Loop versus Roux-en-Y duodenojejunal bypass with sleeve gastrectomy for type 2 diabetes: short-term outcomes of a single-center randomized controlled trial


Background

Duodenojejunal bypass with sleeve gastrectomy (DJB-SG) is a novel bariatric surgery
composed of sleeve gastrectomy (SG) and duodenojejunal anastomosis. Both loop and
Roux-en-Y DJB-SGs were reported to have acceptable hypoglycemic and weight loss outcomes,
but it remains unclear which reconstruction method is better regarding therapeutic
efficacy and safety for type 2 diabetes (T2D).

Objective

This study was undertaken to prospectively compare the short-term therapeutic outcomes
and surgical safety of loop versus Roux-en-Y DJB-SG.

Setting

University hospital.

Methods

A total of 96 patients with T2D with body mass index of 27.5–40 kg/m2 were randomized in a 1:1 ratio to undergo loop or Roux-en-Y DJB-SG from January 2020
to December 2020. The primary end point was to determine the 1-year T2D remission
rate. Additionally, medical cost, operative outcomes, weight loss, metabolic improvement,
nutritional status, and gastrointestinal disorders at 1-year follow-up also were determined.

Results

The preoperative data were comparable at baseline. The 1-year follow-up rate was 89.6%
(43 of 48 patients) for loop DJB-SG and 93.8% (45 of 48 patients) for Roux-en-Y DJB-SG.
The T2D remission rates were 93.02% (40 of 43) for loop DJB-SG and 88.89% (40 of 45)
for Roux-en-Y DJB-SG at 1-year follow-up. Loop DJB-SG patients exhibited higher total
weight loss (30.85% ± 7.24% versus 26.11% ± 7.12%), shorter operative times, and less
medical cost than Roux-en-Y DJB-SG patients. However, there was no statistical difference
regarding lipid profiles, major postoperative complications, nutritional status, and
gastrointestinal disorders between the 2 groups.

Conclusion

Despite similar hypoglycemic effects, loop DJB-SG was simpler and exhibited better
weight loss and less medical cost than Roux-en-Y DJB-SG. Thus, loop DJB-SG was better
than Roux-en-Y DJB-SG for T2D.



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