A Prospective Single-Arm Trial of Modified Long Biliopancreatic and Short Alimentary Limbs Roux-En-Y Gastric Bypass in Type 2 Diabetes Patients with Mild Obesity

• Published in: Obesity surgery Vol. 28; no. 3; pp. 599 - 605
• Main Authors: Murad, Abdon José, Cohen, Ricardo Vitor, de Godoy, Eudes Paiva, Scheibe, Christian Lamar, Campelo, Giuliano Peixoto, Ramos, Almino Cardoso, de Lima, Roclides Castro, Pinto, Luís Eduardo Veras, Coelho, Daniel, Costa, Hamilton Belo França, Pinto, Ígor Marreiros Pereira, Pereira, Tiago, Teófilo, Francisco Raúl Santos, Valadão, José Aparecido
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-03-2018; Springer Nature B.V
• Subjects: Adult; Blood Glucose - metabolism; Body Mass Index; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - surgery; Dyslipidemias - prevention & control; Female; Gastric Bypass - adverse effects; Gastric Bypass - methods; Gastrointestinal surgery; Glycated Hemoglobin A - metabolism; Humans; Hypertension - prevention & control; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Obesity; Obesity - complications; Obesity - pathology; Obesity - surgery; Original Contributions; Severity of Illness Index; Surgery; Surgical outcomes; Surgical techniques; Treatment Outcome; Weight control; Weight Loss; Type-2 diabetes; Metabolic surgery in mild obesity; Roux-en-Y gastric bypass; Long biliopancreatic limb
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-017-2933-x

Background
Type-2 diabetes (T2D) patients with body mass index (BMI) below 35 kg/m
2
carry lower remission rates than severely obese T2D individuals submitted to “standard limb lengths” Roux-en-Y gastric bypass (RYGB). Mild-obese patients appear to have more severe forms of T2D, where the mechanisms of glycemic control after a standard-RYGB may be insufficient. The elongation of the biliopancreatic limb may lead to greater stimulation of the distal intestine, alterations in bile acids and intestinal microbiota, among other mechanisms, leading to better metabolic outcomes. The aim of this study is to evaluate the safety and efficacy of the RYGB with a biliopancreatic limb of 200 cm in the control of T2D in patients with BMI 30–35 kg/m
2
.
Methods
From January 2011 to May 2015, 102 T2D patients with BMI from 30 to 34.9 kg/m
2
underwent laparoscopic RYGB with the biliopancreatic-limb of 200 cm and the alimentary-limb of 50 cm.
Results
There were no deaths or reoperations. The mean follow-up was 28.1 months. The mean BMI dropped from 32.5 to 25.1 kg/m
2
, while the mean fasting glucose decreased from 182.9 to 89.8 mg/dl and the mean glycated hemoglobin (HbA1c) went from 8.7 to 5.2%. During follow-up, 92.2% had their T2D under complete control (HbA1c < 6%, no anti-diabetic medications), while 7.8% were under partial control. Control of hypertension and dyslipidemia were 89.4 and 85.5%, respectively. No patient developed hypoalbuminemia, and there were mild micronutrient deficiencies.
Conclusions
RYGB with long-biliopancreatic and short-alimentary limbs is safe and seems effective in achieving complete control of T2D in patients with BMIs between 30 and 35 kg/m
2
.