The effectiveness of new bariatric surgery in the type 2 diabetes treatment

Abstract

The aim — to compare the efficacy of Santoro biliopancreatic shunting with a new bariatric operation: sleeve gastrectomy with one gastroileal anastomosis in the treatment of patients with type 2 diabetes mellitus, and with morbid obesity.Materials and methods. А retrospective cohort study enrolled 32 patients (21 women and 11 men) with morbid obesity and type 2 diabetes who underwent bariatric surgery (Santoro biliopancreatic bypass surgery (first group) and sleeve gastrectomy with one gastroileal anastomosis (second group)) was conducted from 2013 to 2018. Exclusion criteria included the presence of previous bariatric surgeries, previous upper middle laparotomy, severe concomitant diseases (ASA III — IV), and the presence of psychological instability. Patients’ age ranged from 25 to 65 years (mean age 42.6 years). Average preoperative body weight — 107.5 kg (92.0 — 189.5 kg), average body mass index — 41.2 kg/m2 (36.7 — 65.0 kg/m2), average excess body weight — 50, 8 kg (28 — 106 kg). The average duration of metabolic disease before surgery was 7.5 years (3 — 21 years). Only 2 patients monitored the disease with diet, 15 received oral hypoglycemic medications, and 15 received insulin.Results and discussion. The duration of laparoscopic bariatric surgery ranged from 92 to 180 minutes. The average duration of Santoro biliopancreatic shunting surgery was significantly longer than the operations of sleeve gastrectomy with one gastroileal anastomosis (158 ± 28 minutes compared with 112 ± 16 minutes (p < 0.05)). There were no serious intraoperative complications or mortality in both groups of patients. The average length of stay in the hospital was 7.2 days (6 to 9 days) in the first group and 5.6 days (5 to 8 days) in the second (p > 0.05). The follow‑up period was 6 to 48 months. The lipid profile improved significantly in both groups. In the first year after surgery, 90 % of patients had normal cholesterol, 85 % had normal triglycerides. Arterial hypertension was cured in 13 patients, improved — in 2. There were no statistically significant differences in the normalization of comorbidities between groups.Conclusions. Santoro bariatric surgery, as well as sleeve gastrectomy with one gastroileal anastomosis, have the same effect on overweight, metabolic disturbances, and the frequency of complications. At the same time, sleeve gastrectomy with one gastroileal anastomosis is an effective and gentle surgical operation for the treatment of patients with morbid obesity and type 2 diabetes.