Laparoscopic sleeve gastrectomy with duodenal-jejunal bypass for the treatment of type 2 diabetes mellitus

Abstract

Objective To investigate the clinical effects of laparoscopic sleeve gastrectomy with duodenal-jejunal bypass (LSG+ DJB) for the treatment of type 2 diabetes mellitus. Methods The clinical data of 17 patients with type 2 diabetes mellitus who underwent LSG+ DJB at the Xijing Hospital of the Fourth Military Medical University from March 2013 to February 2014 were retrospectively analyzed. The fasting blood glucose, postprandial 2-hour blood glucose, glycosylated hemoglobin (HbA1c) and body mass index (BMI) in 17 patients before operation were (9.2±0.6)mmol/L, (14.4±2.2)mmol/L, 8.3%±1.2% and (29.4±2.2)kg/m2, respectively. All the patients received LSG+ DJB and were followed up by outpatient examination up to March 2015. The pre- and post-operative 12- month fasting blood glucose, postprandial 2-hour blood glucose, HbA1c and BMI in 17 patients were compared. Measurement data with normal distribution were presented as ±s and analyzed by the t test. Results All the 17 patients received successful laparoscopic LSG+ DJB without conversion to open surgery. The operation time, volume of intraoperative blood loss and recovery time of postoperative gastrointestinal function were (141±53)minutes, 40 mL and 2.5 days. Of 3 patients with postoperative complications, 1 patient with anastomotic leakage at postoperative day 5 received reoperation by laparoscopic Roux-en-Y gastric bypass, 1 patient with digestive tract obstruction at postoperative day 10 released obstruction by reoperation and 1 patient with left subphrenic abscess and leakage at the upper of the stomach at postoperative week 2 was cured by the sympto-matic treatment. The duration of hospital stay was 5.2 days. All the patients were followed up for a median time of 16 months (range, 13-24 months). The postoperative 12-month fasting blood glucose, postprandial 2-hour blood glucose, HbA1c and BMI in 17 patients were (5.5±0.7)mmol/L, (8.8±1.7)mmol/L, 5.1%±0.7% and (24.7±2.3)kg/m2, which were significantly different from preoperative indicators (t=19.96, 10.52, 12.06, 31.99, P<0.05). During the follow-up, no anastomotic ulcer and stenosis, dumping syndrome and severe malnutrition were occurred. Conclusion LSG+ DJB is safe and feasible for the treatment of type 2 diabetes mellitus, with a good short-term hypoglycemic effect. Key words: Diabetes mellitus, type 2; Sleeve gastrectomy; Duodenal jejunal bypass; Laparoscopy