Laparoscopic Roux / 中南大学学报(医学版)

Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been proved to be a safe and effective treatment for Type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) >27.5 kg/m

Therapeutic effect of laparoscopic Roux-en-Y gastric bypass in non-obese patients with type 2 diabetes / 南方医科大学学报

OBJECTIVE@#To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery for treatment of type 2 diabetes (TD) in patients with a body mass index (BMI) < 27.5 kg/m.@*METHODS@#We retrospectively analyzed the data of patients who underwent LRYGB surgery from March, 2012 to June, 2018 in the General Hospital of Guangzhou Military Command and Jinshazhou Hospital of Guangzhou University of Chinese Medicine. The changes in the parameters of glucose metabolism and physical indicators of the patients in the first, second and third years after the surgery were analyzed in patients in low BMI group and high BMI group.@*RESULTS@#All the 74 patients underwent LRYGB successfully without conversion to open surgery. One year after the surgery, fasting blood glucose (FBG), HbA1c, postprandial blood glucose, fasting insulin, HOMA-IR, fasting C-peptide, BMI, body weight and waistline were significantly improved compared with their preoperative values in low BMI group ( < 0.05). At 2 years after the operation, FBG, HbA1c, postprandial blood glucose, HOMA-IR, BMI, body weight and waistline were significantly improved compared with the preoperative values in low BMI group ( < 0.05). In the third year, FBG, HOMA-IR, fasting C-peptide, body weight and waistline were significantly improved compared with the preoperative values in low BMI group ( < 0.05). There was no significant difference in the parameters of glucose metabolism and islet function between low BMI group and high BMI group at different stages. No serious complications occurred in these patients after the surgery.@*CONCLUSIONS@#LRYGB is effective for treatment of T2D in Chinese patients with a BMI < 27.5. After the surgery, the patient show reduced waistline without significant weight loss. The long-term results of the surgery still require further investigations with a larger samples and longer follow-up.

Clinical application of laparoscopic Roux-en-Y gastric bypass in patients with type 2 diabetes mellitus / 中华内分泌外科杂志

Objective To evaluate the clinical effects of the laparoscopic Roux-en-Y gastric bypass (LRYGB) on patients with type 2 diabetes mellitus (T2DM).Methods From Dec.2013 to Dec.2015,83 cases with T2DM received LRYGB were enrolled to this study.They were divided into low body mass index group (LBMI,25≤BMI＜28),intermediate body mass index group (IBMI,28≤BMI＜32) and high body mass index group (HBMI,BMI≥33).Meanwhile,the clinical effects and side-effects were evaluated among three groups.The factors of adverse effects were evaluated by Cox multivariate analysis.Results Only one patient in HBMI was conversed to open surgery,all the others received LRYGB.The surgery time,intraoperative blood loss and complica tion were positively related to BMI,and the difference was statistically significant between the 3 groups(P＜0.05).The main side-effect of LRYGB was gastrointestinal reaction.The level of fasting blood-glucose,postprandial 2 hours blood sugar,HbA1c and cholesterol total in three groups were lower than baseline (P＜0.05),however,there was no significant difference among the three groups (P＞0.05).The rate of clinical effects in three groups was 89.5％,89.3％ and 91.7％.There was no significant difference among the three groups(P＞0.05);In Cox multivariate analysis,cholesterol total and BMI were independent prognostic indicator for LRGB adverse.Conclusions LRYGB is a safe and effective method for patients with T2DM,which can effectively improve glucose and lipid metabolism.The increased BMI can increase the incidence of LRYGB complications.Total cholesterol is an independent prognostic indicator for the adverse of LRYGB.

Laparoscopic Roux-en-Y gastric bypass on bowel habits in patients with type 2 diabetes mellitus / 中华内分泌外科杂志

Objective To observe the impact of laparoscopic Roux-en-Y gastric bypass on bowel habits in patients with type 2 diabetes mellitus(T2DM).Methods 70 cases of T2DM undergoing laparoscopic Roux-en-Y gastric bypass were studied.Changes in bowel habits, frequency and odor of flatulence, and social life were estimated at least 6 months after surgery using a self-administered questionnaire.Results 67.1%of the patients had normal bowel habit, 68.6%of patients maintained normal flatus before undergoing surgery, and visual ana-logue scale reveals bowel and flatus habit would cause little trouble on daily life.47.1% of patients maintained their normal bowel habit, and 45.7%of patients had loose stools and diarrhea after surgery.The number of pa-tients with loose stools significantly increased(28/70, 40% after surgery vs 5/70, 7.1% before surgery), with statistical difference( P<0.001) .42.9%patients believed that eating high-fat diet was related with loose stools (P<0.001).Patients with constipation decreased significantly after surgery(5/70, 7.1% vs the preoperative 16/70, 22.9%), with statistical difference(P=0.016).Visual analogue scale showed that 57.1% of patients thought their daily life and social activities were not affected(P=0.05).50%of patients considered an increase flatus, and 55.7%had malodorous flatus, which had statistical significance compared with those before surgery ( P<0.001) .A visual analogue scale showed that 60%of patients thought that this change would not affect their daily life and social activities( P=0.212) .Conclusions After laparoscopic Roux-en-Y gastric bypass surgery, some patients had loose stod, diarrhea, increased flatus and and offensive odor, but after proper treatment these changes do not affect their daily life and social activities.

