Seven Years of Mini-Gastric Bypass in Type II Diabetes Patients with a Body Mass Index <35 kg/m(2)

Iron deficiency anemia after one anastomosis gastric bypass: A systematic review and meta-analysis

BACKGROUND

One anastomosis gastric bypass (OAGB) currently stands as the third most common metabolic and bariatric surgical procedure with increasing popularity worldwide. Iron deficiency anemia (IDA) is the most prevalent anemia observed after gastric bypass procedures.

METHODS

This systematic review and meta-analysis aimed to assess the overall incidence of IDA and identify the effect of biliopancreatic limb (BPL) length on the incidence of IDA in patients undergoing OAGB by a systematic literature search in PubMed, Web of Sciences, and Scopus.

RESULTS

Twenty-six studies including 11,015 patients were finally included for review. The mean age and mean BPL lengths were 40.1 ± 7.2 years and 190.4 ± 29.2 cm respectively. The IDA prevalence after OAGB was 16% and BPL length was shown to predict IDA rates after OAGB (p = 0.042). Specifically, 8% of patients with a BPL length of 150-179 cm, 12% of patients with a BPL length of 180-199 cm, and 9% of patients with a BPL length of ≥ 200 cm experienced IDA.

CONCLUSION

Despite the promising trends of performed OAGB worldwide, further studies are required to ascertain the risks related to this procedure and refine the surgical techniques.

Midterm outcomes of one anastomosis gastric bypass for patients with BMI < 35 kg/m2 from a large single center

BACKGROUND

One-anastomosis gastric bypass (OAGB) is gaining more attention in patients with severe obesity and recently is used for patients with body mass index (BMI) < 35 kg/m2. In this 5-year single center experience we aim to report our outcomes of using OAGB for patients with BMI < 35 kg/m2.

METHODS

This is a retrospective analysis of prospectively collected data recorded in to our national obesity registry database. Variables including age, sex, weight, BMI, any associated disease, blood levels of metabolic markers, nutrients, and vitamins before and after surgery were extracted and analyzed.

RESULTS

173 patients with mean age and BMI of 41 ± 10 years and 33 ± 1 kg/m2 underwent OAGB and at least one of the obesity-associated medical problems was found in 88 (50.5%) of them preoperatively. The mean duration of surgery and length of hospital stay were 60.7 ± 7.4 min and 1.3 ± 1.4 days. 78% and 70% of patients had available data at 24 and 60 months, respectively. The mean BMI was 23.9 ± 2.2 kg/m2 1 year after surgery and each year after that till 5 years was 24 ± 2, 24.4 ± 2.6, 25.1 ± 2.7, and 25.5 ± 2.7 kg/m2. Significant improvement in levels of fasting blood glucose, lipid profile, and liver enzymes were observed.

CONCLUSION

OAGB for BMI < 35 kg/m2 has significant effects in weight loss, helps remit diabetes and hypertension in the majority of cases, improves lipid profile, and has no increased burden of postoperative problems or deficiency in nutritional factors rather than what is known and predictable.

Technical Variations and Considerations around OAGB in IFSO-APC and IFSO-MENAC Chapters, an Expert Survey

OBJECTIVE

This study aimed to evaluate the technical variations of one-anastomosis gastric bypass (OAGB) among IFSO-APC and MENAC experts.

BACKGROUND

The multitude of technical variations and patient selection challenges among metabolic and bariatric surgeons worldwide necessitates a heightened awareness of these issues. Understanding different perspectives and viewpoints can empower surgeons performing OAGB to adapt their techniques, leading to improved outcomes and reduced complications.

METHODS

The scientific team of IFSO-APC, consisting of skilled bariatric and metabolic surgeons specializing in OAGB, conducted a confidential online survey. The survey aimed to assess technical variations and considerations related to OAGB within the IFSO-APC and IFSO-MENAC chapters. A total of 85 OAGB experts participated in the survey, providing their responses through a 35-question online format. The survey took place from January 1, 2024, to February 15, 2024.

