1 diabetes, 4 (16.6%) had impaired glucose
tolerance, while the remainder had fasting hyperglycemia. In 20
patients (83.3%), hypercholesterolemia and alterations in lipid
profile were present. Another 20 patients were taking drugs for
arterial hypertension. The pluri-metabolic syndrome was present in
41.6% of patients. RESULTS: Mean follow-up was 4 years. BMI reduction
and weight loss were not large. 2 patients who had severe longstanding
diabetes type 2 needed a second operation of the classical BPD because
of failure in improving diabetes. Another 2 patients were changed to
classical BPD because of a relapsing chronic duodeno-ileal ulcer. The
incidence of ileal ulcer was 29.1%. Regarding hypercholesterolemia,
hypertrigliceridemia, and type 2 diabetes when there is a good
pancreatic "reservoir", the operation seems effective in the
long-term. Protein absorption is better than that obtained with the
classical BPD. CONCLUSIONS: Our long-term results suggest that in
carefully selected patients suffering from serious
hypercholesterolemia or type 2 diabetes with insulin reserves still at
an acceptable level, and with BMI 30-40, DS without gastric resection
can be proposed as a surgical treatment for metabolic diseases but not
for obesity.

PMID: 15603651 [PubMed - indexed for MEDLINE]

_______________________________________________________

1: JAMA. 2004 Oct 13;292(14):1724-37. Related Articles, Links

Erratum in:

* JAMA. 2005 Apr 13;293(14):1728.


Comment in:

* JAMA. 2005 Apr 13;293(14):1726; author reply 1726.
* JAMA. 2005 Apr 13;293(14):1726; author reply 1726.

Click here to read
Bariatric surgery: a systematic review and meta-analysis.

Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K,
Schoelles K.

Department of Surgery, University of Minnesota, Minneapolis 55455,
USA. buchw001@...

CONTEXT: About 5% of the US population is morbidly obese. This disease
remains largely refractory to diet and drug therapy, but generally
responds well to bariatric surgery. OBJECTIVE: To determine the impact
of bariatric surgery on weight loss, operative mortality outcome, and
4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and
obstructive sleep apnea). DATA SOURCES AND STUDY SELECTION: Electronic
literature search of MEDLINE, Current Contents, and the Cochrane
Library databases plus manual reference checks of all articles on
bariatric surgery published in the English language between 1990 and
2003. Two levels of screening were used on 2738 citations. DATA
EXTRACTION: A total of 136 fully extracted studies, which included 91
overlapping patient populations (kin studies), were included for a
total of 22,094 patients. Nineteen percent of the patients were men
and 72.6% were women, with a mean age of 39 years (range, 16-64
years). Sex was not reported for 1537 patients (8%). The baseline mean
body mass index for 16 944 patients was 46.9 (range, 32.3-68.8). DATA
SYNTHESIS: A random effects model was used in the meta-analysis. The
mean (95% confidence interval) percentage of excess weight loss was
61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients
who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass;
68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%),
biliopancreatic diversion or duodenal switch. Operative mortality (<
or =30 days) in the extracted studies was 0.1% for the purely
restrictive procedures, 0.5% for gastric bypass, and 1.1% for
biliopancreatic diversion or duodenal switch. Diabetes was completely
resolved in 76.8% of patients and resolved or improved in 86.0%.
Hyperlipidemia improved in 70% or more of patients. Hypertension was
resolved in 61.7% of patients and resolved or improved in 78.5%.
Obstructive sleep apnea was resolved in 85.7% of patients and was
resolved or improved in 83.6% of patients. CONCLUSIONS: Effective
weight loss was achieved in morbidly obese patients after undergoing
bariatric surgery. A substantial majority of patients with diabetes,
hyperlipidemia, hypertension, and obstructive sleep apnea experienced
complete resolution or improvement.

Publication Types:

* Meta-Analysis
* Review


PMID: 15479938 [PubMed - indexed for MEDLINE]
________________________________________________________________
1: Obes Surg. 1998 Jun;8(3):267-82. Related Articles, Links
Click here to read
Biliopancreatic diversion with a duodenal switch.

Hess DS, Hess DW.

Wood County Hospital, Bowling Green, OH, USA.

BACKGROUND: This paper evaluates biliopancreatic diversion combined
with the duodenal switch, forming a hybrid procedure which is a
combination of restriction and malabsorption. METHODS: The evaluation
is of the first 440 patients undergoing this procedure who had had no
previous bariatric surgery. The mean starting weight was 183 kg, with
41% of our patients considered super morbidly obese (BMI > 50).
RESULTS: There was an average maximum weight loss of 80% excess weight
by 24 months postoperation; this continued at a 70% level for 8 years.
Major complications were found in almost 9% of the cases. There were
two perioperative deaths, one from pulmonary embolism and one from
acute pulmonary obstruction. There were 36 type II diabetics, all of
whom have discontinued medication following the surgery. Seventeen
revisions were performed to correct excess weight loss and low protein
levels. There have been no marginal ulcers, no cases of dumping
syndrome, no foreign material used, and the procedure is a pyloric
saving procedure which is functionally reversible. CONCLUSIONS: This
operation has vastly improved the lives of seriously obese patients
with many comorbidities. All type II diabetics have essentially been
cured of their disease. The procedure was tolerated well and patients
are quite satisfied. There was minimal regain of weight with this method.

PMID: 9678194 [PubMed - indexed for MEDLINE]