Laparoscopic Sleeve Gastrectomy Versus Single Anastomosis (Mini-) Gastric Bypass for the Treatment of Type 2 Diabetes Mellitus: 5-Year Results of a Randomized Trial and Study of Incretin Effect

Abstract

In mildly obese patients with T2DM, SG is effective at improving glycemic control at 5 years, but SAGB was more likely to achieve better glycemic control than SG and had a higher incretin effect compared to SG.

What is the impact of sleeve gastrectomy and gastric bypass on metabolic control of diabetes? A clinic-based cohort of Mediterranean diabetic patients

“…Our findings are consistent with those reported in recent clinical trials comparing bariatric surgery and intensive medical therapy alone. However, our data not only indicate a beneficial metabolic effect of bariatric surgery in diabetic patients but also importantly confirm clinical effectiveness in unselected patients [11][12][13][14][15][16]. It is noteworthy that mean diabetes duration was longer than in previous studies, suggesting that obese patients are delayed from undergoing bariatric surgery even after diabetes diagnosis in our clinical setting, thus hampering the likelihood of a complete restoration of β-cell function.…”

“…Weight loss surgeries also have beneficial glycemic effects that are independent of weight, likely due to favorable changes in gut hormone secretion [10]. Although bariatric surgery is emerging as the most effective treatment for selected obese diabetic patients, studies supporting a more extensive use of surgical approaches in obese diabetic patients have several limitations, such as the low number of studied patients and the short duration of follow-ups [11][12][13][14][15][16][17]. Furthermore, there is little information on the metabolic effects of laparoscopic sleeve gastrectomy as a stand-alone operation, which is emerging as an especially attractive procedure for high-risk patients [18][19][20].…”

Mini-Gastric Bypass for Bariatric Surgery Increasing Worldwide

“…Also, better quality of life has been found after MGB [56,57]. Regarding diabetes type 2, Lee reported greater elevation of GLP-1 after MGB than after RYGB [55].…”

“…Comparative studies have documented more durable weight loss after the MGB [3,13,22,[52][53][54][55]. Also, better quality of life has been found after MGB [56,57].…”

Recent advancements in bariatric/metabolic surgery

“…RYGB is a better choice for morbidly obese patients with significant reflux disease. For diabetic patients, RYGB or LSAGB may be a better choice for T2DM patients, especially in patients with low BMI and long duration of disease 92, 110. However, SG‐DJB might be a better choice for patients from a gastric cancer endemic area or with a family history of gastric cancer.…”