1.
Early Endocrine and Metabolic Changes After Bariatric Surgery in Grade III Morbidly Obese Patients: A Randomized Clinical Trial Comparing Sleeve Gastrectomy and Gastric Bypass.
de Barros, F, Setúbal, S, Martinho, JM, Monteiro, AB
Metabolic syndrome and related disorders. 2015;(6):264-71
Abstract
BACKGROUND We compared the early endocrine and metabolic changes associated with sleeve gastrectomy (SG) and gastric bypass (GB) in grade III obese patients. METHODS Fifty morbidly obese patients were randomized into two groups on the basis of their position in the queue-group A comprised SG and group B was GB. Comparison between the two groups was based on clinical and laboratory variables such as fasting blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), lipids, albumin, and ferritin. Patients were assessed after 7, 14, 30, 60, and 90 days and additional laboratory tests were done on the 90(th) day. RESULTS The following mean values were recorded for groups A and B, respectively: Age (years), 36.4 and 31.1; weight (kg), 123.2 and 128.3; and body mass index (BMI; kg/m(2)), 45.6 and 47.3. In the first postoperative week, group B showed a greater weight loss (P=0.047) that was not observed after 14, 30, 60, and 90 days (P>0.05). Group A had an average excess weight loss of 31.09 kg compared to 32.69 kg in group B (P=0.222). Glycemic control was better in group B (P=0.023), whereas the control of systemic arterial pressure was better in group A (P=0.026). There were no significant differences in early lipid control and micronutrient deficiencies between the two groups. CONCLUSIONS SG and GB were equally effective in promoting weight loss after 90 days. However, whereas SG was associated with better early remission rates for hypertension, GB was more effective in fasting blood glucose control but not in HOMA-IR and HbA1c levels. There was no difference in the protein or vitamin deficiencies of the two groups.
2.
Laparoscopic duodenojejunal bypass with sleeve gastrectomy: preliminary results of a prospective series from India.
Raj, PP, Kumaravel, R, Chandramaliteeswaran, C, Vaithiswaran, V, Palanivelu, C
Surgical endoscopy. 2012;(3):688-92
Abstract
BACKGROUND Bariatric surgeries are now redefined as metabolic surgeries given the excellent resolution of metabolic derangements accompanying obesity. Duodenojejunal bypass (DJB) is a novel metabolic surgery based on foregut hypothesis. Reports describe DJB as a stand-alone procedure for the treatment of diabetes in nonobese subjects. For obese subjects, DJB is combined with sleeve gastrectomy. This combination of DJB and sleeve gastrectomy is proposed as an ideal alternative to Roux-en-Y gastric bypass (RYGB) with these advantages: (1) easy postoperative endoscopic surveillance, (2) preservation of the pyloric mechanism, which prevents dumping syndrome, and (3) reduced alimentary limb tension. This study aimed to analyze the short-term outcomes of laparoscopic DJB with sleeve gastrectomy for morbidly obese patients. METHODS At our institution, 38 patients who underwent laparoscopic DJB with sleeve gastrectomy were followed up. The inclusion criteria for the study were according to the Asian Pacific Bariatric Surgery Society guidelines. Sleeve gastrectomy was performed over a 36-Fr bougie, with the first part of the duodenum mobilized and transected. The jejunum was divided 50 cm distal to duodenojejunal flexure. A 75- to 150-cm alimentary limb was fashioned and brought in a retrocolic manner. End-to-end hand-sewn duodenojejunostomy was performed. Intestinal continuity was restored with a stapled jejunojejunostomy, and mesenteric rents were closed. RESULTS The study population consisted of 38 patients (15 men and 23 women) ranging in age from 31 to 48 years. During a mean follow-up period of 17 months, the excess body weight loss was 72%, with a 92% resolution of diabetes. One patient presented with internal herniation through the retrocolic window 1 month after the operation and was managed surgically without any complication. No other minor or major complications occurred, and there was no mortality. CONCLUSION Laparoscopic DJB with sleeve gastrectomy is safe and effective in achieving durable weight loss and excellent resolution of comorbidities. Long-term follow-up studies are needed.