Kermansaravi Mohammad, Chiappetta Sonja, Kassir Radwan, Bosco Alfonso, Giudicelli Xavier, Lainas Panagiotis, Safieddine Maissa
Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Minimally Invasive Surgery Research Center, Hazrat-E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran.
Department of General Surgery, Center of Excellence for Bariatric and Metabolic Surgery, Ospedale Evangelico Betania, Naples, Italy.
Obes Surg. 2024 Dec;34(12):4555-4562. doi: 10.1007/s11695-024-07564-z. Epub 2024 Nov 4.
The worldwide prevalence of type 2 diabetes mellitus (T2DM) is increasing in parallel with obesity. One anastomosis gastric bypass (OAGB) is considered effective to treat both T2DM and obesity. The aim of this study was to evaluate the efficacy of OAGB versus sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for treatment of T2DM, analyzing data exclusively from randomized control trials (RCTs). Α systematic review of published RCTs comparing OAGB versus RYGB or SG (control groups) in T2DM patients regarding diabetes remission and weight loss was performed. Primary endpoints were T2DM remission rate and 1-year and 5-year % weight loss postoperatively. Initial search identified 39 references, of which 8 RCTs were considered eligible for meta-analysis inclusion, comprising 636 patients (311 OAGB, 122 RYGB, 203 SG patients). Main meta-analysis findings were: i) higher 1-year %EWL for OAGB than control group (p = 0.04); ii) higher 5-year %EWL for OAGB than control group (p < 0.01); iii) no difference in 1-year remission rate of T2DM between OAGB and control group (p = 0.14); iv) 28% higher 5-year remission rate of T2DM for OAGB than control group (p < 0.01). OAGB had statistically significant better outcomes compared to RYGB and SG regarding T2DM remission and %EWL at 5 years. Further pathophysiologic studies are needed to indicate the most potent bariatric procedure in patients with T2DM and obesity.
2型糖尿病（T2DM）在全球的患病率正随着肥胖率的上升而同步增加。单吻合口胃旁路术（OAGB）被认为对治疗T2DM和肥胖均有效。本研究的目的是评估OAGB与袖状胃切除术（SG）和Roux-en-Y胃旁路术（RYGB）治疗T2DM的疗效，仅分析来自随机对照试验（RCT）的数据。我们对已发表的RCT进行了系统评价，比较了T2DM患者中OAGB与RYGB或SG（对照组）在糖尿病缓解和体重减轻方面的差异。主要终点为T2DM缓解率以及术后1年和5年的体重减轻百分比。初步检索确定了39篇参考文献，其中8项RCT被认为符合纳入荟萃分析的条件，共纳入636例患者（311例接受OAGB，122例接受RYGB，203例接受SG）。荟萃分析的主要结果如下：i）OAGB组术后1年的体重减轻百分比高于对照组（p = 0.04）；ii）OAGB组术后5年的体重减轻百分比高于对照组（p < 0.01）；iii）OAGB组与对照组在T2DM的1年缓解率上无差异（p = 0.14）；iv）OAGB组T2DM的5年缓解率比对照组高28%（p < 0.01）。在T2DM缓解和5年体重减轻百分比方面，OAGB与RYGB和SG相比具有统计学上显著更好的结果。需要进一步的病理生理学研究来确定T2DM和肥胖患者中最有效的减重手术。
