Skip to main content
Erschienen in: Obesity Surgery 11/2018

01.08.2018 | Original Contributions

Metabolic Surgery Comparing Sleeve Gastrectomy with Jejunal Bypass and Roux-en-Y Gastric Bypass in Type 2 Diabetic Patients After 3 Years

verfasst von: Matías Sepúlveda, Munir Alamo, Yudith Preiss, Juan P. Valderas

Erschienen in: Obesity Surgery | Ausgabe 11/2018

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Sleeve gastrectomy with jejunal bypass (SGJB) and Roux-en-Y gastric bypass (RYGB) has shown good results with respect to type 2 diabetes mellitus (T2D) remission in our institution. In this study, we compared the efficacy and safety of SGJB versus RYGB in terms of T2D remission up to 3 years postoperatively.

Materials and Methods

A retrospective cohort study of two groups of patients with T2D who underwent SGJB or RYGB. All patients were matched by age, presurgical body mass index (BMI), glycated hemoglobin (HbA1c), and diabetes duration. Complete remission was defined as HbA1c of < 6%, fasting plasma glucose (FPG) of < 100 mg/dL, and no antidiabetic drugs.

Results

In total, 57 and 55 patients in the SGJB and RYGB groups, respectively, met the inclusion criteria. The diabetes remission rate was similar between the SGJB and RYGB groups at 1 year postoperatively (69.2 vs. 64.7%) and 3 years postoperatively (56.1 vs. 58.8%). There were no significant differences in HbA1c or FPG at 1 or 3 years between the two groups. Additionally, weight loss and other metabolic parameters were similar between the groups. Clinical chemistry values were similar at 12 months except for hematocrit and calcium, which were significantly lower in the RYGB group. There were no differences in surgical complications.

