Comparison between the Effect of Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini-gastric Bypass on Type 2 Diabetes Mellitus in Obese Patients: A Prospective Study
Osama A Adly, Mohamed KE Elhadary, Mohammad Farouk, Hamdy Shaban
Bariatricsurgery, Metabolic disorders, Obesity, Type 2 diabetes mellitus
Citation Information :
Adly OA, Elhadary MK, Farouk M, Shaban H. Comparison between the Effect of Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini-gastric Bypass on Type 2 Diabetes Mellitus in Obese Patients: A Prospective Study. World J Lap Surg 2021; 14 (2):131-135.
Background: One of the major global health burdens is type 2 diabetes mellitus (T2DM). Laparoscopic sleeve gastrectomy (LSG) has recently been shown to be effective and safe for T2DM management. Laparoscopic mini-gastric bypass (LMGB) was introduced as a simple (one anastomosis) operation combining both restrictive and malabsorptive functions thus suitable for obese patients with metabolic derangements like T2DM. This study aims to compare the effect of LSG and LMGB on T2DM in obese patients.
Materials and methods: A cohort study was carried out on obese patients with T2DM submitted for LSG or LMGB in the department of surgery at Suez Canal university hospital and Suez Canal authority hospital, Egypt, from June 2018 to September 2020. The patients were followed up for 12 months.
Results: A total of 20 patients were allocated to each group. The change in the mean body mass index (BMI) was significantly higher in the LSG, compared to the LMGB group (p<0.05). Both groups exhibited a significant reduction in the HbA1c at the end of follow-up 12 months after surgery; however, the reduction was significantly higher in the LMGB group (p<0.05).Among the LSG group, 75% of the cases showed complete diabetic remission, 15% showed partial remission, and 10% showed improvement in their glycemic control at the end of follow-up. Among the LMGB group, 85% of the cases showed complete diabetic remission and 10% showed partial remission. The difference between the study groups was statistically significant.
Conclusion: The study showed good improvement for T2DM and a great response in losing weight with a significant superiority of LMGB over the LSG.
Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol 2018;14(2):88–98. DOI: 10.1038/nrendo.2017.151. Available from: www.nature.com/nrendo.
Johar D, Ahmed SM, ElHayek S, et al. Diabetes-induced proteome changes throughout development. EndocrMetab Immune Disord Drug Targets2019;19(6):732–743. DOI: 10.2174/1871530319666190305153810. Available from: http://www.eurekaselect.com/170449/article.
DePaula AL, Macedo ALV, Rassi N, et al. Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35. Surg Endosc 2008;22(3):706–716. DOI: 10.1007/s00464-007-9472-9.
Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009;122(3):248–256.e5. DOI: 10.1016/j.amjmed.2008.09.041.
Nathan DM, Buse JB, Davidson MB, et al. Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: update regarding thiazolidinediones: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2008;31(1):173–5. https://doi.org/10.2337/dc08-9025
Keidar A. Bariatric surgery for type 2 diabetes reversal: the risks. Diabetes Care 2011;34(Suppl.2):S361–S266. DOI: 10.2337/dc11-s254.
Abu-Jaish W, Rosenthal RJ. Sleeve gastrectomy: a new surgical approach for morbid obesity. Expert Rev Gastroenterol Hepatol 2010;4(1):101–119. DOI: 10.1586/egh.09.68.
Sasaki A, Wakabayashi G, Yonei Y. Current status of bariatric surgery in Japan and effectiveness in obesity and diabetes. J Gastroenterol 2014;49(1):57–63. DOI: 10.1007/s00535-013-0802-5.
Guerrier JB, Dietch ZC, Schirmer BD, et al. Laparoscopic sleeve gastrectomy is associated with lower 30-day morbidity versus laparoscopic gastric bypass: an analysis of the american college of surgeons NSQIP. Obes Surg 2018;28(11):3567–3572. DOI: 10.1007/s11695-018-3396-4.
Nocca D, Guillaume F, Noel P, et al. Impact of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on HbA1c blood level and pharmacological treatment of type 2 diabetes mellitus in severe or morbidly obese patients. Results of a multicenter prospective study at 1 year. Obes Surg 2011;21(6):738–743. DOI: 10.1007/s11695-011-0385-2.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. N Engl J Med 2017;376(7):641–651. DOI: 10.1056/NEJMoa1600869.