RESULTS

Most experts do not perform OAGB for children and adolescents younger than 18 years. Most experts create the gastric pouch over a 36-40-F bougie and prefer to create a gastrojejunostomy, at the posterior wall of the gastric pouch. An anti-reflux suture during OAGB is performed in all patients by 51.8% of experts. Most experts set a common limb length of > 4 m in revisional and conversional OAGBs to prevent nutritional complications.

CONCLUSION

The ongoing debate among metabolic and bariatric surgeons regarding the technical variations and patient selection in OAGB remains a significant point of discussion. This survey demonstrated the variations in technical aspects and patient selection for OAGB among MBS surgeons in the IFSO-APC and IFSO-MENAC chapters. Standardizing the OAGB technique is crucial to ensure optimal safety and efficacy in this procedure.

American Society for Metabolic and Bariatric Surgery position statement on one-anastomosis gastric bypass

The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the society by patients, physicians, society members, hospitals, health insurance payors, and others regarding one-anastomosis gastric bypass as a treatment for obesity and metabolic disease. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement may be revised in the future as more information becomes available.

An overview of therapeutic options of obesity management in India: the Integrated Diabetes and Endocrinology Academy (IDEA) 2023 Congress update

INTRODUCTION

With newer anti-obesity medications (AOMs) being introduced at a rapid pace, it is prudent to make a concise and updated clinical practice document that may help busy clinicians in daily clinical practice. A group of metabolic physicians, diabetologists, endocrinologists, and bariatric surgeons assembled during the Integrated Diabetes and Endocrine Academy 2023 Congress (IDEACON, July 2023, Kolkata, India) to compile an update of pharmacotherapeutic options for managing people with obesity in India.

AREAS COVERED

After an extensive review of the literature by experts in different domains, this update provides all available information on the management of obesity, with a special emphasis on both currently available and soon-to-be-available AOMs, in people with obesity.

EXPERT OPINION

Several newer AOMs have been shown to reduce body weight significantly, thus poised to make a paradigm shift in the management of obesity. While the tolerability and key adverse events associated with these AOMs appear to be acceptable in randomized controlled trials, pharmacovigilance is vital in real-world settings, given the absence of sufficiently long-term studies. The easy availability and affordability of these drugs is another area of concern, especially in developing countries like India.

Metabolic and bariatric surgery in patients with class I obesity; a two-year follow-up

BACKGROUND

Patients with class I obesity may need metabolic and bariatric surgery (MBS) in the presence of obesity-associated medical problems, but MBS in this class of obesity is under debate. This study aimed to investigate the efficacy and safety of MBS in patients with class I obesity.

METHODS AND MATERIALS

This study was a historical cohort carried out on 112 patients with class I obesity with body mass index (BMI) of 30-35 kg/m2 with a 24-month follow-up underwent MBS at Rasoul-e-Akram Hospital. The required data were extracted through the Iran National Obesity Surgery Database. The data required for the study consisted of demographic information such as age, gender, and obesity-associated medical problems like type-2 diabetes mellitus (T2DM), hypertension, obstructive sleep apnea, and dyslipidemia before surgery, 6, 12, and 24 months after surgery.

RESULTS

Mean age of the patients was 38.10 ± 10.04 years; mean BMI was 32.96 ± 1.35 kg/m2 and 83.9% (n = 94) of patients were female. Out of 18 patients with T2DM, 11 patients (61.11%) had complete remission and seven patients (38.88%) had partial remission. Obstructive sleep apnea, hypertension, dyslipidemia, and gastroesophageal reflux disease were observed in 18 (16.07%), 23 (20.53%), 43 (38.39%), and 13 patients (11.60%) before surgery and resolved at 24-month follow-up. Post-operative complications during the 24-month follow-up were checked to assess safety and there were no De novo gastroesophageal reflux disease, intolerance, leakage, pulmonary thromboembolism, deep vein thrombosis, incisional hernia, hypoalbuminemia (Albumin < 3.5 g/dl), excessive weight loss (BMI < 18.5 kg/m2) at any time during 24-months follow-ups and mortality. Early complications occurred as splenic injury in one case (0.89%), wound infection in one patient (0.89%), and extra-luminal bleeding in 10 (8.92%) after surgery, without any mortality.

