Efficacy and safety analysis of laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus with low body mass index

Abstract

Objective To investigate the efficacy and safety of laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus (T2DM) with low body mass index (BMI). Methods clinical data of 81 patients with T2DM undergoing laparoscopic Roux-en-Y gastric bypass in the Daping hospital of Army Medical University between May 2010 and May 2017 were studied retrospectively. According to their BMI, these patients were divided into the higher BMI group (BMI>27.5 kg/m2) and lower BMI group (BMI≤27.5 kg/m2). 53 patients were included into the BMI>27.5 kg/m2 group, among them, 31 were males and 22 were females with an average age of (41.4±11.3) years old. 28 patients were included into the BMI≤27.5 kg/m2 group, among them, 13 were males and 15 were females with an average age of (48.5±7.5) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. BMI, Waist, Fasting plasma glucose (FPG), glycosylated hemoglobin A1c (HbA1c), total cholesterol, triglyceride, high density lipoprotein cholesterol and low density lipoprotein cholesterol after 1, 3, 6, 12, 24, 36 months were compared. Results The FPG, HbA1c, BMI and waist declined over time after surgery in both groups, and maintained stable 6 months after surgery, which were significantly lower than the preoperative (P 27.5 kg/m2 group (t= -1.21, P>0.05); the average HbA1c level of the BMI≤27.5 kg/m2 group was significantly lower than that before surgery (t=2.513, P 27.5 kg/m2 group (t= -0.181, P>0.05). Although the average TC, TG, LDL-C level of two groups showed a decreasing trend, they had no statistical difference with the preoperative (P>0.05). The average HDL-C level of two groups showed an increasing trend, but had no statistical difference with the preoperative (P>0.05). There were no significant difference in glucose and lipid metabolism at any point in both groups. The differences of clinical complete remission rate and partial remission rate of T2DM among two groups were not statistically significant (P>0.05). There were no early and late mortality, and seven patients (8.6%) developed early or late complications. Conclusions Laparoscopic Roux-en-Y gastric bypass can significantly reduce weight and improve glucose and lipid metabolism for T2DM with low BMI, and the short-term and long-term postoperative safety is reliable. Key words: Laparoscopic Roux-en-Y gastric bypass; Diabetes mellitus, Type 2; Body mass index