Peterli R, Wolnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-y gastric bypass onweight loss in patients with morbid obesity the sm-boss randomized clinical trial. JAMA – J Am Med Assoc 2018;319(3):255–265. DOI: 10.1001/jama.2017.20897.
Berry MA, Urrutia L, Lamoza P, et al. Sleeve gastrectomy outcomes in patients with BMI between 30 and 35–3 years of follow-up. Obes Surg 2018;28(3):649–655. DOI: 10.1007/s11695-017-2897-x.
Rutledge R. The mini gastric bypass experience with the first 1,274 cases. Obes Surg 2001;11(3):276–280. DOI: 10.1381/096089201321336584.
A. MC, A. T, M. O, et al. Mini-gastric bypass/one anastomosis gastric bypass (MGB/OAGB): our results after 2 years of follow up. gastric bypass procedures including Roux-en-y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB)/MGB. Obes Surg2017. DOI: 10.1007/s11695-016-2428-1
Abdel-Rahim MM, Magdy MM, Mohamad AAM. Comparative study between effect of sleeve gastrectomy and mini-gastric bypass on type 2 diabetes mellitus. Diabetes Metab Syndr Clin Res Rev 2018;12(6):949–954. DOI: 10.1016/j.dsx.2018.06.001.
Matthew C. Riddle M. ADA. Standards of medical care in diabetes – 2019. Am Diabetes Assoc 2019;42:204. Available from: http://fmdiabetes.org/wp-content/uploads/2019/01/ada-2019.pdf. https://doi.org/10.2337/dci17-0054
Lee MH, Almalki OM, Lee WJ, et al. Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: long-term result and recurrence of diabetes. Obes Surg 2020;30(10):3669–3674. DOI: 10.1007/s11695-020-04737-4.
Seki Y, Kasama K, Kikkawa E, et al. Five-year outcomes of laparoscopic sleeve gastrectomy in Japanese patients with class I obesity. Obes Surg 2020;30(11):4366–4374. DOI: 10.1007/s11695-020-04789-6.
Sawada S, Kodama S, Tsuchiya S, et al. Continuous glucose monitoring in patients with remission of type 2 diabetes after laparoscopic sleeve gastrectomy without or with duodenojejunal bypass. Clin Obes 2020;10(6):e12409. DOI: 10.1111/cob.12409.
Wu D, Wang L, Jiang T. Efficacy comparison of laparoscopic sleeve gastrectomy in type 2 diabetes patients with a BMI 30–34.9 kg/m2 versus BMI <30 kg/m2. Surg Endosc 2021;35(4):1544–1550. DOI: 10.1007/s00464-020-07749-4.
Park JY, Song D, Kim YJ. Clinical experience of weight loss surgery in morbidly obese Korean adolescents. Yonsei Med J 2014;55(5):1366–1372. DOI: 10.3349/ymj.2014.55.5.1366.
Lee WJ, Ser KH, Lee YC, et al. Laparoscopic roux-en-Y Vs. Mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg 2012;22(12):1827–1834. DOI: 10.1007/s11695-012-0726-9.
Kular KS, Manchanda N, Rutledge R. A 6-year experience with 1,054 mini-gastric bypasses – first study from Indian subcontinent. Obes Surg 2014;24(9):1430–1435. DOI: 10.1007/s11695-014-1220-3.
Rutledge R, Walsh TR. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg 2005;15(9):1304–1308. DOI: 10.1381/096089205774512663.
Nosso G, Angrisani L, Saldalamacchia G, et al. Impact of sleeve gastrectomy on weight loss, glucose homeostasis, and comorbidities in severely obese type 2 diabetic subjects. J Obes 2011;2011:340867. DOI: 10.1155/2011/340867.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes – 3-year outcomes. N Engl J Med 2014;370(21):2002–2013. DOI: 10.1056/NEJMoa1401329.
Wang W, Wei PL, Lee YC, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg2005;15(5):648–654. DOI: 10.1381/0960892053923752.