Obesity surgery · 2026
Five-Year Outcomes of Sleeve Gastrectomy with Transit Bipartition in Women with Severe Obesity and Insulin-Treated Type 2 Diabetes: A Prospective Single-Center Cohort Study of 35 Women.
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Bilecik Tuna
Аннотация
INTRODUCTION: Five-year data on metabolic durability, nutritional outcomes, and late morbidity after sleeve gastrectomy with transit bipartition (SG + TB) remain limited. We evaluated glycemic, weight, nutritional, and safety outcomes in women with severe obesity and insulin-treated type 2 diabetes mellitus (T2DM).
METHODS: This prospective single-center follow-up included 35 women who underwent laparoscopic SG + TB in 2016-2017. At 5 years, 30/35 (85.7%) retained SG + TB anatomy and had complete efficacy data; weight and HbA1c were available in one additional revised patient (31/35, 88.6%). T2DM remission was defined as HbA1c < 6.5% at least 3 months after stopping glucose-lowering pharmacotherapy. Nutritional assessment used a prespecified limited biochemical panel.
RESULTS: In the 30-patient anatomy-retained complete-case cohort, mean HbA1c decreased from 9.2 ± 1.0% to 5.5 ± 0.7%, body weight from 118.0 ± 10.6 to 75.6 ± 6.8 kg, and mean total weight loss was 35.7 ± 5.1%. Medication-free T2DM remission was 23/30 (76.7%; 95% CI, 59.1-88.2%); the conservative all-enrolled estimate was 23/35 (65.7%; 95% CI, 49.2-79.2%). At year 5, hypoalbuminemia was 20.0%, low serum iron 30.0%, vitamin B12 deficiency 13.3%, and vitamin D deficiency 73.3%; 27/30 (90.0%) had at least one predefined biochemical abnormality. Two patients required an SG + TB-related invasive intervention, including one revision; two additional patients underwent laparoscopic cholecystectomy.
CONCLUSION: SG + TB was associated with substantial 5-year weight loss and glycemic improvement, but the lower all-enrolled remission estimate highlights attrition and revision-related exclusion. Biochemical abnormalities and clinically important gastrointestinal morbidity show that preserved duodenal continuity does not eliminate potential hypoabsorptive consequences. Lifelong metabolic and nutritional surveillance is warranted.
METHODS: This prospective single-center follow-up included 35 women who underwent laparoscopic SG + TB in 2016-2017. At 5 years, 30/35 (85.7%) retained SG + TB anatomy and had complete efficacy data; weight and HbA1c were available in one additional revised patient (31/35, 88.6%). T2DM remission was defined as HbA1c < 6.5% at least 3 months after stopping glucose-lowering pharmacotherapy. Nutritional assessment used a prespecified limited biochemical panel.
RESULTS: In the 30-patient anatomy-retained complete-case cohort, mean HbA1c decreased from 9.2 ± 1.0% to 5.5 ± 0.7%, body weight from 118.0 ± 10.6 to 75.6 ± 6.8 kg, and mean total weight loss was 35.7 ± 5.1%. Medication-free T2DM remission was 23/30 (76.7%; 95% CI, 59.1-88.2%); the conservative all-enrolled estimate was 23/35 (65.7%; 95% CI, 49.2-79.2%). At year 5, hypoalbuminemia was 20.0%, low serum iron 30.0%, vitamin B12 deficiency 13.3%, and vitamin D deficiency 73.3%; 27/30 (90.0%) had at least one predefined biochemical abnormality. Two patients required an SG + TB-related invasive intervention, including one revision; two additional patients underwent laparoscopic cholecystectomy.
CONCLUSION: SG + TB was associated with substantial 5-year weight loss and glycemic improvement, but the lower all-enrolled remission estimate highlights attrition and revision-related exclusion. Biochemical abnormalities and clinically important gastrointestinal morbidity show that preserved duodenal continuity does not eliminate potential hypoabsorptive consequences. Lifelong metabolic and nutritional surveillance is warranted.