Sleeve gastrectomy with loop bipartition as a novel procedure for management of type 2 diabetes in obese patients

Abstract

Background Amidst the current worldwide epidemic of type 2 diabetes mellitus (T2DM), the global diabetes health burden is projected to reach 522 million in 2030, with much of this increase occurring in developing countries. Aim of the work to evaluate the role of laparoscopic sleeve gastrectomy with loop bipartition (single anastomosis sleeve ileal bypass) as a bariatric and metabolic procedure in control of type 2 diabetes in obese patients. Patients and methods This prospective cohort study included 20 obese adult patients with type 2 DM recently diagnosed within last 5 years. Some of them have other associated comorbidities. They were recruited at department of surgery Ain Shams University. The follow up was obtained during the first year post-operative. Results In this study, complete remission of diabetes was achieved in 75% of the patients by the 3rd post-operative month and in 95% by the end of the study. This was beside marked weight reduction and improvement of lipid profile without causing micronutrients deficiencies during the study period. Conclusion SASI bypass can be one of the most efficient metabolic procedures and could be associated with less risks. The procedure should be considered under investigations until enough long term data are available. Thus it is worth to be explored in research aiming for more data.

The Effect of Single‐Anastomosis Sleeve Ileal (SASI) Bypass on Patients with Severe Obesity in Three Consecutive Years

“…In the present study, HTN complete remission and improvement was observed in 75.8%, 80.7%, and 80.0% of hypertensive patients in the 1st, 2nd, and 3rd years after the surgery, respectively. The present findings were similar to previous studies, which were only conducted in the first [3, 10–13, 15–17] and second year after the surgery [18]. Also, according to the patients’ laboratory data and their feedback, HLD and OSA had 100% improvement in the present study, which is concordant the previous studies.…”

“…Results of 3-year follow-up of RYGB and SG showed efficacy in mean EWL, 45.0% and 39.2% and comorbidities resolution under 50% [9]. However, SASI permits a better weight control than RYGB and SG, and, the studies investigating the efficacy of SASI bypass were very promising at one year post-surgery [3,[10][11][12][13][14][15][16][17]. In patients undergoing SASI bypass in this study, EWL at 1 year was 87.3%, comparable to the 64-90% reported by previous studies [3,[10][11][12][13][14][15][16][17], and at 2 years was 90.7%, comparable to the 91.97% reported by Khalaf et al [18].…”

“…In the present study, the 1‐year, 2‐year, and 3‐year T2DM remission rate was 100%, 96.4%, and 90.9%, respectively. The rate of diabetic remission or improvement in previous studies after 1‐year was reported as 84–100% [3, 10–13, 15–17], and 2‐years was 97.9% [18]. Indeed, previous studies have demonstrated that T2DM remission and improvement in short and medium‐term follow‐ups is high, and the SASI procedure appears to be more effective than the Roux‐en‐Y gastric bypass and sleeve gastrectomy [20, 21].…”

“…However, SASI permits a better weight control than RYGB and SG, and, the studies investigating the efficacy of SASI bypass were very promising at one year post-surgery [3,[10][11][12][13][14][15][16][17]. In patients undergoing SASI bypass in this study, EWL at 1 year was 87.3%, comparable to the 64-90% reported by previous studies [3,[10][11][12][13][14][15][16][17], and at 2 years was 90.7%, comparable to the 91.97% reported by Khalaf et al [18]. The wide variation in the rate of EWL beyond 1 year can be explained by wide variation in surgeon experience, preoperative BMI (35-80 kg/m 2 ), and lack of technical standardization.…”