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Five-Year-Results of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Weight Loss and Type 2 Diabetes Mellitus

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Abstract

Background

Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) has been designated as a novel bariatric surgery procedure. This combination of sleeve gastrectomy and proximal intestinal bypass theoretically offers an effective and prolonged anti-diabetes effect. This is a follow-up of our institution’s previous report on the short-term effects of LSG-DJB on type 2 diabetes mellitus (T2DM), which a 68.7 % remission (HbA1c <6 % without diabetes medication) rate 1 year after surgery. The aforementioned result was comparable to the reported remission rates of laparoscopic Roux-en-Y gastric bypass. However, the durability of remission remains unknown.

Objective

The objective of this study is to investigate the medium-term (up to 5 years) effects of LSG-DJB on weight loss and T2DM.

Methods

In this analysis, consecutive 120 patients (female to male ratio = 61:59, mean age = 44.8 years) with T2DM who underwent LSG-DJB from April 2007 to November 2013 and were followed up beyond 1 year were included. The preoperative mean body weight and BMI were 105.7 kg and 38.5 kg/m2, respectively. The mean HbA1c and fasting blood glucose values were 8.9 % and 194 mg/dL, respectively. The mean duration of T2DM was 7.3 years. Fifty-five patients (46 %) were being treated with insulin prior to surgery.

Results

The follow-up rate was 97.5 % at 1 year, 73.3 % at 3 years, and 50.0 % at 5 years. The mean body weight was 74.9 kg at 1 year, 76.8 kg at 3 years, and 72.8 kg at 5 years (p < 0.001, compared to the baseline). The mean percent of total body weight loss (%TWL) was 28.9, 28.6, and 30.7 % at 1, 3, and 5 years, respectively. Remission of T2DM was achieved at 63.6, 55.3, and 63.6 % at 1, 3, and 5 years, respectively. Among those who achieved diabetes remission at 1 year, 10.8 % of them experienced recurrence during the subsequent follow-up period.

Conclusion

Although recurrence of T2DM is observed in some patients over time, LSG-DJB is an effective procedure for achieving significant weight loss and improvement of glycemic control, and the effects seem to be durable up to 5 years.

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Authors and Affiliations

  1. Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan

    Yosuke Seki, Kazunori Kasama, Hidenori Haruta & Atsushi Watanabe

  2. Center for Clinical Research, Okinawa Prefectural Chubu Hospital, Okinawa, Japan

    Renzo Yokoyama

  3. Weight Management and Bariatric-Metabolic Surgery Center, St. Luke’s Medical Center, Quezon, City, Philippines

    Jose Paolo Cabreira Porciuncula

  4. Department of Surgery, Yotsuya Medical Cube, Tokyo, Japan

    Akiko Umezawa & Yoshimochi Kurokawa

Authors
  1. Yosuke Seki
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  2. Kazunori Kasama
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  3. Hidenori Haruta
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  4. Atsushi Watanabe
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  5. Renzo Yokoyama
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  6. Jose Paolo Cabreira Porciuncula
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  7. Akiko Umezawa
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  8. Yoshimochi Kurokawa
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Correspondence to Yosuke Seki.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments of comparable ethical standards.

Informed Consent

Informed consent was obtained from all individuals participants included in the study.

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Seki, Y., Kasama, K., Haruta, H. et al. Five-Year-Results of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Weight Loss and Type 2 Diabetes Mellitus. OBES SURG 27, 795–801 (2017). https://doi.org/10.1007/s11695-016-2372-0

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  • DOI: https://doi.org/10.1007/s11695-016-2372-0

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