Published online Feb 28, 2020. doi: 10.3748/wjg.v26.i8.865
Peer-review started: September 24, 2019
First decision: November 27, 2019
Revised: December 23, 2019
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: February 28, 2020
Processing time: 156 Days and 18.9 Hours
There is a staggering rise in the incidence of obesity worldwide. A sedentary lifestyle, unhealthy food, and multiple comorbidities such as Type 2 diabetes mellitus (T2DM), hypertension and hyperlipidemia are major risk factors for obesity. In order to curtail the epidemic of obesity, a host of treatment strategies are offered, including lifestyle change, dietary consultations, medications, as well as surgical therapies. Of these, surgical remedies carry great promise in achieving effective weight loss and the resolution of comorbidities. Generally, bariatric procedures are considered superior to medical therapies in treating obesity-related T2DM. Though Laparoscopic Roux-en-Y gastric bypass (LRYGB) and Laparoscopic sleeve gastric bypass (LSG) are the most popular bariatric surgical procedures worldwide, there is no consensus about the superiority of one procedure over the other in terms of the resolution of obesity-related T2DM.
This study determines the effectiveness of LSG and LRYGB for treating obesity-related T2DM. Short-, mid- and long-term follow-up results after bariatric surgery were analyzed. The literature is divided about the estimated outcomes by various bariatric surgical procedures in achieving excess percentage weight loss and T2DM. This study quantitatively compares the resolution of T2DM by LSG and LRYGB.
We conducted the current study to quantitatively compare the impact of LSG and LRYGB in T2DM resolution over 1 to 5 years post-surgery follow-up.
We conducted a literature search by using selected keywords in pre-defined databases for full-text English language clinical studies. This study compared short-, mid- and long-term outcomes of T2DM resolution by LRYGB and LSG. The data from all selected studies were analyzed by Review Manager® 5.3. Forest plots were generated for overall effect summaries. The homogeneity of the selected studies was determined by funnel plots and, finally, the findings were interpreted and compared with published reports.
A total of 1650 titles were retrieved from the selected databases. Using PRISMA guidelines, both investigators shortlisted and then finally selected nine studies for further analysis. We report a T2DM remission rate of 82.3% by LRYGB and 80.7% by LSG. This study shows insignificant differences for T2DM resolution by LRYGB and LSG, with an odds ratio of 0.93 (95%CI: 0.64-1.35, Z statistics = 0.38, P = 0.71). Deeper analysis of subsets for T2DM resolution for short-, mid- and long-term follow-up showed similar results at 24 mo (χ2 = 1.24, df = 4, P = 0.87, overall Z effect = 0.23), 36 mo (χ2 = 0.41, df = 2, P = 0.81, overall Z effect = 0.51), and 60 mo (χ2 = 4.75, df = 3, P = 0.19, overall Z effect = 1.20).
This study provides comparative quantitative evidence regarding the role of LSG and LRYGB in treating obesity-related T2DM. Technically, compared to LRYGB, LSG is much easier to perform, and takes significantly shorter operative time. Being a relatively easier bariatric surgical procedure, LSG may be favored in achieving T2DM resolution. However, before we can reach a consensus, the results of long-term follow-up over 10 years should be quantitatively analyzed. By and large, this study implies a comparable achievement in T2DM resolution by both procedures up to 5 years follow-up.
LSG and LRYGB, although quite different bariatric surgical procedures, achieve similar T2DM resolution up to 5 years post-surgery. Future research should investigate different neurohormonal mechanisms that lead to a common goal of T2DM resolution by both surgical procedures.