Three-year result of efficacy for type 2 diabetes mellitus control between laparoscopic duodenojejunal bypass compared with laparoscopic Roux-en-Y gastric bypass.

PURPOSE

The mechanism by which bariatric surgery facilitates diabetic control is still unknown. Duodenojejunal bypass supports the foregut theory; however, its efficacy when used alone is not yet established.

METHODS

During the period from January 2008 to December 2009, patients who underwent laparoscopic duodenojejunal bypass (LDJB) or laparoscopic Roux-en-Y gastric bypass (LRYGB) for type 2 diabetes mellitus (T2DM) with or without morbid obesity were included. Patients who had a follow-up for less than 3 years were excluded. Patient baseline characteristics, change of body weight, body mass index (BMI), glycosylated hemoglobin (HbA), and diabetic treatments were analyzed.

RESULTS

In total, 8 LDJB and 20 LRYGB patients were analyzed. The LDJB group had more number of male patients than the LRYGB group (LDJB 75% . LRYGB 30%, P = 0.030). Baseline BMI in the LRYGB group was higher than in the LDJB group (LDJB 27.0 ± 2.5 . LRYGB 32.6 ± 3.4, P < 0.001). Age, DM duration, baseline HbA, and C-peptide levels were similar. Longer operation time was needed to perform LDJB (LDJB 367.5 ± 120.2 . LRYGB 232.9 ± 41.1, P < 0.001), but no differences were observed in the hospital stay and complication rate between the 2 groups. At the third year of follow-up, the T2DM remission rate was observed in 40% of patients in the LRYGB group and 12.5% of patients in the LDJB group.

CONCLUSION

LDJB is not an effective method for controlling T2DM compared with LRYGB. Foregut theory may not be the main mechanism of diabetic control during bariatric surgery.