Highlights
- •Laparoscopic Loop Duodenaljejunal Bypass with Sleeve Gastrectomy (LDJB-SG) is a relatively safe and feasible metabolic surgery.
- •Pyloric preservation of this bypass procedure reduce the post-operative complications such as dumping syndrome, marginal ulcer or gastroesophageal reflux disease (GERD).
- •At 2 years, our cohort showed a significant drop of A1C from 8.8 % to 6.4 %; diabetes remission and glycemic control rates were, 54% and 77%, respectively.
Abstract
Background
Laparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) is a new
metabolic procedure. Our initial data on type 2 diabetes (T2D) remission after LDJB-SG
were promising.
Objectives
The aim of this study was to look at our intermediate outcomes after LDJB-SG.
Setting
An academic medical center.
Methods
A prospective analysis of T2D patients who underwent LDJB-SG between October 2011
and October 2014 was performed. Data collected included baseline demographic, body
mass index, fasting blood glucose, glycosylated hemoglobin, C-peptide, resolution
of co-morbidities, and postoperative complications.
Results
A total of 163 patients with minimum of follow-up >1 year were enrolled in this study
(57 men and 106 women). The mean age and body mass index were 47.7 (±10.7) years and
a 30.2 (±5.1) kg/m2, respectively. There were 119 patients on oral hypoglycemic agents only, 29 patients
were on oral hypoglycemic agents and insulin, 3 patients were on insulin only, and
the other 12 patients were not on diabetic medication. Mean operation time and length
of hospital stay were 144.7 (± 45.1) minutes and 2.4 (± 1.0) days, respectively. Seven
patients (3.6%) needed reoperation due to bleeding (n = 1), anastomotic leak (n = 2),
sleeve strictures (n = 2), and incisional hernia (n = 2). At 2 years of follow-up,
there were 56 patients. None of the patients were on insulin and only 20% of patients
were on oral hypoglycemic agents. Mean body mass index significantly dropped to 22.9
(±5.6) kg/m2 at 2 years. The mean preoperative fasting blood glucose, glycosylated hemoglobin,
and C-peptide levels were 174.7 mg/dL (± 61.0), 8.8% (±1.8), and 2.6 (±1.7) ng/mL,
respectively. The mean fasting blood glucose, glycosylated hemoglobin, and C-peptide
at 2 years were 112.5 (±60.7) mg/dL, 6.4% (±2.0), and 1.5 (±0.6) ng/mL, respectively.
No patient needed revisional surgery because of dumping syndrome, marginal ulcer,
or gastroesophageal reflux disease at the last follow up period.
Conclusion
At 2 years, LDJB-SG is a relatively safe and effective metabolic surgery with significant
weight loss and resolution of co-morbidities.
