Ann Surg Treat Res.  2017 Nov;93(5):260-265. 10.4174/astr.2017.93.5.260.

Three-year result of efficacy for type 2 diabetes mellitus control between laparoscopic duodenojejunal bypass compared with laparoscopic Roux-en-Y gastric bypass

• Kim DJ
• Paik KY
• Kim MK
• Kim E
• Kim W

• KMID: 2393991
• DOI: http://doi.org/10.4174/astr.2017.93.5.260

Abstract

PURPOSE
The mechanism by which bariatric surgery facilitates diabetic control is still unknown. Duodenojejunal bypass supports the foregut theory; however, its efficacy when used alone is not yet established.
METHODS
During the period from January 2008 to December 2009, patients who underwent laparoscopic duodenojejunal bypass (LDJB) or laparoscopic Roux-en-Y gastric bypass (LRYGB) for type 2 diabetes mellitus (T2DM) with or without morbid obesity were included. Patients who had a follow-up for less than 3 years were excluded. Patient baseline characteristics, change of body weight, body mass index (BMI), glycosylated hemoglobin (HbA1c), and diabetic treatments were analyzed.
RESULTS
In total, 8 LDJB and 20 LRYGB patients were analyzed. The LDJB group had more number of male patients than the LRYGB group (LDJB 75% vs. LRYGB 30%, P = 0.030). Baseline BMI in the LRYGB group was higher than in the LDJB group (LDJB 27.0 ± 2.5 vs. LRYGB 32.6 ± 3.4, P < 0.001). Age, DM duration, baseline HbA1c, and C-peptide levels were similar. Longer operation time was needed to perform LDJB (LDJB 367.5 ± 120.2 vs. LRYGB 232.9 ± 41.1, P < 0.001), but no differences were observed in the hospital stay and complication rate between the 2 groups. At the third year of follow-up, the T2DM remission rate was observed in 40% of patients in the LRYGB group and 12.5% of patients in the LDJB group.
CONCLUSION
LDJB is not an effective method for controlling T2DM compared with LRYGB. Foregut theory may not be the main mechanism of diabetic control during bariatric surgery.

Keyword

Bariatric surgery; Diabetes mellitus; Laparoscopy

MeSH Terms

Bariatric Surgery
Body Mass Index
Body Weight
C-Peptide
Diabetes Mellitus
Diabetes Mellitus, Type 2*
Follow-Up Studies
Gastric Bypass*
Hemoglobin A, Glycosylated
Humans
Laparoscopy
Length of Stay
Male
Methods
Obesity, Morbid
C-Peptide

Figure

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  Fig. 1 Illustration for the duodeno-jejunal bypass.

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  Fig. 2 Body weight change from preoperative period to postoperative third year (A), body mass index (BMI) change from preoperative period to postoperative third year (B), change of BMI difference from the baseline BMI (C), change of glycosylated hemoglobin (HbA1c) difference from the baseline HbA1c (D). *P < 0.05. **P < 0.1.

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