Conclusions

Both procedures showed similar results in terms of T2D remission and other metabolic markers at 3 years. Hematocrit and calcium were significantly higher in the SGJB than RYGB group. SGJB is as effective and safe as RYGB in obese patients with T2D.
Literatur
1.
Zurück zum Zitat Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world—a growing challenge. N Engl J Med. 2007;356(3):213–5.CrossRefPubMed Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world—a growing challenge. N Engl J Med. 2007;356(3):213–5.CrossRefPubMed
2.
Zurück zum Zitat Chan JCN, Gagliardino JJ, Baik SH, et al. Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS). Diabetes Care. 2009;32(2):227–33.CrossRefPubMedPubMedCentral Chan JCN, Gagliardino JJ, Baik SH, et al. Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS). Diabetes Care. 2009;32(2):227–33.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304.CrossRefPubMed Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304.CrossRefPubMed
5.
Zurück zum Zitat Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefPubMed Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefPubMed
7.
Zurück zum Zitat Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRefPubMedPubMedCentral Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73.CrossRefPubMed Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73.CrossRefPubMed
9.
Zurück zum Zitat Lee W-J, Chong K, Ser K-H, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146(2):143–8.CrossRefPubMed Lee W-J, Chong K, Ser K-H, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146(2):143–8.CrossRefPubMed
10.
Zurück zum Zitat Zellmer JD, Mathiason MA, Kallies KJ, et al. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg. 2014;208(6):903–10. –discussion 909–10CrossRefPubMed Zellmer JD, Mathiason MA, Kallies KJ, et al. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg. 2014;208(6):903–10. –discussion 909–10CrossRefPubMed
11.
Zurück zum Zitat von Drygalski A, Andris DA, Nuttleman PR, et al. Anemia after bariatric surgery cannot be explained by iron deficiency alone: results of a large cohort study. Surg Obes Relat Dis. 2011;7(2):151–6.CrossRef von Drygalski A, Andris DA, Nuttleman PR, et al. Anemia after bariatric surgery cannot be explained by iron deficiency alone: results of a large cohort study. Surg Obes Relat Dis. 2011;7(2):151–6.CrossRef
12.
Zurück zum Zitat Cable CT, Colbert CY, Showalter T, et al. Prevalence of anemia after Roux-en-Y gastric bypass surgery: what is the right number? Surg Obes Relat Dis. 2011;7(2):134–9.CrossRefPubMed Cable CT, Colbert CY, Showalter T, et al. Prevalence of anemia after Roux-en-Y gastric bypass surgery: what is the right number? Surg Obes Relat Dis. 2011;7(2):134–9.CrossRefPubMed
13.
Zurück zum Zitat Dallal RM, Leighton J, Trang A. Analysis of leukopenia and anemia after gastric bypass surgery. Surg Obes Relat Dis. 2012;8(2):164–8.CrossRefPubMed Dallal RM, Leighton J, Trang A. Analysis of leukopenia and anemia after gastric bypass surgery. Surg Obes Relat Dis. 2012;8(2):164–8.CrossRefPubMed
14.
Zurück zum Zitat Malone M, Alger-Mayer S, Lindstrom J, et al. Management of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study. Surg Obes Relat Dis. 2013;9(6):969–74.CrossRefPubMed Malone M, Alger-Mayer S, Lindstrom J, et al. Management of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study. Surg Obes Relat Dis. 2013;9(6):969–74.CrossRefPubMed
15.
Zurück zum Zitat Suter M, Donadini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass. Ann Surg. 2011;254(2):267–73.CrossRefPubMed Suter M, Donadini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass. Ann Surg. 2011;254(2):267–73.CrossRefPubMed
16.
Zurück zum Zitat Alamo M, Sepúlveda C, Zapata L. Vertical isolated gastroplasty with gastro-enteral bypass: preliminary results. Obes Surg. 2006;16(3):353–8.CrossRef Alamo M, Sepúlveda C, Zapata L. Vertical isolated gastroplasty with gastro-enteral bypass: preliminary results. Obes Surg. 2006;16(3):353–8.CrossRef
17.
Zurück zum Zitat Alamo M, Sepulveda M, Gellona J, et al. Sleeve gastrectomy with jejunal bypass for the treatment of type 2 diabetes mellitus in patients with body mass index <35 kg/m2. A cohort study. Obes Surg. 2012;22(7):1097–103.CrossRefPubMed Alamo M, Sepulveda M, Gellona J, et al. Sleeve gastrectomy with jejunal bypass for the treatment of type 2 diabetes mellitus in patients with body mass index <35 kg/m2. A cohort study. Obes Surg. 2012;22(7):1097–103.CrossRefPubMed
19.
Zurück zum Zitat Sepulveda M, Astorga C, Hermosilla JP, et al. Staple line reinforcement in laparoscopic sleeve gastrectomy: experience in 1023 consecutive cases. Obes Surg. 2017;27:1474–80.CrossRefPubMed Sepulveda M, Astorga C, Hermosilla JP, et al. Staple line reinforcement in laparoscopic sleeve gastrectomy: experience in 1023 consecutive cases. Obes Surg. 2017;27:1474–80.CrossRefPubMed
20.
