Is Laparoscopic Duodenojejunal Bypass with Sleeve an Effective Alternative to Roux En Y Gastric Bypass in Morbidly Obese Patients: Preliminary Results of a Randomized Trial

“…Overall, 23 studies met the eligibility criteria from the screened and assessed full-text publications. Due to overlap, 6 publications were excluded, leaving 17 publications in the final analysis (11 for DJBL and 6 for PPBS) [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Details are listed in the flow chart presented in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Identical to OAGB, the jejunum (150-200 cm measured downwards from the ligament of Treitz) is used to create the duodeno-jejunal anastomosis in SADJ-SG. Both methods have a similar effect on weight loss and metabolic improvements, with affordable complication rates [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

Balint¹,

Csaszar

Somodi

et al. 2021

Langenbecks Arch Surg

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Purpose Based on recent scientific evidence, bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. Pylorus preserving surgical procedures (PPBS) such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical method in the inventory of metabolism focused manual interventions that excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures without the risk of surgical intervention. The aim of this article is to summarize and compare differences between safety-related features and weight loss outcomes of DJBL and PPBS. Methods A literature search was conducted in the PubMed database. Records of DJBL-related adverse events (AEs), occurrence of PPBS-related complications and reintervention rates were collected. Mean weight, mean body mass index (BMI), percent of excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI value alterations were recorded for weight loss outcomes. Results A total of 11 publications on DJBL and 6 publications on PPBS were included, involving 800 and 1462 patients, respectively. The baseline characteristics of the patients were matched. Comparison of DJBL-related AEs and PPBS-related severe complications showed an almost equal risk (risk difference (RD): −0.03 and confidence interval (CI): −0.27 to 0.21), despite higher rates among patients having received endoscopic treatment. Overall AE and complication rates classified by Clavien-Dindo showed that PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25, CI: 0.01–0.49). Reintervention rates were more favourable in the PPBS group, without significant differences in risk (RD: −0.03, CI: −0.27 to 0.20). However, PPBS seemed more efficient regarding weight loss outcomes at 1-year follow-up according to raw data, while meta-analysis did not reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74–1.59 for BMI changes). Conclusion Only limited conclusions can be made based on our findings. PPBS was superior to DJBL with regard to safety outcomes (GRADE IIB), which failed to support the authors’ hypothesis. Surgical procedures showed lower complication rates than the incidence of DJBL-related AEs, although it should be emphasized that the low number of PPBS-related mild to moderate complications reported could be the result of incomplete data recording from the analysed publications. Weight loss outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted into the upper gastrointestinal tract for 6 to 12 months, it seems a promising additional method in the inventory of metabolic interventions.

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“…Even if SG will be found to be inferior in the treatment of T2DM, it has one strong argument that has to be taken into account when surgery for T2DM patients is planned. In cases of failure, it can easily be converted into gastric bypass, BPD with duodenal switch, single anastomosis duodeno-ileal bypass with SG (48), or even to newer procedures such as SG with an ileal interposition or duodenojejunal bypass with sleeve (49, 50).…”

Section: Surgical Treatment Of T2dm In Overweight and Obese Patientsmentioning

confidence: 99%

Surgery in the treatment of type 2 diabetes mellitus

et al. 2015

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Background and Aims: the prevalence of diabetes is increasing worldwide, and most of the cases are type 2 diabetes mellitus. the relationship between type 2 diabetes mellitus and obesity is well established, and surgical treatment is widely used for obese patients with type 2 diabetes mellitus. the aim was to present current knowledge about the possible mechanisms responsible for glucose control after surgical procedures and to review the surgical treatment results.Material and Methods: medical literature was searched for the articles presenting the impact of surgical treatment on glycemic control, long-term results, and possible mechanisms of action among obese individuals with type 2 diabetes mellitus.Results: remission of type 2 diabetes mellitus after bariatric surgery depends on the definition of the remission used. complete remission rate after surgery with the new criteria is lower than was considered before. randomized controlled studies demonstrate that surgery is superior to best medical treatment for the patients with type 2 diabetes mellitus. the recurrence of type 2 diabetes mellitus after bariatric surgery is observed in up to 40% of cases with ≥5 years of follow-up. despite the recurrence of type 2 diabetes mellitus in this group, better glycemic control and lower risk of macrovascular complications are present. incretin effects on glycemic control after bariatric surgery are well described, but the role of other possible mechanisms (bile acids, microbiota, intestinal gluconeogenesis) in humans is unclear.Conclusion: Surgery is an effective treatment of type 2 diabetes mellitus in obese patients. the most optimal surgical procedure for the treatment of obese patients with type 2 diabetes mellitus is still to be established. more research is needed to explore the mechanisms of glycemic control after bariatric surgery.

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Is Laparoscopic Duodenojejunal Bypass with Sleeve an Effective Alternative to Roux En Y Gastric Bypass in Morbidly Obese Patients: Preliminary Results of a Randomized Trial

Cited by 37 publications

References 30 publications

Effect of Bariatric Surgery on Hypertension

Effect of Bariatric Surgery on Hypertension

Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

Surgery in the treatment of type 2 diabetes mellitus

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