Key words
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References
- Global and societal implication of the diabetes epidemic.Nature. 2001; 414: 782-787
- Bariatric surgery: a systematic review and meta-analysis.JAMA. 2004; 292: 1724-1737
- Clinical outcomes of metabolic surgery: efficacy of glycemic control, weight loss, and remission of diabetes.Diabetes Care. 2016; 39: 902-911
- Improvement in co-morbid illness after placement of the Swedish adjustable gastric band.Surg Obes Relat Dis. 2008; 4: S39-S46
- Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis.Am J Med. 2009; 122: 248-256
- Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus?.Can J Surg. 2009; 52: E269-E275
- American Society for Metabolic and bariatric surgery statement on single-anastomosis duodenal switch.Surg Obes Relat Dis. 2016; 12: 944-945
- A matched cohort analysis of single anastomosis loop duodenal switch versus Roux-en-Y gastric bypass with 18-month follow-up.Surg Endosc. 2016; 30: 3958-3964
- Single-anastomosis duodenoileal bypass as a second step after sleeve gastrectomy.Surg Obes Relat Dis. 2015; 11: 351-355
- Single-anastomosis duodenoileal bypass with sleeve gastrectomy: metabolic improvement and weight loss in first 100 patients.Surg Obes Relat Dis. 2013; 9: 731-735
- Novel metabolic surgery for type II diabetes mellitus: loop duodenojejunal bypass with sleeve gastrectomy.Surg Laparosc Endosc Percutan Tech. 2013; 23: 481-485
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Use and abuse of HOMA modelling.Diabetes Care. 2004; 27: 1487-1495
- How do we define cure of diabetes?.Diabetes Care. 2009; 32: 2133-2135
- Cardiovascular disease and risk management.Diabetes Care. 2017; 40: S75-S87
- Standardized outcomes reporting in metabolic and bariatric surgery.Surg Obes Relat Dis. 2015; 11: 489-506
- The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes.Ann Surg. 2006; 244: 741-749
- Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.Ann Surg. 1995; 222 (discussion 350–2): 339-350
- Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus.Ann Surg. 2003; 238: 467-485
- Lifestyle intervention and medical management with versus without Roux-en-Y gastric bypass and control of hemoglobin A1c, LDL cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study.JAMA. 2018; 319: 266-278
- Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomized controlled trial.Lancet. 2015; 386: 964-973
- et al; for the STAMPEDE Investigators. Metabolic surgery versus intensive medical therapy for diabetes: 5-year outcomes.N Engl J Med. 2017; 376: 641-651
- Duodenal-jejunal bypass with sleeve gastrectomy versus the sleeve gastrectomy procedure alone: the role of duodenal exclusion.Surg Obes Relat Dis. 2015; 11: 765-770
- Laparoscopic duodenojejunal bypass with sleeve gastrectomy: preliminary results of a prospective series from India.Surg Endosc. 2012; 26: 688-692
- Health effects of overweight and obesity in 195 countries over 25 years.N Engl J Med. 2017; 377: 13-27
- Trends in the prevalence of type 2 diabetes in Asians versus whites: results from the United States National Health Interview Survey, 1997–2008.Diabetes Care. 2011; 34: 353-357
- IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030.Diabetes Res Clin Pract. 2011; 94: 311-321
- Laparoscopic duodenal–jejunal exclusion in the treatment of type 2 diabetes mellitus in patients with BMI < 30 kg/m2 (LBMI).Obes Surg. 2009; 19: 307-312
- Clinical improvement after duodenojejunal bypass for nonobese type 2 diabetes despite minimal improvement in glycemic homeostasis.World J Surg. 2009; 33: 972-979
- Diabetes remission and insulin secretion after gastric bypass in patients with body mass index < 35 kg/m2.Obes Surg. 2011; 21: 889-895
- Laparoscopic Roux-en-Y gastric bypass for the treatment of type II diabetes mellitus in Chinese patients with body mass index of 25–35.Obes Surg. 2011; 21: 1344-1349
- Predictors of long-term diabetes remission after metabolic surgery.J Gastrointest Surg. 2015; 19: 1015-1021
- Predictors of remission of T2D and metabolic effects after laparoscopic Roux-en-y gastric bypass in obese Indian diabetics-a 5-year study.Obes Surg. 2015; 25: 1191-1197
- Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes.Diabetes Care. 2013; 36: 20-26
- Individualized metabolic surgery score: procedure selection based on diabetes severity.Ann Surg. 2017; 266: 650-657
- Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study.Lancet Diabetes Endocrinol. 2014; 2: 38-45
- Preoperative prediction of type 2 diabetes remission after gastric bypass surgery: a comparison of DiaRem scores and ABCD scores.Obes Surg. 2016; 26: 2418-2424
Article info
Publication history
Published online: January 25, 2019
Accepted:
January 22,
2019
Received in revised form:
January 12,
2019
Received:
August 6,
2018
Footnotes
This study was presented at IFSO 2017, London, U.K.
Identification
Copyright
© 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.