Original articleIs sleeve gastrectomy as effective as gastric bypass for remission of type 2 diabetes in morbidly obese patients?
Section snippets
Methods
A retrospective analysis was performed. The patients who had undergone RYGB or SG from January 2003 to December 2007 were eligible. The patients with T2DM at surgery were included. All procedures were done laparoscopically.
At our institution, SG is indicated for patients for whom a staged procedure is planned (body mass index >60 kg/m2 or >50 kg/m2 plus severe co-morbidities) or as a stand-alone procedure. We also consider SG for patients with contraindications for a malabsortive procedure. We
Results
During the study period, 495 patients underwent surgery at Bellvitge University Hospital for morbid obesity. Of the 495 patients, 90 were eligible for the present analysis. Of the 90 patients, 60 underwent RYGB (group 1) and 30 underwent SG (group 2). The patient characteristics are listed in Table 1.
Both groups had an excellent weight reduction (Table 2). No differences were seen between the weight loss at 1 and 2 years after surgery. The difference in weight loss had not achieved statistical
Discussion
Morbid obesity is related to all the co-morbidities defined under the metabolic syndrome. One of the most important is T2DM. Bariatric surgery has proved to be cost-effective, and the best treatment of long-term weight control in these patients [3], [4].
During the past decade, the number of reports, experimental research, and clinical trials showing that T2DM and the other components of the metabolic syndrome improve after bariatric surgery has grown exponentially. More importantly, it has also
Conclusion
We did not find any significant differences in weight loss or T2DM resolution between the 2 techniques. Our results highlight that the 1 of the mechanisms implicated in T2DM remission after bariatric surgery is weight loss. The role of other factors, such as incretins that we have not studied, cannot be ruled out and should be analyzed further.
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
Acknowledgment
We would like to acknowledge to Dr. Monica Millan and Dr. Andrew Vicens for their kind help in correcting our report.
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Cited by (33)
Predictors of glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass: A meta-analysis, meta-regression, and systematic review
2018, Surgery for Obesity and Related DiseasesCitation Excerpt :2 and eTable 2 in the Supplement). The included studies consist of 5 RCTs [4,12,33,37–39,41], 6 prospective OBSs [23,31,34–36,40], and 6 retrospective OBSs [26–30,32]. All reported well-matched preoperative data between the SG and RYGB groups.
Midterm outcomes of laparoscopic sleeve gastrectomy as a stand-alone procedure in super-obese patients
2018, Surgery for Obesity and Related DiseasesCitation Excerpt :A study reported that RYGB was associated with better overall remission of T2D in patients with an average BMI of 45 kg/m2 during an 18-month follow-up [15]. In contrast, a retrospective study consisting of 90 patients with morbid obesity showed that LSG and RYGB achieved similar resolution of T2D at 1- and 2-year follow-up [26]. The Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently study, a 3-group, randomized, controlled trial comparing bariatric surgery (RYGB and LSG) with intensive medical treatment in diabetic control of 150 obese patients, showed superior reduction in HbA1C level with surgery compared with that with medical therapy during 3-year follow-up.
Resolution of type 2 diabetes after sleeve gastrectomy: a 2-step hypothesis
2018, Surgery for Obesity and Related DiseasesCitation Excerpt :It has been shown that metabolic surgery improves glycemic control and decreases cardiovascular risk factors [2,4]. Among the bariatric procedures, LSG is able to induce the remission of T2D in a high rate of patients, with results comparable to gastric bypass in several series [3,16–18]. In comparison to purely restrictive bariatric procedures, such as gastric banding, glycemic control after LSG often occurs before significant weight loss [19].
Effect of sleeve gastrectomy on type 2 diabetes as an alternative treatment modality to Roux-en-Y gastric bypass: Systemic review and meta-analysis
2015, Surgery for Obesity and Related DiseasesA patient with type ii diabetes and a body mass index of 30-35 kg/m <sup>2</sup>: Surgery must always wait
2014, Avances en DiabetologiaClinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: Cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery
2013, Endocrine PracticeCitation Excerpt :In the presence of an established fat-soluble vitamin deficiency with hepatopathy, coagulopathy, or osteoporosis, assessment of a vitamin Kx level should be considered (Grade D). R53(76/77/109-112)-r. Anemia without evidence of blood loss warrants evaluation of nutritional deficiencies, as well as age appropriate causes during the late postoperative period (Grade D). Iron status should be monitored in all bariatric surgery patients (Grade D).
A grant from Ethicon-EndoSurgery was received to present this report at the 27th Annual Meeting of the American Society for Metabolic and Bariatric Surgery.