Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Surg Obes Relat Dis. 2022 Nov;18(11):1277-1285. doi: 10.1016/j.soard.2022.07.003. Epub 2022 Jul 13.
Duodenojejunal bypass with sleeve gastrectomy (DJB-SG) is a novel bariatric surgery composed of sleeve gastrectomy (SG) and duodenojejunal anastomosis. Both loop and Roux-en-Y DJB-SGs were reported to have acceptable hypoglycemic and weight loss outcomes, but it remains unclear which reconstruction method is better regarding therapeutic efficacy and safety for type 2 diabetes (T2D).
This study was undertaken to prospectively compare the short-term therapeutic outcomes and surgical safety of loop versus Roux-en-Y DJB-SG.
University hospital.
A total of 96 patients with T2D with body mass index of 27.5-40 kg/m were randomized in a 1:1 ratio to undergo loop or Roux-en-Y DJB-SG from January 2020 to December 2020. The primary end point was to determine the 1-year T2D remission rate. Additionally, medical cost, operative outcomes, weight loss, metabolic improvement, nutritional status, and gastrointestinal disorders at 1-year follow-up also were determined.
The preoperative data were comparable at baseline. The 1-year follow-up rate was 89.6% (43 of 48 patients) for loop DJB-SG and 93.8% (45 of 48 patients) for Roux-en-Y DJB-SG. The T2D remission rates were 93.02% (40 of 43) for loop DJB-SG and 88.89% (40 of 45) for Roux-en-Y DJB-SG at 1-year follow-up. Loop DJB-SG patients exhibited higher total weight loss (30.85% ± 7.24% versus 26.11% ± 7.12%), shorter operative times, and less medical cost than Roux-en-Y DJB-SG patients. However, there was no statistical difference regarding lipid profiles, major postoperative complications, nutritional status, and gastrointestinal disorders between the 2 groups.
Despite similar hypoglycemic effects, loop DJB-SG was simpler and exhibited better weight loss and less medical cost than Roux-en-Y DJB-SG. Thus, loop DJB-SG was better than Roux-en-Y DJB-SG for T2D.
空肠十二指肠旁路加袖状胃切除术（DJB-SG）是一种新型减重手术，由袖状胃切除术（SG）和空肠十二指肠吻合术组成。有报道称环式和 Roux-en-Y 式 DJB-SG 均具有可接受的降糖和减重效果，但对于 2 型糖尿病（T2D），哪种重建方法在治疗效果和安全性方面更优仍不清楚。
本研究旨在前瞻性比较环式与 Roux-en-Y DJB-SG 的短期治疗效果和手术安全性。
大学医院。
2020 年 1 月至 2020 年 12 月，96 例 T2D 患者（BMI 为 27.5-40 kg/m²）按 1:1 比例随机分为环式或 Roux-en-Y DJB-SG 组。主要终点为确定 1 年 T2D 缓解率。此外，还在 1 年随访时评估医疗费用、手术结果、体重减轻、代谢改善、营养状况和胃肠道疾病。
环式 DJB-SG 组的 1 年随访率为 89.6%（43/48 例），Roux-en-Y DJB-SG 组为 93.8%（45/48 例）。环式 DJB-SG 组 1 年 T2D 缓解率为 93.02%（40/43），Roux-en-Y DJB-SG 组为 88.89%（40/45）。与 Roux-en-Y DJB-SG 组相比，环式 DJB-SG 组患者的总减重（30.85%±7.24%比 26.11%±7.12%）更高、手术时间更短、医疗费用更少。然而，两组间的血脂谱、主要术后并发症、营养状况和胃肠道疾病无统计学差异。
尽管降糖效果相似，但环式 DJB-SG 比 Roux-en-Y DJB-SG 更简单，且减重效果更好、医疗费用更低。因此，对于 T2D，环式 DJB-SG 优于 Roux-en-Y DJB-SG。
