Comparative study on weight loss and remission of metabolic disorders after laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy

doi:10.16139/j.1007-9610.2020.05.009

Abstract

Abstract:

Objective To compare the short-term effect of bariatric surgery on obesity patients with type 2 diabetes mellitus between laparoscopic Roux-en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). Methods A retrospective study was performed from January 2011 to December 2018 for the obesity patients with type-2 diabetes who underwent LRYGB (n=38) and LSG (n=38) and matched in age, gender, body mass index, glycosylated hemoglobin A1c level, and diabetes duration to analyze the surgical effects. Results There was no any major complication and no any malnutrition during 24 months of follow-up. Both surgical procedures achieved weight loss and diabetes remission significantly. LRYGB reduced serum cholesterol levels [(4.31±0.94) mmol/L vs. (5.36±1.22) mmol/L, P<0.01] and low-density lipoprotein-c levels [(2.39±0.70) mmol/L vs. (3.22±0.94) mmol/L, P<0.01], as well as diabetes remission rate by glycosylated hemoglobin A1c (89.5% vs. 71.1%, P=0.044) significantly when compared with LSG. Conclusions Both LRYGB and LSG could get significant weight loss and disorders remission of glucose and lipid metabolism in short-term postoperatively. LRYGB may have a more favorable effect on reducing glycosylated hemoglobin A1c level and improving dyslipidemia compared with LSG.

Key words: Type 2 diabetes mellitus, Obesity, Laparoscopic Roux-en-Y gastric bypass, Laparoscopic sleeve gastrectomy

CLC Number:

R589.2

ZHANG Chenyang, ZHANG Hongwei, HAN Xiaodong, LIU Weijie, YU Haoyong, ZHANG Pin. Comparative study on weight loss and remission of metabolic disorders after laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy[J]. Journal of Surgery Concepts & Practice, 2020, 25(05): 397-401.

Figures/Tables 5

References 20

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项目	LRYGB (n=38)	LSG (n=38)	P值
年龄（岁）	43.94±11.45	44.63±11.10	0.792
糖尿病病程（年）	5.47±4.86	5.10±5.46	0.757
男	18	18
女	20	20
BMI	35.07±3.96	35.47±4.12	0.668
HbA1c（%）	7.96±1.68	7.85±1.68	0.770

指标	组别	术前	术后3个月	术后6个月	术后12个月	术后24个月
BMI	LRYGB	35.07±3.96	28.18±3.21^**	26.89±3.11^**	26.60±2.63^**	26.93±2.81^**
	LSG	35.47±4.12	28.90±3.79^**	26.73±3.53^**	26.07±3.55^**	27.09±3.66^**
收缩压 (mmHg)	LRYGB	138.07±16.16	129.14±17.07^**	125.12±13.80^**	125.80±10.94^**	126.50±15.51^**
	LSG	136.45±18.14	132.72±14.28	127.03±17.93^*	123.96±14.95^**	127.00±15.13^*
舒张压(mmHg)	LRYGB	85.21±10.88	81.26±11.46	78.09±9.27^**	78.73±7.31^**	77.40±10.37^**
	LSG	87.25±11.13	83.27±11.59	82.21±10.79	78.06±9.99^**	80.40±12.55^*
HbA1c (%)	LRYGB	7.96±1.68	5.75±0.75^**	5.68±0.76^**	5.75±0.66^**	5.87±0.81^**
	LSG	7.85±1.68	5.84±0.65^**	5.75±0.78^**	5.77±0.75^**	5.71±0.68^**
FPG(mmol/L)	LRYGB	8.41±2.54	5.46±1.22^**	5.22±0.91^**	5.56±1.21^**	5.39±0.92^**
	LSG	8.29±2.56	5.44±0.86^**	5.35±0.97^**	5.30±1.02^**	5.14±0.59^**
PBG(mmol/L)	LRYGB	13.61±4.22	6.56±2.14^**	6.64±2.41^**	6.53±2.48^**	6.40±2.26^**
	LSG	12.83±3.75	6.55±1.94^**	5.89±1.57^**	6.22±2.45^**	5.87±1.49^**
HOMA-IR	LRYGB	6.42(4.96,11.27)	2.02(1.21,3.62)^**	1.42(1.03,2.39)^**	1.44(1.19,2.72)^**	1.32(1.14,2.79)^**
	LSG	7.78(4.95,11.31)	1.97(1.40, 2.76)^**	1.61(1.20,2.15)^**	1.61(0.96,2.14)^**	1.83(1.30,2.36)^**
空腹C肽(nmol/L)	LRYGB	1.09±0.09	0.85±0.07^**	0.77±0.05^**	0.69±0.04^**	0.69±0.05^**
	LSG	1.21±0.09	0.87±0.06^**	0.68±0.04^**	0.72±0.05^**	0.73±0.05^**
空腹胰岛素(pmol/L)	LRYGB	18.99(12.77,30.1)	8.10(5.91,14.45)^**	6.56(4.51,8.87)^**	6.76(4.85,11.39)^**	6.15(4.54,12.64)^**
	LSG	20.85(13.50,29.1)	8.25(5.85,11.05)^**	6.86(4.47,9.31)^**	7.15(4.95,9.08)^**	7.74(5.80,9.86)^**

指标	组别	术前	术后3个月	术后6个月	术后12个月	术后24个月
Tc (mmol/L)
	LRYGB	5.44±1.84	4.29±0.87^**	4.04±0.79^**	4.19±0.92^**	4.31±0.94^**
	LSG	5.05±1.28	5.41±1.08^##	5.08±1.09^##	4.99±1.05^##	5.36±1.22^##
Tg (mmol/L)
	LRYGB	3.19±2.97	1.40±0.67^**	1.23±0.57^**	1.11±0.41^**	1.25±0.53^**
	LSG	2.71±1.91	1.47±0.63^**	1.25±0.48^**	1.11±0.41^**	1.28±0.79^**
HDL-c (mmol/L)
	LRYGB	1.03±0.23	1.04±0.22	1.16±0.23^*	1.26±0.2^**	1.26±0.29^**
	LSG	0.99±0.14	1.08±0.24^**	1.19±0.26^**	1.28±0.29^**	1.34±0.36^**
LDL-c (mmol/L)
	LRYGB	2.97±0.85	2.55±0.73^**	2.25±0.7^**	2.32±0.64^**	2.39±0.70^**
	LSG	2.95±0.94	3.42±0.83^##*	3.16±0.91^##	2.98±0.96^##	3.22±0.94^##
ASI
	LRYGB	4.57±2.85	3.23±1.01^**	2.54±0.81^**	2.35±0.77^**	2.53±0.91^**
	LSG	4.19±1.49	4.19±1.45^##	3.47±1.43^##*	3.03±1.15^##**	3.18±1.09^##**

时间	LRYGB	LSG	P值
术前	6(15.8)	9(23.7)	0.387
术后3个月	31(81.6)	25(65.8)	0.118
术后6个月	35(92.1)	28(73.7)	0.033
术后12个月	33(86.8)	28(73.7)	0.150
术后24个月	34(89.5)	27(71.1)	0.044