Why sleeve gastrectomy is a better strategy than Roux-en-Y gastric bypass for type-2 diabetes mellitus

Abstract

Type-2 diabetes mellitus is a chronic disease that affects now 417 millions worldwide. Surgery is now the only efficacious treatment, when compared to best medical treatment. Sleeve gastrectomy, the most frequent bariatric/metabolic surgery performed in the world, is associated with significant improvement in glycemic status in long-term. There are no real significant differences between the sleeve gastrectomy and gastric bypass at 5 years, nor in weight loss, nor in resolution of type-2 diabetes mellitus as measured by fasting blood glucose. The author strongly advocates sleeve gastrectomy as a first intention. If the patients fail to have substantial effect on their diabetes or if recidivism is seen, then the second stage intestinal procedures can be added, which include single anastomosis duodeno-ileostomy, duodenal switch, ileal inter-position, duodeno-jejunal bypass, amongst others, all preserving the sleeve and pylorus. Conversion from sleeve to Roux-en-Y gastric bypass may be problematic, increasing risks of peptic ulcers, dumping syndromes, bowel obstructions, micro-nutrients deficiencies and it may not be strong enough to reverse diabetes. Because of the loss of pylorus, the risk of glycemic deregulations with severe hypoglycemia or delayed hyperglycemia syndromes would possibly appear. Key words: Diabetes mellitus, type 2; Sleeve gastrectomy; Gastric bypass