Loop Duodenojejunal Bypass with Sleeve Gastrectomy: Comparative Study with Roux-en-Y Gastric Bypass in Type 2 Diabetic Patients with a BMI <35 kg/m(2), First Year Results.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has shown good diabetes remission in obese patients with type 2 diabetes mellitus (T2DM), but long-term complications were observed. We developed loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) to achieve diabetes remission and avoid the drawbacks of RYGB. We compare 1-year results between LDJB-SG and RYGB with body mass index (BMI) <35 kg/m(2) of T2DM patients. METHODS: We conducted a case-matched study of BMI < 35 kg/m(2) T2DM patients who underwent RYGB and LDJB-SG matching on age, BMI, and duration of diabetes. The 1-year surgical results were compared. RESULTS: Sixty patients were included from March 2010 to August 2012. Thirty patients underwent RYGB and 30 underwent LDJB-SG. The operative time (mean ± SD) and length of stay (median [IQR]) were significantly longer in the LDJB-SG group than in the RYGB group (127.0 ± 40.2 vs. 105.0 ± 64.7 min and 3[3, 4] vs. 3[2, 3] days, respectively). There were no statistical differences between the groups in the mean BMI, fasting plasma glucose, and %HbA1c either at baseline or at 1 year. However, these parameters dropped significantly from the preoperative values (p < 0.01). The level of HOMA-%B at 1 year was significantly higher in the LDJB-SG group than in the RYGB group (p = 0.004). The resolution of comorbidities was similar. Late complications seemed higher in the RYGB group (12 vs. 5, p = 0.08). There were no deaths, but two patients in each group required reoperation. CONCLUSIONS: LDJB-SG was comparable to RYGB in terms of weight loss, glycemic control, and comorbidity resolution in BMI <35 kg/m(2) T2DM patients in the short-term.

Laparoscopic Adjustable Gastric Banded Plication (Lagbp): Standardization of Surgical Technique and Analysis of Surgical Outcomes.

BACKGROUND: Laparoscopic adjustable gastric banded plication (LAGBP) is a novel bariatric procedure which is restrictive and reversible. The aim of this study were to compare two LAGBP techniques and analyze its postoperative outcomes, in order to standardize the procedure. METHODS: Eighty patients who underwent LAGBP were enrolled in this study. Forty patients who underwent LAGBP (group 1) from December 2011 to June 2012 were compared with 40 patients (group 2) who underwent a modified LAGBP technique, which included preserving the right gastroepiploic vessels and uniform plication volume between July 2012 and January 2013. Relevant patient's data were collected and analyzed. RESULTS: Both groups were similar in age, gender, preoperative body mass index (BMI), and hospital stay. The median total operative time was shorter in group 2 (100.5 min; range 41-189) compared to group 1 (124 min; range 63-192), p = 0.048. There were two major complications involving gastric fold herniation (GFH) in group 1, while none was seen in group 2, p = 0.07. The minor complications encountered in both groups were similar, p = 0.37. At 6-month follow-up, there was no difference in mean frequency of band adjustments, weight, and BMI reduction in both groups. No mortality was seen in our series. CONCLUSIONS: A standardized LAGBP procedure which includes uniform plication volume and preservation of right gastroepiploic vessels could potentially avoid early GFH. However, larger comparative studies with longer follow-up would be needed to evaluate the late outcomes of this procedure and its efficacy in weight loss.

Worthy or not? Six-year experience of revisional bariatric surgery from an Asian center of excellence.

BACKGROUND: Revisional bariatric surgery (RBS) is increasing. The various primary operations with their distinctive complications make this group of patients quite heterogeneous, and treatment has to be individualized. There are concerns regarding the safety profile and efficacy of these procedures. The objective of the present study was to analyze the indications, safety, and efficacy of RBS at a high-volume Asian center and provide insight into the different treatment options. METHODS: Of a total of 1578 bariatric surgeries from July 2006 to June 2012, 52 patients underwent revisional bariatric procedures. The primary operations included 6 different procedures. The indications for surgery were grouped into weight loss failure (n = 21) or complications related to the primary operation (n = 31). The revisional operations performed were conversion to another procedure (n = 22), revision of existing anatomy (n = 29), or reversal to normal anatomy (n = 1). RESULTS: 96% of revisional surgeries were performed laparoscopically. The median operating time was 72 minutes (25-240 min), and the median duration of hospital stay was 4 days (3-25 d). The mean body mass index for weight loss failure decreased significantly from 36.3 to 29.6 kg/m(2) after 1 year of revisional surgery (P<.01). However, revision of RYGB was only associated with a body mass index loss of 3.2 kg/m(2) and percentage of excess weight loss of 31.8%. More than 90% of the patients with complications had complete resolution of their preoperative symptoms. There were 3 major complications with an overall morbidity rate of 5.8%. There was no mortality. CONCLUSIONS: RBS is well-tolerated, with satisfactory early outcomes, in high-volume centers. However, larger studies with longer follow-up periods are needed to determine the long-term efficacy of these procedures.

Laparoscopic Roux-en-Y gastric bypass for nonobese type II diabetes mellitus in Asian patients.

BACKGROUND: The beneficial role of laparoscopic Roux-en-Y gastric bypass (LRYGB) for type 2 diabetes mellitus (T2 DM) in morbidly obese patients has been established; however, there is scant evidence supporting its effectiveness in nonobese T2 DM Asian patients. The objective of this study was to evaluate the effect of LRYGB in nonobese T2 DM patients and elucidate the predictors of DM remission after one year follow-up. METHODS: Between June 2009 and May 2011, twenty-nine nonobese (body mass index (BMI)<27 kg/m(2)) Asian patients with T2 DM who underwent LRYGB were enrolled. All patients were prospectively followed up for one year. Baseline demographic characteristics, diabetic status, and clinical and biochemical data were collected preoperatively and one year after LRYGB. DM remission was defined as those with hemoglobin A1 c (HbA1 c)<6.5% without oral hypoglycemic drugs (OHA)/insulin. Outcomes in the DM remission group were compared with the nonremission group and analyzed. RESULTS: All clinical and biochemical parameters, except uric acid, were significantly improved. DM remission was achieved in eleven patients (37.9%) of whom five (45.5%) were male. Blood glucose, HbA1 c, c-peptide, homeostatic model assessment (HOMA-%B), and low density lipoprotein (LDL)-cholesterol were the significant variables in patients with DM remission; however, multiple logistic regression showed that only preoperative HOMA-%B (odds ratio (OR) = 1.13, 95% CI = 1.03-1.24) was a predictor for DM remission. Though no mortality was seen, the complication rate was 20.7%, of which 17.3% was related to marginal ulcers. CONCLUSION: LRYGB resulted in significant clinical and biochemical improvements in nonobese Asian patients, with HOMA-%B indicating ß-cell function as the main predictor of T2 DM remission. Appropriate patient selection with better ß-cell function and evidence from long-term follow-up may justify this therapeutic approach.