Zurück zum Zitat Jørgensen NB, Dirksen C, Bojsen-Møller KN, et al. Exaggerated glucagon-like peptide 1 response is important for improved cell function and glucose tolerance after Roux-en-Y gastric bypass in patients with type 2 diabetes. Diabetes. 2013;62(9):3044–52.CrossRefPubMedPubMedCentral Jørgensen NB, Dirksen C, Bojsen-Møller KN, et al. Exaggerated glucagon-like peptide 1 response is important for improved cell function and glucose tolerance after Roux-en-Y gastric bypass in patients with type 2 diabetes. Diabetes. 2013;62(9):3044–52.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Salehi M, D’Alessio DA. Mechanisms of surgical control of type 2 diabetes: GLP-1 is the key factor—maybe. Surg Obes Relat Dis. 2016;12(6):1230–5.CrossRefPubMedPubMedCentral Salehi M, D’Alessio DA. Mechanisms of surgical control of type 2 diabetes: GLP-1 is the key factor—maybe. Surg Obes Relat Dis. 2016;12(6):1230–5.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Nergård BJ, Lindqvist A, Gislason HG, et al. Mucosal glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide cell numbers in the super-obese human foregut after gastric bypass. Surg Obes Relat Dis. 2015;11(6):1237–46.CrossRefPubMed Nergård BJ, Lindqvist A, Gislason HG, et al. Mucosal glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide cell numbers in the super-obese human foregut after gastric bypass. Surg Obes Relat Dis. 2015;11(6):1237–46.CrossRefPubMed
23.
Zurück zum Zitat Guedes TP, Martins S, Costa M, et al. Detailed characterization of incretin cell distribution along the human small intestine. Surg Obes Relat Dis. 2015;11(6):1323–31.CrossRefPubMed Guedes TP, Martins S, Costa M, et al. Detailed characterization of incretin cell distribution along the human small intestine. Surg Obes Relat Dis. 2015;11(6):1323–31.CrossRefPubMed
24.
Zurück zum Zitat Kefurt R, Langer FB, Schindler K, et al. Hypoglycemia after Roux-en-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test. Surg Obes Relat Dis. 2015;11(3):574–9.CrossRef Kefurt R, Langer FB, Schindler K, et al. Hypoglycemia after Roux-en-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test. Surg Obes Relat Dis. 2015;11(3):574–9.CrossRef
25.
Zurück zum Zitat Love AL, Billett HH. Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol. 2008;83(5):403–9.CrossRefPubMed Love AL, Billett HH. Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol. 2008;83(5):403–9.CrossRefPubMed
26.
Zurück zum Zitat Holzbach RT. Hepatic effects of jejunoileal bypass for morbid obesity. Am J Clin Nutr. 1977;30(1):43–52.CrossRefPubMed Holzbach RT. Hepatic effects of jejunoileal bypass for morbid obesity. Am J Clin Nutr. 1977;30(1):43–52.CrossRefPubMed
27.
Zurück zum Zitat Iber FL, Copper M. Jejunoileal bypass for the treatment of massive obesity. Prevalence, morbidity, and short- and long-term consequences. Am J Clin Nutr. 1977;30(1):4–15.CrossRefPubMed Iber FL, Copper M. Jejunoileal bypass for the treatment of massive obesity. Prevalence, morbidity, and short- and long-term consequences. Am J Clin Nutr. 1977;30(1):4–15.CrossRefPubMed
28.
Zurück zum Zitat O’Leary JP. Gastrointestinal malabsorptive procedures. Am J Clin Nutr. 1992;55(2 Suppl):567S–70S.CrossRefPubMed O’Leary JP. Gastrointestinal malabsorptive procedures. Am J Clin Nutr. 1992;55(2 Suppl):567S–70S.CrossRefPubMed
29.
Zurück zum Zitat Hollenbeck JI, O’leary JP, Maher JW, et al. An etiological basis for fatty liver after jejunoileal bypass. J Surg Res. 1975;18:83–9.CrossRefPubMed Hollenbeck JI, O’leary JP, Maher JW, et al. An etiological basis for fatty liver after jejunoileal bypass. J Surg Res. 1975;18:83–9.CrossRefPubMed
30.
Zurück zum Zitat Duquez M, Acero F. Composition and functions of intestinal bacterial flora. Report Med Cir. 2011;20(2):74–82. Duquez M, Acero F. Composition and functions of intestinal bacterial flora. Report Med Cir. 2011;20(2):74–82.
31.
Zurück zum Zitat Manterola C, Alamo M, Horta J, et al. Resultados Iniciales de la Cirugía de la Obesidad con Gastrectomía Vertical y By-Pass de Yeyuno. Int J Morphol. 2014;32(3):991–7.CrossRef Manterola C, Alamo M, Horta J, et al. Resultados Iniciales de la Cirugía de la Obesidad con Gastrectomía Vertical y By-Pass de Yeyuno. Int J Morphol. 2014;32(3):991–7.CrossRef
32.
Zurück zum Zitat Huang C-K, Mahendra R, Hsin M-C, et al. Novel metabolic surgery: first Asia series and short-term results of laparoscopic proximal jejunal bypass with sleeve gastrectomy. Ann Laparosc Endosc Surg. 2016;1(1):37.CrossRef Huang C-K, Mahendra R, Hsin M-C, et al. Novel metabolic surgery: first Asia series and short-term results of laparoscopic proximal jejunal bypass with sleeve gastrectomy. Ann Laparosc Endosc Surg. 2016;1(1):37.CrossRef
Metadaten
Titel
Metabolic Surgery Comparing Sleeve Gastrectomy with Jejunal Bypass and Roux-en-Y Gastric Bypass in Type 2 Diabetic Patients After 3 Years
verfasst von
Matías Sepúlveda
Munir Alamo
Yudith Preiss
Juan P. Valderas
Publikationsdatum
01.08.2018
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 11/2018
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3402-x

Weitere Artikel der Ausgabe 11/2018

Obesity Surgery 11/2018 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.