Brief Article
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World J Gastroenterol. Oct 21, 2013; 19(39): 6590-6597
Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6590
Bariatric surgery and diabetes remission: Sleeve gastrectomy or mini-gastric bypass?
Marco Milone, Matteo Nicola Dario Di Minno, Maddalena Leongito, Paola Maietta, Paolo Bianco, Caterina Taffuri, Dario Gaudioso, Roberta Lupoli, Silvia Savastano, Francesco Milone, Mario Musella
Marco Milone, Matteo Nicola Dario Di Minno, Maddalena Leongito, Paola Maietta, Paolo Bianco, Caterina Taffuri, Dario Gaudioso, Roberta Lupoli, Silvia Savastano, Francesco Milone, Mario Musella, Department of Advanced Biomedical Science, University of Naples “Federico II”, 80131 Naples, Italy
Author contributions: Musella M and Milone M designed experiments; Musella M and Milone M performed research; Di Minno MND, Milone M, Lupoli R, Leongito M, Maietta P, Bianco P, Taffuri C, and Gaudioso G collected and analyzed the data; Milone M and Di Minno MND wrote the paper; Milone F and Musella M critically revised the manuscript.
Correspondence to: Dr. Marco Milone, MD, Department of Advanced Biomedical Science, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy. milone.marco@alice.it
Telephone: +39-8-17463067 Fax: +39-8-17462896
Received: June 16, 2013
Revised: July 29, 2013
Accepted: August 5, 2013
Published online: October 21, 2013
Abstract

AIM: To investigate the weight loss and glycemic control status [blood glucose, hemoglobin A1c (HbA1c) and hypoglycaemic treatment].

METHODS: The primary risk factor for type 2 diabetes is obesity, and 90% of all patients with type 2 diabetes are overweight or obese. Although a remarkable effect of bariatric surgery is the profound and durable resolution of type 2 diabetes clinical manifestations, little is known about the difference among various weight loss surgical procedures on diabetes remission. Data from patients referred during a 3-year period (from January 2009 to December 2011) to the University of Naples “Federico II” diagnosed with obesity and diabetes were retrieved from a prospective database. The patients were split into two groups according to the surgical intervention performed [sleeve gastrectomy (SG) and mini-gastric bypass (MGB)]. Weight loss and glycemic control status (blood glucose, HbA1c and hypoglycaemic treatment) were evaluated.

RESULTS: A total of 53 subjects who underwent sleeve gastrectomy or mini-gastric bypass for obesity and diabetes were screened for the inclusion in this study. Of these, 4 subjects were excluded because of surgical complications, 7 subjects were omitted because young surgeons conducted the operations and 11 subjects were removed because of the lack of follow-up. Thirty-one obese patients were recruited for this study. A total of 15 subjects underwent SG (48.4%), and 16 underwent MGB (51.6%). After adjusting for various clinical and demographic characteristics in a multivariate logistic regression analysis, high hemoglobin A1c was determined to be a negative predictor of diabetes remission at 12 mo (OR = 0.366, 95%CI: 0.152-0.884). Using the same regression model, MGB showed a clear trend toward higher diabetes remission rates relative to SG (OR = 3.780, 95%CI: 0.961-14.872).

CONCLUSION: Although our results are encouraging regarding the effectiveness of mini-gastric bypass on diabetes remission, further studies are needed to provide definitive conclusions in selecting the ideal procedure for diabetes remission.

Keywords: Bariatric surgery, Sleeve, Bypass, Obesity and diabetes

Core tip: Duodenum exclusion could suggest the potential superiority of mini-gastric bypass over sleeve gastrectomy to obtain diabetes remission. This mechanism could suggest the potential superiority of mini-gastric bypass over sleeve gastrectomy to obtain diabetes remission. Thus, although the gold standard for diabetes remission is still the Roux-en-y gastric by pass, being similar mechanisms of diabetes remission involved and being easier to be performed, the mini-gastric by pass could become a valuable alternative.