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SG vs. RYGB

SG has similar outcomes to RYGB in Chinese patients

At three-month and six-month visiting post operation, HbA1c values were much lower for RYGB group than SG group and reductions of HbA1c were more significant for RYGB group (p<0.01).

Sleeve gastrectomy has similar effects to RYGB in remission of T2DM and metabolic disorders for Chinese mildly obese (BMI28-35) T2DM patients, according to Chinese researchers from the First Affiliated Hospital of Jinan University, Guangzho, China. Despite the positive three-year results, their paper, Long-term effects of laparoscopic sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28-35 kg/m 2., published in BMC Surgery, does emphasise that a longer follow-up period is still required to confirm the long-term effects.

The aim of the study was to compare the long term efficacy of SG and RYGB in Chinese T2DM patients with BMI28-35 using a prospective randomised trial over 36 months post-operatively, which was conducted from July 1 2009 to July 30 2014. A total of 64 patients were enrolled in this study after they were assessed for their general condition and mental status, complications of obesity and diabetes mellitus, risk factors, and motivations for surgery.

In one year post operation, the patients attended the visit every three months, and half-yearly thereafter. The researchers collected data on patients’ height, body weight, BMI, waist circumference, usage of medication and adverse events. In addition, laboratory test included HbA1c, FBG, C-peptide, and serum lipid profiles. The primary outcome was glycaemic control with HbA1c values less than 6.0% in addition to fasting plasma glucose levels less than 7.0mmol/L without glycaemic agents at the 36-month visit. Secondary outcome measures included the percentage of weight loss and improvement of dyslipidaemia.

A total of nine (14.1%) patients failed to finish the whole 36 months follow-up (four from SG group and five from RYGB group). At baseline, both groups had similar baseline anthropometric measurements, including age, gender, weight, height, BMI, waist circumference, duration of diabetes, and medication usage conditions. Baseline values of HbA1c (8.5% vs. 8.9%, p=0.321), FBG (10.2 vs. 10.4mmol/L, p=0.700), and C-peptide (2.2 vs. 2.6ng/ml, p=0.062) in the SG group were comparable to the RYGB group. The two groups also had similar baseline serum lipid levels that included cholesterol, triglyceride, HDL, and LDL.

Outcomes

The mean post-operative hospital stay was 5.2 days for the SG group and 6.6 days for the RYGB group (p=0.000). There were no deaths or major complications in either group. Minor complications occurred in 3 of 55 patients (5.5%), including 2 gastroesophageal reflux cases in the SG group and 1 case of anaemia in the RYGB group

In total, 22 patients (78.6%) in SG group and 23 patients (85.2%) in RYGB group achieved complete remission of diabetes mellitus with HbA1c < 6.0% (p=0.525) and without taking antidiabetic medications, and 25 patients in each group (89.3% vs. 92.6%) gained successful treatment of diabetes with HbA1c ≤ 6.5% (p=0.100). At study end point, 27 patients in SG group and 28 in RYGB group stopped receiving oral hypoglycemic agents, and 13 patients in the SG group and 18 patients in the RYGB group no longer needed insulin injections.

At each visit time, percentage of total weight loss (%TWL),%EWL and change in BMI were greater in the RYGB group compared to the SG group. The most weight loss time point was two-year post operation in both groups, and after that maintained the weight reduction outcomes (Figure 1).

Figure 1: Percentage of excess weight loss are plotted for the 3, 6, 9, 12, 18, 24 and 36 month time points. Error bars indicate 95 % CIs; P values for differences are all <0.05

At three-year post operation, HbA1c were similar in the two study groups (5.9 vs. 5.7 mmol/L, p=0.334). At three-month and six-month visiting post operation, HbA1c values were much lower for RYGB group than SG group and reductions of HbA1c were more significant for RYGB group (p<0.01).

“…our study showed that in both groups, all blood lipid indexes were significantly decreased after operation in the patients with dyslipidemia. Three years after operation, the blood lipid indexes, including total cholesterol, triglyceride, LDL, and HDL, stayed at normal levels with similar degrees of decline,” the researchers write.  “Meanwhile, the percentages of patients that stopped taking lipid-lowering drugs and antihypertensive drugs were the same, illustrating that both SG and RYGB have similar effects on obesity relevant metabolic disturbances…Our study suggests that both groups obtained similar diabetic remission rate but different weight loss effects three years after operation. The relationship between glycaemic control and weight loss needs to be further investigated.”

To access this paper, please click here

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