Jejuno-ileal Bypass (JIB) "cures" most of T2DM but it was fortunately abandoned.

We now understand that, in metabolic syndrome, there is a imbalance in the gut activity: High glycemic index food provokes a hyperactive proximal gut and a hypoactive distal gut (The Gut Imbalance Theory) and a JIB obviously resolves this problem but at an unbearable high price: a long intestinal exclusion and an intense malabsorption.

Other forms of more "developed" surgery are available, as a Sleeve gastrectomy with a transit bipartition that aims to reestablish a balanced gut hormonal activity.

Check: Ann Surg 2012;256:104–110

Check also: From Bariatric to Pure Metabolic Surgery: New Concepts on the Rise. Ann Surg 2014, Published ahead of print

Thanks for that input Dr. Santoro. Aslo, congratulation on publishing in Annals of Surgery.

What are your thoughts about duodenojejunal bypass based on foregut hypothesis in non-obese diabetics?

I am skeptical to believe that the non-obese T2DM have the same pathphysiology of the obese (genetically, T2DM is a heterogeneous disease), therefore, I am rather cautious in this issue.

However, any diabetic gets better if he eats much and starts to eat less (because of the anoretic effects of distal gut hormones) or if he looses weight. Even a T1DM would need less insulin, in this circumstances.

By this rationale, a DJB improves any DM. But malabsorption is a bad disease.

The ICD K.90 points to Malabsorption. So it is a disease.

I think we have the duty to apply these new understandings in the development of efficient surgical procedures that do not bring new diseases.

These is the spirit of Pure Metabolic Surgery.

That makes perfect sense, thanks Dr. Santoro

jejuno-ileal Bypass was practiced for Hypercholesterlemia also .It very effectively cures the problem but adds several other problems including fractures due to severe malabsorption,hence this is not being practiced.I had an opportunity to reverse one.

Thanks for your input. Dr. Reddy. Reversal would have been technically difficult?

Thanks for input sir. Reversal must have been technically difficult? What are the indications for reversal?

Orientation was difficult as it was an open procedure done many years ago in London.Anastamosis was also difficult as the defunctioned bowel of many years duration was very contracted.It took some time to open up after side to side aastamosis.Indication for reversal after such along time is due to metabolic problems

including spontanious #of Hip leading to THR.But the primary problem was cured.