Ajjana Techagumpuch, Dr, Pakkavuth Chanswangphuvana, Dr, Soravith Vijitpornkul, Dr, Chadin Tharavej, Dr, Suppa-ut Pungpapong, Dr, Patpong Navicharern, Dr, Suthep Udomsawaengsup, Dr. Department of Surgery, Chulalongkorn University, Bangkok, Thailand.
BACKGROUND: Bariatric surgery has been an acceptable treatment in morbid obese patient which demonstrated efficacy on weight loss and comorbidity resolution especially diabetes. The effect on diabetes control obviously occur within 3 months after surgery. Gastric bypass (LRYGB) is still the standard procedure and thought to has the major role in glucose homeostasis and diabetes control. Sleeve gastrectomy(LSG) is gaining the popularity as an option procedure in morbid obese patient with comparable outcome to gastric bypass in previous study. However there is still lack of data in Asia-pacific.
OBJECTIVE: To compare the remission rate of diabetes within 3 months after LSG and LRYGB surgery including the data of anti-hyperglycemic drug use, excess weight loss, and complication rate of both operations.
METHOD: A cohort study in morbid obese patients with type 2 diabetes (T2DM) who undergo LRYGB and LSG in King Chulalongkorn Memorial Hospital. We recruited all Thai patient with age between 15-60 years, BMI 32.5-60, history of T2DM at less 6 months but not more than 10 years. At 3 months after surgery, the remission rate, excessive weight loss, the reduction of anti-hyperglycemic drugs use, change of HbA1c and complication rate were collected.
RESULT: 237 bariatric surgeries were performed in our hospital since 2003. 66 patients diagnosed of diabetes and compatible with inclusion criteria were identified. There were 38 patients in LRYGB group and 28 patients in LSG group. Overall average BMI was 50.7(34.10-76.5). The age, gender and BMI were comparable in both groups (BMI 49.38±8.73 and 52.49±10.77 , age 37.39±9.82 and 52.49±12.68 in LRYGB and LSG respectively). At 3 months after surgery, mean percentage of excessive weight loss was 43.9±15.84 in LRYGB group and 28.57±10.89 in LSG group with significant difference(P=0.004). The major complication was found 2.6% in LRYGB and 3.5% in LSG group (1 leakage in LRYGB and 1 bleeding in LSG), both were controlled by laparoscopic procedure without any mortality. There was no significant differences in reduction of mean HbA1c level from 8.01 to 5.72 in LSG group and from 8.73 to 5.56 in LRYGB group (P=0.343). The remission rate was 47.34% in LRYGB vs 39.28% in LSG with p = 0.513 while 95% of LRYGB and 89% of LSG showed decrease or discontinued of anti-hyperglycemic drugs use after surgery.
CONCLUSION: The study shows that bypass surgery is significant effective than sleeve gastrectomy in reduce weight but could not demonstrate significant difference in diabetes control in Thai patients. However this report shows that both procedures are feasible and have high success rate in glycemic control.