Shibo Lin1, Ningli Yang1, Wei Guan1, Hui Liang2. 1. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 2. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Electronic address: drhuiliang@126.com.
Abstract
BACKGROUND: Loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) is a simplified biliopancreatic diversion with duodenal switch. OBJECTIVES: This study investigated the therapeutic outcomes of LDJB-SG and predictors of type 2 diabetes (T2D) remission in Chinese patients with a body mass index (BMI) of 20 to 32.5 kg/m2. SETTING: A university hospital. METHODS: This retrospective study included 28 T2D patients with a BMI of 20 to 32.5 kg/m2 who underwent LDJB-SG. T2DM remission, weight loss, postoperative nutrition status, and complications at 1- and 3-year follow-up were assessed. Remission of T2DM was defined as a fasting blood glucose <7 mmol/L and HbA1C <6.5% for 1 year without pharmacological intervention. RESULTS: At 1-year follow-up after LDJB-SG, the T2D remission rate was 75% (21/28), and the mean total weight loss was 23.6%. The 3-year T2D remission rate and percent of total weight loss were 68.4% (13/19) and 20.3%, respectively. Univariate and multivariate analysis indicated that duration of T2D was the only risk factor associated with T2D remission (P < .05). LDJB-SG improved the metabolic syndrome by increasing the high-density lipoprotein cholesterol level (P = .0157), decreasing waist circumference (P < .0001), and decreasing triglycerides (P = .0053). Postoperative complications of LDJB-SG included malodorous flatus (64.3%), accidental diarrhea induced by greasy food (57.1%), de novo gastroesophageal reflux disease (28.6%), anemia (25%), fatigue (21.4%), underweight (17.9%), intolerance to cooked rice (10.7%), constipation (7.1%), and steatorrhea (3.6%). CONCLUSION: LDJB-SG resulted in acceptable T2D remission and metabolic improvement at 1- and 3-year follow-up in Chinese T2D patients with a BMI of 20 to 32.5 kg/m2. T2D duration may serve as the predictor of T2D remission. LDJB-SG should be performed with caution because of the high incidence of postoperative complications.
BACKGROUND: Loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) is a simplified biliopancreatic diversion with duodenal switch. OBJECTIVES: This study investigated the therapeutic outcomes of LDJB-SG and predictors of type 2 diabetes (T2D) remission in Chinese patients with a body mass index (BMI) of 20 to 32.5 kg/m2. SETTING: A university hospital. METHODS: This retrospective study included 28 T2Dpatients with a BMI of 20 to 32.5 kg/m2 who underwent LDJB-SG. T2DM remission, weight loss, postoperative nutrition status, and complications at 1- and 3-year follow-up were assessed. Remission of T2DM was defined as a fasting blood glucose <7 mmol/L and HbA1C <6.5% for 1 year without pharmacological intervention. RESULTS: At 1-year follow-up after LDJB-SG, the T2D remission rate was 75% (21/28), and the mean total weight loss was 23.6%. The 3-year T2D remission rate and percent of total weight loss were 68.4% (13/19) and 20.3%, respectively. Univariate and multivariate analysis indicated that duration of T2D was the only risk factor associated with T2D remission (P < .05). LDJB-SG improved the metabolic syndrome by increasing the high-density lipoprotein cholesterol level (P = .0157), decreasing waist circumference (P < .0001), and decreasing triglycerides (P = .0053). Postoperative complications of LDJB-SG included malodorous flatus (64.3%), accidental diarrhea induced by greasy food (57.1%), de novo gastroesophageal reflux disease (28.6%), anemia (25%), fatigue (21.4%), underweight (17.9%), intolerance to cooked rice (10.7%), constipation (7.1%), and steatorrhea (3.6%). CONCLUSION: LDJB-SG resulted in acceptable T2D remission and metabolic improvement at 1- and 3-year follow-up in Chinese T2Dpatients with a BMI of 20 to 32.5 kg/m2. T2D duration may serve as the predictor of T2D remission. LDJB-SG should be performed with caution because of the high incidence of postoperative complications.
Authors: Wendy A Brown; Guillermo Ponce de Leon Ballesteros; Geraldine Ooi; Kelvin Higa; Jacques Himpens; Antonio Torres; Scott Shikora; Lilian Kow; Miguel F Herrera Journal: Obes Surg Date: 2021-01-06 Impact factor: 4.129