Effect of Laparoscopic Sleeve Gastrectomy, One Anastomosis Gastric Bypass, and Single Anastomosis Sleeve Ileal Bypass; on Type II Diabetes in Obese Patients

Document Type : Original Article

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Department of General Surgery, Faculty of Medicine, Mansoura University

Abstract

Introduction: Type II diabetes mellitus and obesity have a strong pathophysiological relationship, and both
problems have become a major health issue in Egypt. Bariatric surgery is an excellent option for both problems.
Herein, we compared five-year outcomes of the most common three bariatric procedures performed for patients
harboring both problems.
Patients and methods: The five-year data of 93 cases were retrospectively reviewed. They underwent either
“Laparoscopic sleeve gastrectomy” (LSG), “One Anastomosis Gastric Bypass” (OAGB), or “Single anastomosis
sleeve ileal bypass” (SASI).
Results: Although weight loss outcomes were almost similar among the three groups for a three-year duration,
subsequent assessment revealed the inferiority of LSG compared to the other two procedures, as some patients
showed decreased excess weight loss. Diabetes showed similar changes, as its outcomes were comparable for
three years. Nonetheless, recurrence occurred in 28% and 36% of cases four and five years after LSG, respectively,
and the recurrent cases had the lowest weight loss values. The impact of the three procedures on the other
comorbidities was statistically comparable. However, the incidence of reflux worsening, as well as de novo reflux,
was higher in the LSG group.
Conclusion: On the long-term follow-up, both OAGB and SASI are associated with a significantly better impact
on type II diabetes compared to LSG. Cases undergoing the latter procedure express recurrence in the long term,
and they also express troublesome reflux manifestations. We recommend either OAGB or SASI in cases with type
II diabetes and obesity.

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