Ajjana Techagumpuch, MD1, Kharikarn Augsornchat, MD1, Chadin Tharavej, MD2, Suppa-ut Pungpapong, MD2, Patpong Navicharern, MD2, Suthep Udomsawaengsup, MD2. 1Thammasat university, 2King Chulalongkorn Memorial University
BACKGROUND: Bariatric surgery has been effective in weight loss and also comorbidity resolution especially diabetes. Gastric bypass (LRYGB) is still a standard procedure and thought to play a major role in glucose homeostasis and diabetic control. Laparoscopic Sleeve gastrectomy (LSG) is gaining the popularity as an optional procedure in morbid obese patient with comparable outcome to gastric bypass in previous studies. However, there is a lack of data in Thailand.
OBJECTIVE : Primary outcome is to compare the effect on diabetic control after LSG and LRYGB surgery. Secondary outcome is to evaluate the excess weight loss.
METHOD : A prospective, randomized clinical trial in morbid obese patient with type 2 diabetes(T2DM). This study examined Thai patients with age between 15-60 years, BMI 32.5-60, history of T2DM less than 10 years and preoperative plasma HbA1c level more than 7%. Follow up at 6 months and 2 years after surgery to evaluate plasma HbA1c level, % excess weight loss and remission rate of diabetes after surgery
RESULTS : One hundred and four patients were randomized into 48 patients in LSG group and 56 patients in LRYGB group. There was no different in baseline BMI and plasma HbA1c level between two groups. Average EWL at 6 months were 42.76% in LSG group and 55.07% in LRYGB group (P=0.006) and EWL at 2 years were 58.32% in LSG group and 70.12% in LRYGB group (P<0.001). Reduction in mean plasma HbA1c level at 6 months after surgery from 8.52% to 6.65% in LSG group and from 8.40% to 5.68% in LRYGB group (P=0.619). Reduction in mean HbA1c level at 2 years after surgery from 8.52% to 6.09% in LSG group and from 8.40% to 5.53% in LRYGB group (P=0.737). Remission rate of T2DM at 6 months were 58.30% in LSG group and 62.07% in LRYGB group (P=0.481). Remission rate of T2DM at 2 years were 66.67% in LSG and 70.64% in LRYGB group (P=0.454). Both groups showed a decrease in antihyperglycemic drugs use after surgery but there was no statistic significant difference.
CONCLUSION : LRYGB is more effective than LSG in excess weight loss with statistic significant. However there is no different in the effective of diabetic control between two procedures in both short term and long term results.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80483
Program Number: S024
Presentation Session: Bariatric and Metabolic Surgery
Presentation Type: Podium