Comparative Study between the Effect of Single Anastomosis Gastric Bypass versus Roux-en-Y Gastric Bypass in Morbidly Obese Patient as Regard Remission of Type-2 DM

Abstract

Abstract Background Accumulating evidence obviously supports the superiority of weight loss surgery over non-surgical treatments for management of morbidly obese patients in terms of outcomes as sustained weight loss, improved quality of life and prevention, reduction, or resolution of comorbidities (e.g., Type 2 Diabetes Mellitus, dyslipidemia), as well as reduced overall mortality. Objective To compare Type 2 DM remission as well as the metabolic effects of 2 types of bariatric surgery; Single Anastomosis gastric Bypass and Roux-en-Y Gastric bypass, in the first year postoperative follow up in relation to DiaRem Scoring system. Patients and Methods This is a prospective randomized clinical trial study conducted in AinShams University Hospitals bariatric surgery unit over 40 patients with minimal follow-up of 12 months. 2 groups of patients: Group A: composed of 20 patients that undergoing OAGB as a metabolic surgery for control of Type 2 DM. Group B: composed of 20 patients that undergoing Reux-en-Y gastric bypass as a metabolic surgery for control of Type 2 DM. Patients were randomly distributed among both groups using simple randomization odds and evens where odd patients were included in group A and even patients were included in group B. Results We find that Roux-en-Y operation is more potent as regard remission of DM than MGB/OAGB (80% versus 65%) and that remission of DM depends on diabetes itself (duration, HBA1C, C-PEPTIDE) and these are the main determinants of remission. And DiaRem score is good predictor of DM remission in low scoring categories however in high scoring categories it is poor in prediction of DM remission Conclusion No statistical difference between both groups as regard remission of DM however numerically it is obvious that Roux-en-Y is more potent metabolic surgery in order to be statistically significant the study needs to be repeated over larger sample size. The main determinant noticed during the study influencing remission is the duration of DM and preoperative C-peptide level-in addition to HBA1C level. We must put into our consideration the post operative complications of MGB/OAGB as regard biliary reflux and failure which are more less in Roux-enY operation but in order to be evaluated longer duration of follow up is needed. We recommend Roux-en-Y as a metabolic surgery for patients with early onset DM type II with BMI ranging from 30-40. The study needs to be repeated over larger sample size and longer duration to determine the long term effects of metabolic surgery.