Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: Gastric bipartition, a novel metabolic surgery procedure: A retrospective cohort study.
TL;DR: SASI bypass is a promising operation that offers excellent weight loss and diabetic resolution and is a therapeutic option for obese T2DM patients.
About: This article is published in International Journal of Surgery.The article was published on 2016-10-01 and is currently open access. It has received 71 citations till now. The article focuses on the topics: Sleeve gastrectomy & Anastomosis.
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TL;DR: Santoro bariatric surgery, as well as sleeve gastrectomy with one gastroileal anastomosis, have the same effect on overweight, metabolic disturbances, and the frequency of complications.
Abstract: The aim — to compare the efficacy of Santoro biliopancreatic shunting with a new bariatric operation: sleeve gastrectomy with one gastroileal anastomosis in the treatment of patients with type 2 diabetes mellitus, and with morbid obesity.Materials and methods. А retrospective cohort study enrolled 32 patients (21 women and 11 men) with morbid obesity and type 2 diabetes who underwent bariatric surgery (Santoro biliopancreatic bypass surgery (first group) and sleeve gastrectomy with one gastroileal anastomosis (second group)) was conducted from 2013 to 2018. Exclusion criteria included the presence of previous bariatric surgeries, previous upper middle laparotomy, severe concomitant diseases (ASA III — IV), and the presence of psychological instability. Patients’ age ranged from 25 to 65 years (mean age 42.6 years). Average preoperative body weight — 107.5 kg (92.0 — 189.5 kg), average body mass index — 41.2 kg/m2 (36.7 — 65.0 kg/m2), average excess body weight — 50, 8 kg (28 — 106 kg). The average duration of metabolic disease before surgery was 7.5 years (3 — 21 years). Only 2 patients monitored the disease with diet, 15 received oral hypoglycemic medications, and 15 received insulin.Results and discussion. The duration of laparoscopic bariatric surgery ranged from 92 to 180 minutes. The average duration of Santoro biliopancreatic shunting surgery was significantly longer than the operations of sleeve gastrectomy with one gastroileal anastomosis (158 ± 28 minutes compared with 112 ± 16 minutes (p 0.05). The follow‑up period was 6 to 48 months. The lipid profile improved significantly in both groups. In the first year after surgery, 90 % of patients had normal cholesterol, 85 % had normal triglycerides. Arterial hypertension was cured in 13 patients, improved — in 2. There were no statistically significant differences in the normalization of comorbidities between groups.Conclusions. Santoro bariatric surgery, as well as sleeve gastrectomy with one gastroileal anastomosis, have the same effect on overweight, metabolic disturbances, and the frequency of complications. At the same time, sleeve gastrectomy with one gastroileal anastomosis is an effective and gentle surgical operation for the treatment of patients with morbid obesity and type 2 diabetes.
TL;DR: OAGB and SASJ bypass are efficient bariatric surgeries for weight reduction and comorbidities resolution with favorable outcomes in OAGB group, with statistically significant differences in post-operative complications.
Abstract: Background: The most effective therapy for morbid obese patients now available is bariatric surgery, which can help patients losing weight effectively and sustainably while also improving their quality of life and comorbidities associated with obesity. Worldwide, the one anastomosis gastric bypass (OAGB) technique is one of the most performed bariatric surgeries. Objective: The study's objective was to compare the outcomes of the OAGB, with those of the single anastomosis sleeve jejunal bypass (SASJ) as a new method in terms of weight reduction, operating time, postoperative complications, and impact on comorbidities three years following surgery. Patients and Methods: This prospective randomized study included a total of 200 morbidly obese patients undergoing OAGB or SASJ for the treatment of morbid obesity and comorbidities, attending at Department of the bariatric Surgery, tertiary care hospital, Ain Shams University Hospitals. The included subjects were divided into two equal groups: 100 each; SASJ and OAGB groups. Results: The operative time was prolonged in SASJ group (104.7 minutes) compared to OAGB group (76.4 minutes). OAGB group had significant lower Body mass index (BMI) mean as well as significant lower body weight mean at all time intervals through the 3 years follow up. OAGB group had 92% resolution of comorbidities while 68% of SASJ group had resolution. Post-operative HbA1c showed rapid improvement in both groups. Concerning the post-operative complications, no statistically significant differences. Conclusion: It could be concluded that OAGB and SASJ bypass are efficient bariatric surgeries for weight reduction and comorbidities resolution with favorable outcomes in OAGB group.
TL;DR: In this paper, the authors compare single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) to established bariatric procedures such as Roux-en-Y gastric bypass (RY...
Abstract: Background: Few studies offer direct comparison of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) to established bariatric procedures such as Roux-en-Y gastric bypass (RY...
01 Jan 2022
01 Jan 2018
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TL;DR: Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery, and a substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.
