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.

Band Slippage after Laparoscopic Adjustable Gastric Banding (LAGB)

Laparoscopic adjustable gastric banding (LAGB) has proved to be safe and effective, worldwide. The perigastric technique was once the most frequent method of band placement, but posterior prolapse was a problem. The introduction of the pars flaccida technique has considerably reduced the incidence of this complication, and, currently, this technique is the most utilized method and recommended by most bariatric surgeons. However, LAGB with pars flaccida technique has rare complications such as band slippage and gastric pouch dilatation in 2~5% of patients. We have experienced 2 band replacement cases for band slippage and pouch dilatation each happening about 1 and 2 years after LAGB.

A Study on the Standards of Medical-Nutritional-Education by the Type of Bariatric Surgery in Morbid-obesity Patients

This study examined the effects of postoperative medical nutrition therapy on patients who had undergone bariatric surgery. Eighty seven patients who underwent bariatic-surgery at Yeouido St. Mary's Hospital from January 2007 to April 2009 were evaluated. The bariatric surgery patients included 42 Laparoscopic Roux-en Y gastric bypass (LRYGB) and 45 Laparoscopic adjustable gastric banding (LAGB) patients. Weight loss was more significant after LRYGB than after LAGB after 9 months (p<0.05). The LRYGB group was more satisfied with the weight loss (LRYGB 4.4/5.0, LAGB 3.0/5.0 p<0.001). The mean albumin, hemoglobin and hematocrit levels were significantly lower in the LRYGB group than in the LAGB group at the time of discharge (p<0.05~0.001). The GOT/GPT was significantly higher in the LRYGB group at the time of the operation than the LAGB group (p<0.01). The LRYGB group showed significantly lower intakes of total energy, carbohydrates, protein and fat from 1 week after surgery than the LAGB group. Multiple regression showed that the weight change after LRYGB was significantly more associated with the intakes of total energy at 1 week after surgery (p<0.01), SWS (sweets and high-calorie beverages) at 1 and 6 months after surgery (p<0.001), and fat at 3 months after surgery (p<0.01). In addition, LAGB was significantly more associated with the intakes of protein and NLS (non-liquid sweets) at 1 week after surgery (p<0.001, p<0.01), carbohydrate at 1 months after surgery (p<0.01), total energy at 3 months after surgery (p<0.001), HCL (high-calorie liquids) at 6 months after surgery (p<0.05), and fat at 9 months after surgery (p<0.01). These results suggest that continuous-follow-up medical nutrition therapy is needed according to the types of bariatric surgery, particularly during the weight loss phase (the first 1 week to 12 months).

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.