Published online Sep 6, 2024. doi: 10.12998/wjcc.v12.i25.5697
Revised: May 31, 2024
Accepted: July 4, 2024
Published online: September 6, 2024
Processing time: 186 Days and 18.4 Hours
Bariatric and metabolic surgery have been routinely performed following the rapid increase in obesity and metabolic diseases worldwide. Of all evolving procedures, Roux-en-Y gastric bypass (RYGB) is considered the gold standard for surgical treatment of patients with type 2 diabetes mellitus (T2DM) and obesity. RYGB was introduced in China nearly 20 years ago, but the number of RYGB surgeries only accounts for 3.1% of the total number of weight loss and metabolic surgeries in China, it’s effect on Chinese people still needs further study.
To investigate the effect and safety of a modified gastric bypass performed in Chinese patients with T2DM.
Patients with obesity and T2DM who underwent modified gastric bypass, with > 5-year follow-up data, were analyzed.
All 37 patients underwent uneventful laparoscopic surgery, no patient was switched to laparotomy during the surgery, and no severe complications were reported. Average weight and body mass index of the patients reduced from 84.6 ± 17.3 (60.0–140.0) kg and 30.9 ± 5.0 (24.7–46.2) kg/m2 to 67.1 ± 12.2 (24.7–46.2) kg and 24.6 ± 3.9 (17.7–36.5) kg/m2, respectively, and fasting plasma glucose and glycated hemoglobin decreased from 7.4 ± 3.4 mmol/L and 8.2% ± 1.7% preoperatively to 6.5 ± 1.3 mmol/L and 6.5% ± 0.9% 5-years postoperatively, respectively. Only 29.7% (11/37) of the patients used hypoglycemic drugs 5-years postoperatively, and the complete remission rate of T2DM was 29.7% (11/37). Triglyceride level reduced significantly but high-density lipoprotein increased significantly (both P < 0.05) compared with those during the preoperative period. Liver and renal function improved significantly postoperatively, and binary logistic regression analysis revealed that the patients’ preoperative history of T2DM and fasting C-peptide were significant prognostic factors influencing complete T2DM remission after RYGB (P = 0.006 and 0.012, respectively).
The modified gastric bypass is a safe and feasible procedure for Chinese patients with obesity and T2DM, exhibiting satisfactory amelioration of weight problems, hyperglycemia, and combination disease.
Core Tip: We described a modified gastric bypass procedure, we report the effect of such procedure in Chinese patients with type 2 diabetes mellitus (T2DM) patients and data of it’s 5 year follow up data. We found that average weight and body mass index of all 37 patients were reduced to 67.1 ± 12.2 kg and 24.6 ± 3.9 kg/m2 respectively, while fasting plasma glucose and glycated hemoglobin A1c also reduced to 6.5 ± 1.3 mmol/L and 6.5% ± 0.9% 5 years later. Complete remission rate of T2DM at was 29.7%. Blood lipid, liver and renal function were significantly improved, history of T2DM and fasting C-peptide were significant prognostic factors influencing complete remission of T2DM after Roux-en-Y gastric bypass.