Three-dimensional laparoscopic sleeve gastrectomy versus gastric bypass in treating obesity complicated with type 2 diabetes mellitus

To compare and analyze the clinical efficacy and safety of Three-dimensional (3D) laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in the treatment of obesity complicated with type 2 diabetes mellitus (T2DM).

A total of 132 T2DM patients were divided into LSG group (n=66) and LRYGB group (n=66). The operation time, time of postoperative gastrointestinal function recovery, postoperative hospital stay, and incidence rate of complications were compared. The glucolipid metabolism indexes [fasting plasma glucose (FPG), fasting insulin (FINS), fasting C-peptide (FCP), glycated hemoglobin A1c (HbA1c)], body weight and nutritional status [body mass index (BMI), hemoglobin (Hb)], insulin function and insulin resistance were recorded. Short-from 36 (SF-36) questionnaire was also conducted.

LSG group had shorter operation time, less blood loss, and quicker postoperative recovery than LRYGB group. Both groups showed significant improvements in BMI, FBG, FINS, FCP, HbA1c, and HOMA-IR. After 12 months, LRYGB group had significantly higher scores in physical function, general health, vitality, role emotional, and mental health in SF-36 questionnaire compared to LSG group. Compared with LRYGB group, LSG group had significantly decreased operation time, reduced intraoperative blood loss, and shortened postoperative off-bed time. BMI, FBG, FINS, FCP, HbA1c and HOMA-IR all markedly declined in the two groups after operation. At 12 months after operation, the scores of physical function, general health, vitality, role emotional and mental health in the SF-36 questionnaire were all remarkably higher in LRYGB group than those in LSG group.

LSG can be used to treat obesity complicated with T2DM, which is characterized by simple operation, small trauma and quick postoperative recovery.