Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery··
One-year outcomes of three weight-loss surgeries in obese patients with type 2 diabetes
Updated
Abstract
Sixty-four patients with type 2 diabetes underwent either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy with Roux-en-Y duodenal bypass (SG+RYDJB) to compare their outcomes after one year.
- Both surgical procedures did not significantly differ in total weight loss percentage (26.5% for SG+RYDJB vs. 25.6% for RYGB) or excess weight loss percentage (109.1% vs. 109.4%).
- Complete remission of diabetes at one year was similar between the SG+RYDJB (80.0%) and RYGB (82.4%) groups.
- The SG+RYDJB group experienced a higher incidence of perioperative complications (20%) compared to the RYGB group (2.9%).
- Anemia occurred more frequently in the RYGB group (26.5%) than in the SG+RYDJB group (3.3%).
- Operation time was significantly longer for SG+RYDJB (137.8 minutes) compared to RYGB (80.0 minutes).
Simplified
To compare the 1-year effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy with Roux-en-Y duodenal bypass (SG+RYDJB) on weight loss, remission of diabetes, and postoperative complications in patients with obesity and type 2 diabetes.A single-center retrospective cohort study was conducted at the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2020. Sixty-four patients with type 2 diabetes and body mass index (BMI) of 27.5-40.0 kg/mwere included in this study and divided into the RYGB group (=34) and the SG+RYDJB group (=30). In both procedures, the biliopancreatic branch was measured 100 cm distal to the Treitz ligament, and the food branch was measured 100 cm distal to the gastric or duodenojejunal anastomosis. Patients were followed up by telephone or WeChat, a free messaging and calling app at 1, 3, 6, and 12 months postoperatively to determine their weight loss and remission of diabetes. The primary outcomes were the weight loss and reduction in blood glucose concentrations at 1 year after surgery and postoperative complications. Other postoperative changes, including body weight, BMI, percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), glycated hemoglobin A1c (HbA1c), and fasting blood glucose at 1 year after surgery were also assessed.There were no significant differences in baseline data between the two groups (all>0.05). No conversion to open surgery or death occurred in either group. Operation time was longer in the SG+RYDJB than the RYGB group (137.8±22.1 minutes vs. 80.0±24.9 minutes,=9.779,<0.001) and the incidence of perioperative complications was higher in the SG+RYDJB than the RYGB group (20% [6/30] vs. 2.9% [1/34], χ=4.761,=0.029). However, the postoperative hospital stay was similar between the two groups [3.0 (3.0, 4.3) days vs. 3.0 (4.0, 6.0) days,=641.500,=0.071]. Perioperative complications comprised small gastric pouch anastomotic leakage in one patient in the RYGB group and leakage (three patients) and bleeding (two patients with gastrointestinal bleeding and one with trocar site bleeding) in the SG+RYDJB group. Long-term complications were as follows. The incidence of anemia was significantly higher in the RYGB than the SG+RYDJB group (26.5% [9/34] vs. 3.3% [1/30], χ=6.472,=0.011). However, there were no significant differences in incidences of postoperative reflux, dumping syndrome, alopecia, diarrhea, constipation or foul-smelling flatus between the two groups (all>0.05). Compared with 1 year before surgery, the body weights and fasting plasma glucose concentrations of patients in the SG+RYDJB and RYGB group (72.4±10.6 kg vs. 98.5±14.2 kg, respectively; 68.2±10.0 kg vs. 91.9±14.8 kg, respectively), BMI (25.2±2.9 kg/mvs. 34.3±4.2 kg/m, respectively; 24.3±2.4 kg/mvs. 32.7±3.7 kg/m, respectively) (5.5±1.6 vs. 10.6±3.3, respectively; 5.8±2.1 vs. 9.0±3.4, respectively); HbA1c (5.7±0.8 vs. 9.7±1.2, respectively; 9.1±1.9 vs. 5.9±0.9, respectively) were significantly lower at 1 year after surgery (all<0.05). However, the % TWL (26.5%±6.0% vs. 25.6%±4.4%,=0.663,=0.510) and % EWL (109.1%±38.2% vs. 109.4%±40.3%,=-0.026,=0.026), rate of complete remission of diabetes at 1 year (80.0% [24/30] vs. 82.4% [28/34], χ=0.058,=0.810] did not differ significantly between the two groups (all>0.05).Although SG+RYDJB surgery compared with RYGB is more difficult to perform, it can achieve similar weight loss and remission of diabetes and is associated with a lower incidence of anemia because of the preservation of the pylorus. Objective: Methods: Results: Conclusions: 2 2 2 2 2 2 2 2n n P t P P U P P P P t P t P P P
Related papers
Sep '23
One-year weight loss results of four types of stomach and intestinal surgeries in patients with severe obesity
cited by 1 paper
observational study
Jul '15
Long-term outcomes of two weight-loss surgeries for Chinese type 2 diabetes patients with BMI 28-35
top 50% journal
cited by 96 papers
randomized controlled trial
Mar '16
Comparing Two Weight-Loss Surgeries for Type 2 Diabetes Patients with BMI Under 35: One-Year Results
top 20% journal
cited by 38 papers
comparative study
Jan '19
Short-term results of sleeve gastrectomy with jejunojejunal bypass compared to sleeve gastrectomy and Roux-en-Y gastric bypass in Chinese patients with BMI 35 or higher
top 20% journal
cited by 34 papers
journal article
Aug '22
Short-term results of two types of stomach and intestine surgery for type 2 diabetes: loop versus Roux-en-Y bypass
top 20% journal
cited by 13 papers
randomized controlled trial
Dec '12
Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy lead to similar weight loss after 1 year
cited by 19 papers
comparative study
Jun '18
Long-term weight loss and health improvements after three types of stomach surgery: sleeve gastrectomy, Roux-en-Y, and one-anastomosis gastric bypass
top 20% journal
cited by 114 papers
randomized controlled trial
Aug '14
Weight Loss Surgery in Adults
cited by 514 papers
systematic review
Aug '19
Comparing Repeat Sleeve Gastrectomy and Gastric Bypass After Failed Weight Loss from Sleeve Gastrectomy
top 20% journal
cited by 25 papers
observational study
Jul '22
Results of minimally invasive surgery changing sleeve stomach surgery to gastric bypass in obese and non-obese Asian patients using different approaches
top 50% journal
cited by 6 papers
journal article