Fares Sami, Barajas-Gamboa Juan S, Díaz Del Gobbo Gabriel, Klingler Michael, Pantoja Juan Pablo, Abril Carlos, Raza Javed, Guerron Alfredo D, Corcelles Ricard, Allemang Matthew, Rodriguez John, Kroh Matthew
Department of Surgery, Case Western Reserve University School of Medicine, Main Campus, Cleveland, OH 44106, USA.
Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi P.O. Box 112412, United Arab Emirates.
J Clin Med. 2023 Aug 2;12(15):5077. doi: 10.3390/jcm12155077.
Type 2 diabetes (T2D) is a chronic medical condition that results in significant health implications and reduced life expectancy. The International Diabetes Federation (IDF) estimated that in 2021, 51.8% of all deaths of people under 60 years old in the Middle East and North Africa (MENA) region were related to diabetes. Bariatric surgery has been demonstrated to be a safe and effective treatment for T2D in different populations worldwide, though few specific data exist on outcomes of procedures in the MENA region. The aim of this study was to compare the safety and postoperative outcomes between patients with and without T2D undergoing primary bariatric surgery at a tertiary referral academic medical center in the United Arab Emirates.
All patients who underwent primary metabolic surgery between September 2015 and July 2020 were retrospectively reviewed from a prospective database. Group 1 included patients with T2D, and Group 2 included patients without T2D. Patients undergoing revisional or correctional operations were excluded. The procedure performed was based on surgeon discretion in discussion with a multidisciplinary team and the patient. Demographics as well as perioperative and postoperative results were examined.
Our study included 542 patients, 160 (29.5%) with T2D and 382 (70.5%) with non-T2D. Mean age was 44.5 years (range 16-70) in the T2D group and 33.3 years (range 15-63) in the non-T2D group; median BMI was 41.8 ± 7.3 and 43.2 ± 7.2, respectively. The T2D group was 37.5% male and 62.5% female, and the non-T2D group was 38.7% male and 61.3% female. There were no significant differences in comorbidities. In the T2D group, 45.6% of patients underwent Roux-en-Y gastric bypass and 54.4% sleeve gastrectomy. In the non-TD2 group, 42.7% of patients received Roux-en-Y gastric bypass and 57.3% sleeve gastrectomy. There were no statistically significant differences in postoperative ED visits (21.8% vs. 24.3%, 0.21), minor complications within 30 days (4.3% vs. 5.2%, 0.67), readmission rates (5.6% vs. 4.9%, 0.77), re-operation rates (3.7% vs. 1.5%, 0.11), median hospital stay (2.0 days vs. 3.0, 0.05), or complications after 30 days (6.2% vs. 11.2%, 0.07). There were no deaths either group.
In this cohort of patients from the MENA region, bariatric surgery in T2D patients is safe and effective, with perioperative outcomes comparable to those of non-T2D patients. To the best of our knowledge, our postoperative findings, which are the first report in the MENA region, are consistent with studies published in North America and Europe.
2型糖尿病（T2D）是一种慢性疾病，会对健康产生重大影响并缩短预期寿命。国际糖尿病联合会（IDF）估计，2021年中东和北非（MENA）地区60岁以下人群中，51.8%的死亡与糖尿病有关。减肥手术已被证明是全球不同人群中治疗T2D的一种安全有效的方法，尽管关于MENA地区手术结果的具体数据很少。本研究的目的是比较在阿拉伯联合酋长国一家三级转诊学术医疗中心接受初次减肥手术的T2D患者和非T2D患者的安全性和术后结果。
对2015年9月至2020年7月期间接受初次代谢手术的所有患者进行回顾性研究，这些患者的数据来自一个前瞻性数据库。第1组包括T2D患者，第2组包括非T2D患者。排除接受翻修或矫正手术的患者。所进行的手术由外科医生与多学科团队及患者讨论后决定。对人口统计学以及围手术期和术后结果进行了检查。
我们的研究包括542例患者，其中160例（29.5%）患有T2D，382例（70.5%）没有T2D。T2D组的平均年龄为44.5岁（范围16 - 70岁），非T2D组为33.3岁（范围15 - 63岁）；中位BMI分别为41.8±7.3和43.2±7.2。T2D组男性占37.5%，女性占62.5%，非T2D组男性占38.7%，女性占61.3%。合并症方面无显著差异。在T2D组中，45.6%的患者接受了Roux-en-Y胃旁路手术，54.4%接受了袖状胃切除术。在非T2D组中，42.7%的患者接受了Roux-en-Y胃旁路手术，57.3%接受了袖状胃切除术。术后急诊就诊率（21.8%对24.3%，P = 0.21）、30天内的轻微并发症发生率（4.3%对5.2%，P = 0.67）、再入院率（5.6%对4.9%，P = 0.77）、再次手术率（3.7%对1.5%，P = 0.11）、中位住院时间（2.0天对3.0天，P = 0.05）或30天后的并发症发生率（6.2%对11.2%，P = 0.07）均无统计学显著差异。两组均无死亡病例。
在这组来自MENA地区的患者中，T2D患者的减肥手术是安全有效的，围手术期结果与非T2D患者相当。据我们所知，我们的术后研究结果是MENA地区的首份报告，与北美和欧洲发表的研究结果一致。
