Loop versus Roux-en-Y Duodenojejunal Bypass with Sleeve Gastrectomy for Type 2 Diabetes: Three-Year Outcomes of a Single-Center Randomized Controlled Trial.

BACKGROUND

Duodenojejunal bypass with sleeve gastrectomy (DJB-SG) was proposed to treat type 2 diabetes (T2D) in patients with obesity by adding loop or Roux-en-Y duodenojejunal bypass to sleeve gastrectomy. Previously, our single-center randomized controlled trial indicated that loop DJB-SG yielded similar T2D remission rates but greater weight loss, simpler surgical techniques and lower medical costs than Roux-en-Y DJB-SG at the 1-year follow-up.

OBJECTIVES

This study aimed to prospectively compare the 3-year outcomes of loop DJB-SG with those of Roux-en-Y DJB-SG.

SETTING

University hospital.

METHODS

We assessed the 3-year outcomes of 96 T2D patients with a BMI ranging from 27.5 to 40 kg/m2 who were randomly assigned to receive loop or Roux-en-Y DJB-SG. The primary outcome was T2D remission, and the secondary outcomes were weight loss, metabolic improvement, nutritional status and gastrointestinal disorders.

RESULTS

A total of 85 patients completed the 3-year follow-up. The rates of T2D remission, complete remission, partial remission and T2D relapse were 83.33% (35/42), 57.14% (24/42), 26.19% (11/42) and 11.90% (5/42) for the loop DJB-SG, and 76.74% (33/43), 48.84% (21/43), 27.91% (12/43) and 16.28% (7/43) for the Roux-en-Y DJB-SG, respectively, with no significant difference (P > 0.05). T2D duration and preoperative %HbA1c were predictors of 3-year T2D remission. Loop DJB-SG resulted in similar weight loss, metabolic improvements, nutritional status and gastrointestinal disorders as Roux-en-Y DJB-SG, except for higher incidence of malodorous flatus (52.38% vs. 30.23%, P < 0.05), as well as steatorrhea (28.57% vs. 9.30%, P < 0.05) and hair loss (35.71% vs. 13.95%, P < 0.05).

CONCLUSIONS

Compared with Roux-en-Y DJB, loop DJB-SG resulted in similar T2D remission, weight loss and metabolic improvements to. A greater incidence of malodorous flatus, steatorrhea and hair loss may be associated with stronger malabsorptive function of loop reconstruction.