Metabolic Efficacy and Diabetes Remission Predictors Following ‘Sleeve Gastrectomy with Loop Duodenojejunal Bypass’ Surgery

Abstract

Purpose Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SLDJB) is a novel metabolic surgery that is a modification of the single anastomosis duodenoileal bypass with sleeve. Compared to conventional surgeries, SLDJB is highly effective in inducing diabetes remission. This study analyzed the metabolic efficacy of SLDJB. Materials and Methods Seventy-eight patients with obesity and diabetes who underwent SLDJB between May 2013 and October 2017 were retrospectively analyzed to investigate the efficacy of their surgery and diabetes remission predictors. Complete diabetes remission was defined as an HbA1 c level <6% with cessation of insulin and oral hypoglycemic agents. Results Complete diabetes remission occurred in 80.52% and 76.71% of patients at 1- and 3-year follow-ups, respectively. There was no significant difference in the rates of complete diabetes remission between the groups based on gender, preoperative body mass index (BMI), diabetes duration or preoperative insulin use. There was a significantly higher rate of complete remission in patients <50 years of age at the 1-year follow-up. Additionally, the rate of complete remission was significantly less when preoperative glycemic control was poor. Preoperative HbA1 c levels negatively predicted complete remission, but was significant only at the 3-year follow-up. Conclusion SLDJB is highly effective in treating obesity with type 2 diabetes, and preoperative glycemic control was found to predict complete remission. Patients under 50 years of age had a better short-term response rate; however, the surgery was effective regardless of gender, preoperative BMI, duration of diabetes or preoperative insulin use.

The Effect of Single‐Anastomosis Sleeve Ileal (SASI) Bypass on Patients with Severe Obesity in Three Consecutive Years

“…Indeed, some previous studies have reported a decline in serum albumin levels after SASI bypass; however, we found no cases of hypoalbuminemia or hypoglycemia. Some studies have indicated a reversal of SASI to SG due to hypoalbuminemia or excessive weight loss > 100% [3, 11, 18, 25]. In the present study, 8 /116 patients had excessive weight loss (EWL% > 100%), which were revised to SG, mostly in the second year after the surgery.…”