Three-dimensional laparoscopic sleeve gastrectomy versus gastric bypass in treating obesity complicated with type 2 diabetes mellitus.

Background: To compare and analyze the clinical efficacy and safety of Three-dimensional (3D) laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in the treatment of obesity complicated with type 2 diabetes mellitus (T2DM).

Methodology: A total of 132 T2DM patients were divided into LSG group (n=66) and LRYGB group (n=66). The operation time, time of postoperative gastrointestinal function recovery, postoperative hospital stay, and incidence rate of complications were compared. The glucolipid metabolism indexes [fasting plasma glucose (FPG), fasting insulin (FINS), fasting C-peptide (FCP), glycated hemoglobin A1c (HbA1c)], body weight and nutritional status [body mass index (BMI), hemoglobin (Hb)], insulin function and insulin resistance were recorded. Short-from 36 (SF-36) questionnaire was also conducted.

Results: LSG group had shorter operation time, less blood loss, and quicker postoperative recovery than LRYGB group. Both groups showed significant improvements in BMI, FBG, FINS, FCP, HbA1c, and HOMA-IR. After 12 months, LRYGB group had significantly higher scores in physical function, general health, vitality, role emotional, and mental health in SF-36 questionnaire compared to LSG group. Compared with LRYGB group, LSG group had significantly decreased operation time, reduced intraoperative blood loss, and shortened postoperative off-bed time. BMI, FBG, FINS, FCP, HbA1c and HOMA-IR all markedly declined in the two groups after operation. At 12 months after operation, the scores of physical function, general health, vitality, role emotional and mental health in the SF-36 questionnaire were all remarkably higher in LRYGB group than those in LSG group.

Conclusion: LSG can be used to treat obesity complicated with T2DM, which is characterized by simple operation, small trauma and quick postoperative recovery.