Medical-Nutrition-Therapy for Obese Patients with Type 2 Diabetes Mellitus Undergoing Metabolic Surgery

Currently, metabolic surgery (Laparoscopic Roux-en-Y gastric bypass, LRYGB) has an important role and should be recommended as an intervention in the management of obese patients with type 2 diabetes mellitus (T2DM). A successful outcome of surgery requires medical nutrition therapy. Therefore, we performed a retrospective study on 25 patients with T2DM who underwent LRYGB at Yeouido St. Mary's Hospital from October 2008 to May 2010. The patients were followed up for an average of 6 months after surgery (range: 2~19 months). Diabetes was resolved in 80% of the patients. Percentage of excess weight loss was (%EWL) was 56.2%. After surgery, fasting blood sugar (FBS) and HbA1c were significantly reduced (123 mg/dl, A1c 6.7%, P<0.001) and triglyceride was also significantly reduced to 107.6 mg/dl (P<0.05). As diets of the patients progressed from liquid to soft to regular diet, energy, carbohydrates, and fat intakes increased significantly (P<0.001). But protein intake did not change significantly. Nutrient intake of the patients after the surgery was significantly lower than the recommended diet for the non-surgery group. Patients experienced side-effects related to the diets after surgery, including hair-loss (76%), smelly gas (52%), vomiting (48%), etc. A significantly positive correlation was observed between vomiting and FBS (P<0.001). There was a significant relationship between side effects and the amount of nutrient intakes. Therefore, guide patients to a diet progression with treatment to minimize side effects, especially vomiting. And monitor their dietary life to be healthy and not to regain weight until remission of T2DM.

The Impact of Metabolic and Bariatric Surgery on Morbidly Obese Patients with Type 2 DM

PURPOSE: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are the most effective intervention and cure in achieving sustained weight loss in the morbidly obese with co-morbities, especially in type 2 diabetes mellitus (DM). Currently, there are few data in the literature presenting early diabetic outcomes between the 2 major bariatric surgeries in Korea. The aim of this study is to observe weight loss, improvement of type 2 DM after LRYGB and LAGB. METHODS: 33 retrospective data were obtained from diabetic subjects undergoing LRYGB (n=53) and LAGB (n=77). These measurements included age, sex, body mass index (BMI), pre-operative diabetic duration, post-operative diabetic at follow-up visit after surgery. Paired t-test, and SPSS12.0 were used for statistical analysis. RESULTS: 33 morbidly obese patients with type 2 DM who had both procedures complain of general weakness. Most patients were taking oral medications or insulin and tired of them. Pre and post-op 12 months of percent of excess weight loss (%EWL), fetal bovine serum (FBS), hemoglobin A1c (HbA1C) presented at 0%, 185.6 mg/dl, 8.7% and 70.6%, 123.4 mg/dl, 6.6% in patients who had LRYGB (P<0.05). Pre and post-op 12 months of %EWL, FBS, HbA1C presented at 0%, 180.6 mg/dl, 8.4% and 32.8%, 136.5 mg/dl, 6.8% in patients who had LAGB (P<0.05). Rate of discontinuance or decreasing for treatment of type 2 DM after surgery showed 94% for LRYGB versus 80% for LAGB, and unchanged rates were 6% versus 20%, respectively. CONCLUSION: This study showed LRYGB and LAGB are quite satisfactory and promising bariatric procedures with significant weight loss and improvement of type 2 DM in Koreans. LRYGB is significantly associated with more weight loss, more diabetic outcome than LAGB. Clinical experiences in Korea with both procedures are limited and a larger number of cases are need, but the recent data shows promising results that are comparable to the international experience.

Laparoscopic Hiatal Hernia Repair during Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) / 대한내시경복강경외과학회지

Obesity is one of the most significant causes of GERD. Nissen fundoplication is a surgical procedure that's performed world widely for treating patients with GERD and a hiatal hernia and who are intractable to medical therapy. However, Nissen fundoplication may have technical difficulties in morbidly obese patients due to the huge perigastric, intraabdominal fat tissue and hepatomegaly. During the laparoscopic Roux-en-Y Gastric Bypass (LRYGB) procedure, the stomach was divided into the gastric pouch and the remnant stomach by vertiacally stapling at the angle of His. The posterior gastric wall and hiatus were easily exposed even when there was huge deposits of perigatric and intraabdominal fat tissue. We report here on a case of concomitant hiatal hernia repair with LRYGB in a morbidly obese patient.

Initial Experience with Bariatric Surgery in Korea: 120 Cases (LRYGB and LAGB) / 대한내시경복강경외과학회지

PURPOSE: Obesity has become a global epidemic disease, and bariatric surgery is now being increasingly performed in Korea as well as in western countries. Bariatric surgery has been performed in Korea since 2003. However, there is no data on cases of Korean bariatric surgery regarding the weight loss as well as the factors associated with the surgical outcome. METHODS: 120 total cases of bariatric surgery [LRYGB=48, LAGB=72] were done at St. Mary's Hospital. We retrospectively reviewed the series of bariatric cases and we analyzed the surgical outcome, the complications and the clinical factors associated with the surgical outcomes. RESULTS: There were no significant differences in age, BMI and pre-existing comorbidities for both procedures. The percentage of excess weight loss (%EWL) of the LRYGB at 6, 12 and 24 months was 63.8%, 73.7% and 87.5%, respectively, and the %EWL of the LAGB was 33.4%, 44.7% and 43.8%, respectively. Factors such age and gender were not associated with the surgical outcome. Yet the initial BMI tended to affect the surgical outcome. CONCLUSION: The results of our study indicate that LRYGB and LAGB are technically feasible and safe procedures. Both are quite satisfactory and promising procedures for loosing a significant amount of weight.