Abstract:Background and Aims: Bariatric-metabolic surgeries are effective treatment for severely obese patients with type 2 diabetes mellitus (T2DM). However, different types of bariatric-metabolic surgeries have different effects on aspects such as weight reduction and blood glucose control. Therefore, this study was conducted to investigate the short-term efficacy of different types of bariatric-metabolic surgeries for severely obese patients with T2DM, and their characteristics in terms of reducing weight, sugar and lipid, so as to provide treatment options for clinical use.
Methods: The clinical data of 63 patients with severe obesity and concomitant T2DM undergoing bariatric-metabolic surgery were retrospectively analyzed. Of the patients, 25 cases underwent laparoscopic sleeve gastrectomy (LSG), 18 cases underwent LSG plus jejuno-jejunal bypass surgery (LSG+JJB), and 20 cases underwent laparoscopic Roux-en-Y gastric bypass surgery (LRYGB). The clinical data before surgery and 6 and 12 months after surgery among the three groups of patients were compared.
Results: The preoperative data were comparable among the three groups. Operations were successfully completed in all patients. Among the three groups, the operative times were significantly different (P<0.05), but all other surgery-related variables showed no significant differences (all P>0.05). The weight loss variables that included the body weight, waist circumference, hip circumference, BMI and the percentage of excess weight loss (%EWL) in the three groups after surgery were significantly improved compared to those before surgery (all P<0.05), in which, the hip circumference showed no significant difference between postoperative 6 and 12 months in the same groups as well as among groups at the same time points (all P>0.05), while all the remaining 4 variables were significantly better at postoperative 12 months than those at 6 months in the same groups, and were significantly better in LSG+JJB group and LRYGB group than those in LSG group (all P<0.05), but showed no significant differences between LSG+JJB group and LRYGB group (all P>0.05). The indexes of glucose metabolism that included the fasting plasma glucose, fasting insulin, glycated hemoglobin, insulin resistance index in the three groups after surgery were significantly improved compared to those before surgery (all P<0.05), but there were no significant differences in these indexes between postoperative 6 and 12 months as well as among groups at the same time points (all P>0.05); the diabetes remission rates at 6 and 12 months after surgery showed no significant difference among the three groups (both P>0.05). The parameters of lipid metabolism that included the blood cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein and uric acid in the three groups after surgery were improved compared to those before surgery (all P<0.05), and the degrees of improvement in triglyceride, high-density lipoprotein, and low-density lipoprotein were similar in the three groups (all P>0.05), but the decreasing amplitudes in blood uric acid and cholesterol in LRYGB group and LSG+JJB group were significantly greater than those in LSG group (all P<0.05).
Conclusion: All LSG, LSG+JJB and LRYGB have good short-term efficacy in reducing weight and improving glucose and lipid metabolism. They have similar effects of reducing blood glucose and some lipid parameters. LSG+JJB has the same effect as LRYGB and both are superior to LSG in reducing weight, uric acid and cholesterol. LSG+JJB is simple in operation with demonstrable efficacy. So, it is recommended to be used in clinical practice.