Loop Duodenojejunal Bypass with Sleeve Gastrectomy: Comparative Study with Roux-en-Y Gastric Bypass in Type 2 Diabetic Patients with a BMI <35 kg/m(2), First Year Results

Chih Kun Huang, Chi-Ming Tai, Po-Chih Chang, Kirubakaran Malapan, Ching-Chung Tsai, Kamthorn Yolsuriyanwong
Obesity Surgery 2016, 26 (10): 2291-301

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has shown good diabetes remission in obese patients with type 2 diabetes mellitus (T2DM), but long-term complications were observed. We developed loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) to achieve diabetes remission and avoid the drawbacks of RYGB. We compare 1-year results between LDJB-SG and RYGB with body mass index (BMI) <35 kg/m(2) of T2DM patients.

METHODS: We conducted a case-matched study of BMI < 35 kg/m(2) T2DM patients who underwent RYGB and LDJB-SG matching on age, BMI, and duration of diabetes. The 1-year surgical results were compared.

RESULTS: Sixty patients were included from March 2010 to August 2012. Thirty patients underwent RYGB and 30 underwent LDJB-SG. The operative time (mean ± SD) and length of stay (median [IQR]) were significantly longer in the LDJB-SG group than in the RYGB group (127.0 ± 40.2 vs. 105.0 ± 64.7 min and 3[3, 4] vs. 3[2, 3] days, respectively). There were no statistical differences between the groups in the mean BMI, fasting plasma glucose, and %HbA1c either at baseline or at 1 year. However, these parameters dropped significantly from the preoperative values (p < 0.01). The level of HOMA-%B at 1 year was significantly higher in the LDJB-SG group than in the RYGB group (p = 0.004). The resolution of comorbidities was similar. Late complications seemed higher in the RYGB group (12 vs. 5, p = 0.08). There were no deaths, but two patients in each group required reoperation.

CONCLUSIONS: LDJB-SG was comparable to RYGB in terms of weight loss, glycemic control, and comorbidity resolution in BMI <35 kg/m(2) T2DM patients in the short-term.

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