Seven-Year Results of a Randomized Trial Comparing Banded Roux-en-Y Gastric Bypass to Sleeve Gastrectomy for Type 2 Diabetes and Weight Loss

Abstract

Introduction Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are common bariatric procedures that are effective in treating type 2 diabetes (T2D) in patients with obesity. Limited data from randomized trials are available comparing longevity of diabetes remission directly between the two procedures beyond 5 years. Methods A prospective, randomized, parallel, two-arm, clinical trial comparing the outcomes of silastic ring (SR)-LRYGB versus LSG was conducted at a single (Auckland, New Zealand) center. Patients and researchers were blinded until the 5-year mark and follow-up after this was unblinded. Eligible patients had T2D of > 6 months duration with a BMI 35––65 kg/m 2 and were aged 20–55 years. Randomization was 1:1 to SR-LRYGB and LSG following induction of anesthesia and was stratified by age group, BMI group, ethnicity, diabetes duration, and insulin therapy. The primary outcome was T2D remission, defined as HbA1c < 6% (42 mmol/mol), without the use of glucose-lowering medications. Results A total of 114 patients were randomized of whom 6 died before the 7-year follow-up (2 SR-LRYGB, 4 LSG). Diabetes remission, assessed in 89 (82.4%) of the remaining patients, was seen in 23/50 (46.0%) after SR-LRYGB and 12/39 (30.8%) after LSG (adjusted OR 4.64, 95% CI 1.39, 15.52, p = 0.013). Percentage total body weight loss was greater after SR-LRYGB than LSG (26.2% vs 13.4%; absolute difference 12.8%; 95% CI 7.2%, 18.2%; p < 0.001). Complication rates were similar between groups. Conclusion SR-LRYGB was superior to LSG for diabetes remission and weight loss at 7 years following surgery, with acceptable complication rates. Graphical Abstract

Breast Cancer Risk After Bariatric Surgery and Influence of Insulin Levels

“…Also, our study includes older surgical methods that are no longer used. However, vertical banded gastroplasty, the most commonly used method in our study, results in weight loss similar to that after sleeve gastrectomy . Since the protective effect of bariatric surgery on cancer risk appears to be related to the degree of weight loss, our results are likely to also be valid for surgical methods used today.…”

Construction and validation of a nomogram for predicting diabetes remission at 3 months after bariatric surgery in patients with obesity combined with type 2 diabetes mellitus

“…28,29 The present study indicates that high levels of HbA1c, longer duration of diabetes and preoperative insulin-requiring are independent risk factors for DR, consistent with previous studies. [30][31][32][33] Clinical markers of advanced diabetes, such as shorter duration of diabetes, better glycaemic control, fewer medications and no insulin use, suggest the presence of greater functional β-cell reserve. 34 Furthermore, higher preoperative β-cell function was significantly associated with a greater likelihood of DR after BMS.…”