Abstract: ContextAbout 5% of the US population is morbidly obese. This disease remains
largely refractory to diet and drug therapy, but generally responds well to
bariatric surgery.ObjectiveTo determine the impact of bariatric surgery on weight loss, operative
mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia,
hypertension, and obstructive sleep apnea).Data Sources and Study SelectionElectronic literature search of MEDLINE, Current Contents, and the Cochrane
Library databases plus manual reference checks of all articles on bariatric
surgery published in the English language between 1990 and 2003. Two levels
of screening were used on 2738 citations.Data ExtractionA total of 136 fully extracted studies, which included 91 overlapping
patient populations (kin studies), were included for a total of 22 094
patients. Nineteen percent of the patients were men and 72.6% were women,
with a mean age of 39 years (range, 16-64 years). Sex was not reported for
1537 patients (8%). The baseline mean body mass index for 16 944 patients
was 46.9 (range, 32.3-68.8).Data SynthesisA random effects model was used in the meta-analysis. The mean (95%
confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%)
for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding;
61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and
70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative
mortality (≤30 days) in the extracted studies was 0.1% for the purely restrictive
procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion
or duodenal switch. Diabetes was completely resolved in 76.8% of patients
and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more
of patients. Hypertension was resolved in 61.7% of patients and resolved or
improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients
and was resolved or improved in 83.6% of patients.ConclusionsEffective weight loss was achieved in morbidly obese patients after
undergoing bariatric surgery. A substantial majority of patients with diabetes,
hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete
resolution or improvement.
6,373 citations
TL;DR: The observation of greatly increased postprandial plasma GLP-1 7-36 levels in patients with postgastrectomy dumping syndrome suggests that it may mediate the hyperinsulinaemia and reactive hypoglycaemia of this disorder.
1,897 citations
TL;DR: The causes of Type 2 diabetes mellitus and prediabetes are embedded in a very complex group of genetic and epigenetic systems interacting within an equally complex societal framework that determines behavior and environmental influences as mentioned in this paper.
Abstract: Over the past three decades, the number of people with diabetes mellitus has more than doubled globally, making it one of the most important public health challenges to all nations. Type 2 diabetes mellitus (T2DM) and prediabetes are increasingly observed among children, adolescents and younger adults. The causes of the epidemic of T2DM are embedded in a very complex group of genetic and epigenetic systems interacting within an equally complex societal framework that determines behavior and environmental influences. This complexity is reflected in the diverse topics discussed in this Review. In the past few years considerable emphasis has been placed on the effect of the intrauterine environment in the epidemic of T2DM, particularly in the early onset of T2DM and obesity. Prevention of T2DM is a 'whole-of-life' task and requires an integrated approach operating from the origin of the disease. Future research is necessary to better understand the potential role of remaining factors, such as genetic predisposition and maternal environment, to help shape prevention programs. The potential effect on global diabetes surveillance of using HbA(1c) rather than glucose values in the diagnosis of T2DM is also discussed.
1,818 citations
"Efficacy of single anastomosis slee..." refers background in this paper
...Obesity and type 2 diabetes mellitus (T2DM) has become a major public health problem [1], and medical treatment fails to provide adequate control in a significant number of obese diabetics....
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TL;DR: In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone.
Abstract: Of the 150 patients, 93% completed 12 months of follow-up. The proportion of patients with the primary end point was 12% (5 of 41 patients) in the medicaltherapy group versus 42% (21 of 50 patients) in the gastric-bypass group (P = 0.002) and 37% (18 of 49 patients) in the sleeve-gastrectomy group (P = 0.008). Glycemic control improved in all three groups, with a mean glycated hemoglobin level of 7.5±1.8% in the medical-therapy group, 6.4±0.9% in the gastric-bypass group (P<0.001), and 6.6±1.0% in the sleeve-gastrectomy group (P = 0.003). Weight loss was greater in the gastric-bypass group and sleeve-gastrectomy group (−29.4±9.0 kg and −25.1±8.5 kg, respectively) than in the medical-therapy group (−5.4±8.0 kg) (P<0.001 for both com parisons). The use of drugs to lower glucose, lipid, and blood-pressure levels decreased significantly after both surgical procedures but increased in patients receiving medical therapy only. The index for homeostasis model assessment of insulin resistance (HOMA-IR) improved significantly after bariatric surgery. Four patients underwent reoperation. There were no deaths or life-threatening complications. Conclusions In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone. Further study will be necessary to assess the durability of these results. (Funded by Ethicon Endo-Surgery and others; ClinicalTrials.gov number, NCT00432809.)
1,542 citations
TL;DR: In this paper, the authors showed that the use of drugs to lower glucose, lipid, and blood-pressure levels decreased significantly after both surgical procedures but increased in patients receiving medical therapy only.
Abstract: Of the 150 patients, 93% completed 12 months of follow-up. The proportion of patients with the primary end point was 12% (5 of 41 patients) in the medicaltherapy group versus 42% (21 of 50 patients) in the gastric-bypass group (P = 0.002) and 37% (18 of 49 patients) in the sleeve-gastrectomy group (P = 0.008). Glycemic control improved in all three groups, with a mean glycated hemoglobin level of 7.5±1.8% in the medical-therapy group, 6.4±0.9% in the gastric-bypass group (P<0.001), and 6.6±1.0% in the sleeve-gastrectomy group (P = 0.003). Weight loss was greater in the gastric-bypass group and sleeve-gastrectomy group (−29.4±9.0 kg and −25.1±8.5 kg, respectively) than in the medical-therapy group (−5.4±8.0 kg) (P<0.001 for both com parisons). The use of drugs to lower glucose, lipid, and blood-pressure levels decreased significantly after both surgical procedures but increased in patients receiving medical therapy only. The index for homeostasis model assessment of insulin resistance (HOMA-IR) improved significantly after bariatric surgery. Four patients underwent reoperation. There were no deaths or life-threatening complications. Conclusions In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone. Further study will be necessary to assess the durability of these results. (Funded by Ethicon Endo-Surgery and others; ClinicalTrials.gov number, NCT00432809.)
797 citations