Expert Consensus
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Nov 15, 2024; 15(11): 2182-2188
Published online Nov 15, 2024. doi: 10.4239/wjd.v15.i11.2182
Guidelines and consensus: Jejunoileostomy for diabetes mellitus-surgical norms and expert consensus (2023 version)
Ji-Wei Shen, Chun-Yong Ji, Xue-Dong Fang, Bo Yang, Tian Zhang, Zheng-Cai Li, Hua-Zhi Li, Zhi-Yi Liu, Jun Tang, Chuan-Wen Liao, Ji-Zhou Lu, Xuan Yang, Xin-Guo Zhang
Ji-Wei Shen, Department of General Surgery, Heilongjiang Provincial People's Hospital, Harbin 150036, Heilongjiang Province, China
Chun-Yong Ji, Department of General Surgery, Zhengzhou Central Hospital, Zhengzhou 450007, Henan Province, China
Xue-Dong Fang, Department of General Surgery, The Third Affiliated Hospital of Jilin University, Changchun 130033, Jilin Province, China
Bo Yang, Department of General Surgery, The Eighth Medical Center of the General Hospital of the People's Liberation Army, Beijing 100091, China
Tian Zhang, Department of General Surgery, 242 Affiliated Hospital of Shenyang Medical College, Shenyang 110034, Liaoning Province, China
Zheng-Cai Li, Department of General Surgery, Jingmen Petrochemical General Hospital in Hubei Province, Jingmen 448001, Hubei Province, China
Hua-Zhi Li, Department of General Surgery, Beijing Chuiyangliu Hospital Affiliated to Tsinghua University, Beijing 100022, China
Zhi-Yi Liu, Department of General Surgery, The Fourth Hospital of Jilin University, Changchun 130011, Jilin Province, China
Jun Tang, Department of General Surgery, The First People's Hospital of Xiangtan, Xiangtan 411101, Hunan Province, China
Chuan-Wen Liao, Department of General Surgery, Jiangxi First People's Hospital, Nanchang 332000, Jiangxi Province, China
Ji-Zhou Lu, Department of General Surgery, The Third People's Hospital of Gansu Province, Lanzhou 730020, Gansu Province, China
Xuan Yang, Department of General Thoracic Surgery, Liaoning Electric Power Center Hospital, Shenyang 110403, Liaoning Province, China
Xin-Guo Zhang, Department of General Surgery, The Third Medical Center of the General Hospital of the People's Liberation Army, Beijing 100039, China
Co-corresponding authors: Xuan Yang and Xin-Guo Zhang.
Author contributions: Shen JW, Ji CY, Fang XD, Yang B, Zhang T and Li ZC contributed to searching data, organizing information, and drafting the manuscript; Li HZ, Liu ZY, Tang J, Liao CW, Lu JZ contributed to screening and sorting information; Zhang XG and Yang X contributed to inspiration, editing and critically revising the manuscript for intellectual content. All authors have read and approved the final manuscript.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Guo Zhang, MMed, Chief Doctor, Department of General Surgery, The Third Medical Center of the General Hospital of the People's Liberation Army, No. 69 Yongding Road, Haidian District, Beijing 100000, China. 13520495188@139.com
Received: July 23, 2024
Revised: September 3, 2024
Accepted: September 18, 2024
Published online: November 15, 2024
Processing time: 84 Days and 22.7 Hours
Abstract

Diabetes mellitus (DM) is a group of diseases characterized by high blood glucose caused by insufficient absolute or relative secretion of insulin. Once diagnosed, patients need long-term treatment with hypoglycemic drugs. Currently, the existing first-line hypoglycemic drugs do not provide effective treatment for DM and its complications. In the past, the first generation and the second generation of weight loss surgery, such as gastric bypass and sleeve gastric surgery, had strict body mass index requirements. Moreover, post-surgery, patients are prone to fluctuating hypoglycemia, gastroesophageal reflux, and dumping syndrome. Hence, the curative effect of this type of surgery was compromised to a certain extent. Jejunoileostomy is a third-generation surgery for patients with DM, which has been shown to improve glucose and lipid metabolism, without changing the original gas-trointestinal tract structure. Different from previous weight loss surgeries, jejunoileostomy has been clinically observed to delay the development of DM-related complications. Additionally, the postoperative complications are mild and do not affect the patient’s quality of life. Based on our clinical observations from multi-center large samples, our team developed a consensus on the operative period and perioperative management of jejunoi-leostomy as a reference for clinical researchers.

Keywords: Surgical; Diabetes; Weight loss surgery; Y-shaped anastomotic jejunal loops; Jejunoileostomy

Core Tip: The surgical treatment of diabetes has evolved through three stages, shifting focus from weight-loss procedures to techniques that address insulin resistance and enhance glucagon-like peptide-1 (GLP-1) production. The most recent stage, jejunoileostomy, has been included in the national medical security. Unlike weight-loss surgeries which center around the stomach, diabetes surgeries aim to reduce insulin resistance and promote GLP-1 production, regardless of pre-surgery obesity status. Given the dissatisfaction rate with simple sleeve stomach surgeries, there's a growing trend to incorporate intestinal bypass. This consensus encapsulates expert opinions on various aspects of jejunoileostomy for diabetes treatment.