Date of Publication: 30-Nov--0001
Laparoscopic Sleeve Gastrectomy Versus Roux-En-Y Gastric Bypass in The Remission of Type 2 Diabetes Mellitus:
Early Results From A Bariatric Centre in Malaysia.
Author: Anivat Ai Pun, Loo Guo Hou, Reynu Rajan, Nik Ritza Kosai, Norlela Sukor
Category: JMSR Surgery
Background: Obesity is strongly associated with Type 2 diabetes mellitus (T2DM). Gastric bypass results in remission of T2DM. Sleeve gastrectomy has been shown to have comparable effects on T2DM resolution. We compared the outcomes of laparoscopic sleeve gastrectomy (LSG) with laparoscopic Roux-en-Y gastric bypass (LRYGB) on T2DM, dyslipidaemia, hypertension and body mass index (BMI) in obese patients with T2DM. Material and Methods: A retrospective chart review was performed on patients above 18years old with T2DM who underwent LSG or LRYGB in our university hospital from January 2012 to June 2017. Post-operative weight and metabolic parameters a year after surgery were collected and analyzed. Results: 167 (LSG:89, LRYGB:78) patients were included. At one year after surgery, 74.2% and 76.9% of patients in the LSG and LRYGB group had HbA1C< 6.1% respectively. Complete remission of T2DM was seen in 52.8% of patient after LSG and 58.9% after LRYGB (p=0.321). HbA1c decreased to 5.74% (?0.8) in LSG group and 5.67% (?0.8) in LRYGB group (p=0.559). Significant BMI reduction was seen in both groups [LSG: 35.2(?7.6), LRYGB 31.2(?7.2), p=0.001]. All patients experienced improvement in lipid profile post operatively. Conclusion: Bariatric surgery results not only in significant weight loss one year after surgery but also in improvement of metabolic disease in the Malaysian population. longer follow-up is required to assess if this effect persists beyond a year.
Keywords: Metabolic surgery, Obesity, Asian population, minimal access surgery, HbA1c
- Eckel RH, Kahn SE, Ferrannini E, et al. Obesity and Type 2 Diabetes: What Can Be Unified and What Needs to Be Individualized? The Journal of Clinical Endocrinology and Metabolism. 2011; 96(6):1654-1663. DOI:10.1210/jc.2011-0585.
- Gloy, V.L., Briel, M., Bhatt, D.L., et al. (2013.) Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. British Medical Journal. DOI: https://doi.org/10.1136/bmj.f5934
- Buchwald H, Avidor Y, Braunwald E, Jensen MD et al.(2004) Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37. DOI: 10.1001/jama.292.14.1724
- Yeo D, Yeo C, Low TY, Ahmed S, Phua S, et al. Outcomes After Metabolic Surgery in Asians-a Meta-analysis. Obes Surg. 2019 Jan;29(1):114-126. doi: 10.1007/s11695-018-3484-5.
- Cho YM. A Gut Feeling to Cure Diabetes: Potential Mechanisms of Diabetes Remission after Bariatric Surgery. Diabetes & Metabolism Journal. 2014; 38(6):406-415. doi:10.4093/dmj.2014.38.6.406.
- Vetter ML, Ritter S, Wadden TA, Sarwer DB. Comparison of Bariatric Surgical Procedures for Diabetes Remission: Efficacy and Mechanisms. Diabetes Spectr. 2012;25(4):200-210. doi:10.2337/diaspect.25.4.200
- Laferrère B, Teixeira J, McGinty J, et al. Effect of Weight Loss by Gastric Bypass Surgery versus Hypocaloric Diet on Glucose and Incretin Levels in Patients with Type 2 Diabetes. The Journal of Clinical Endocrinology and Metabolism. 2008; 93(7):2479-2485.doi:10.1210/jc.2007-2851.
- Chambers AP et al. Regulation of gastric emptying rate and its role in nutrient-induced GLP-1 secretion in rats after vertical sleeve gastrectomy. American Journal of Physiology - Endocrinology and Metabolism. 2014; 306 inferiority (4): E424- E432. doi:10.1152/ajpendo.00469.2013.
- Karamanakos SN1, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008 Mar; 247(3):401-7. doi: 10.1097/SLA.0b013e318156f012.
- Wang MC, Guo XH, Zhang YW, Zhang YL, et al. Laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for obese patients with Type 2 diabetes: a meta-analysis of randomized controlled trials. Am Surg. 2015 Feb; 81 (2): 166- 71. PMID: 25642879.
- Yang J, Wang C, Cao G, Yang W, et al. Long-term effects of laparoscopic sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28-35 kg/m(2). BMC Surg. 2015 Jul 22; 15: 88. doi: 10.1186/s12893-015-0074-5.
- Lee WJ et al. Medium-Term Results of Laparoscopic Sleeve Gastrectomy: a Matched Comparison with Gastric Bypass. Obes Surg. 2015 Aug; 25 (8):1431-8. doi: 10.1007/s11695-015-1582-1.
- Cho JM et al. Effect of sleeve gastrectomy on type 2 diabetes as an alternative treatment modality to Roux-en-Y gastric bypass: systemic review and meta-analysis. Surg Obes Relat Dis. 2015 Nov-Dec; 11 (6): 1273- 80. doi: 10.1016/j.soard.2015.03.001.
- Brethauer et al. ASMBS Clinical Issues Committee. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015; 11 (3):489-506. doi: 10.1016/j.soard.2015.02.003.
- Zhang Y, Wang J, Sun X, Cao Z, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Obes Surg. 2015; 25(1): 19-26. doi: 10.1007/s11695-014-1385- 9.
- Helmiö M et al. SLEEVEPASS: a randomized prospective multi center study comparing laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: preliminary results. Surg Endosc. 2012 Sep; 26(9):2521-6. doi: 10.1007/s00464-012-2225-4. Epub 2012 Apr
- Meydan C, Goldstein N, Weiss-Shwartz E, Lederfine D, et al. Immediate Metabolic Response Following Sleeve Gastrectomy in Obese Diabetics. Obes Surg. 2015 Nov; 25 (11):2023-9. doi: 10.1007/s11695-015-1669-8.
- Zhang, F., Strain, G.W., Lei, W. et al. Changes in Lipid Profiles in Morbidly Obese Patients after Laparoscopic Sleeve Gastrectomy (LSG). OBES SURG 21, 305–309 (2011). Doi: https://doi.org/10.1007/s11695-010-0285-x
- Carswell KA, Belgaumkar AP, Amiel SA, Patel AG. A Systematic Review and Meta-analysis of the Effect of Gastric Bypass Surgery on Plasma Lipid Levels. Obes Surg. 2016 Apr; 26 (4):843-55. doi: 10.1007/s11695-015-1829-x.