CONCLUSION

MBS is safe and effective in class I obesity and can be considered in selected patients with obesity-associated medical problems.

OAGB with shortened excluded ileal loop as an effective treatment for type 2 diabetes mellitus in the cases of Caucasian men and women with obesity of the first degree (BMI 30-35 kg/m2)

INTRODUCTION

The aim of the study is to assess the effect of shortening the excluded loop of the small intestine to 150 cm on the effectiveness of one anastomosis gastric bypass (OAGB) in remission of type 2 diabetes with Io obesity.

MATERIAL AND METHODS

The study included 25 patients with a body mass index (BMI) 30-35 kg/m2, with a diagnosis of diabetes mellitus type 2 (T2DM), and undergoing OAGB with excluded 150 cm of the small intestine.

RESULTS

There were no deaths in the study group, bleeding during the postoperative period requiring reoperation, anastomotic leakage/leakage throught mechanical stitching. The mean a glycated haemoglobin (HbA1C) level 12 months after surgery was 6.16 ± 0.96%, corresponding to a 2.29 ± 3.3% decrease. In more than 85% of the patients taking insulin before surgery, the insulin was discontinued in the postoperative period. Additionally, the level of glycaemia was assessed in patients on the day of surgery (163 ± 58 mg/dl) and on the day of discharge from the hospital (4.7 ± 1.3 days)-it was lower by over 18% (133 ± 39.2 mg). Over the period of 12 months following OAGB, there was a reduction in the mean BMI value from 33.5 ± 2 to 25.5 ± 2.5 kg/m2 and improvement in lipid parameters and mean values of blood pressure.

CONCLUSION

OAGB with excluded 150 cm of the small intestine has beneficial effect on the remission of T2DM in patients with a BMI of 30-35kg/m2 and is associated with an acceptable level of complications. The achieved weight loss after surgery is satisfactory.

One anastomosis gastric bypass surgery in Type2 diabetes patients with body mass index < 35 kg/m2: A multi-center retrospective cohort study

Introduction

Bariatric surgeries have shown efficacy in weight reduction, glycemic control and improvement of type-2 diabetes (T2DM) in patients with obesity. We aimed to assess the efficacy of one anastomosis gastric bypass surgery (OAGB) in T2DM patients with body mass index (BMI) < 35 kg/m² within a year after surgery.

Methods

In this multicenter retrospective cohort study, 14 T2DM patients with BMI <35 kg/m² (females, %: 71.4% (10 of 14), and age, mean (standard deviation): 51.2 (12.3) years) who had underwent OAGB surgery by the same surgeon, were followed at intervals of one, three, six, and 12 months after surgery. The remission rates of T2DM were calculated and the metabolic indices were compared using paired t-test and Wilcoxon rank test.

Results

No adverse outcomes were detected 12 months after surgery. Within six months, seven (50%) patients underwent remission (one (7.1%) within one, three (21.4%) within three, and three (21.4%) within six months). Post-operative weight (p < 0.001) and fasting blood glucose (p < 0.01) in all time periods were significantly lower compared to pre-operative values. Hemoglobin A1C (HbA1C) was significantly lower at three- and six-month intervals (p < 0.05) but not at twelve months (p = 0.2). Thyroid-stimulating hormone and triglyceride levels were lower at six months compared to pre-surgical levels (p < 0.05) but cholesterol levels were not different in any of time points (p > 0.05).

Conclusion

OAGB surgery is associated with weight reduction, glycemic control and a 50% remission rate within six months in patients with diabetes and BMI <35 kg/m².

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One anastomosis gastric bypass (OAGB) surgery has shown efficacy in patients with BMI >35 kg/m².

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Less is known about the efficacy of OAGB in BMI <35 kg/m², especially diabetes-related outcomes.

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OAGB was associated with a 50% rate of diabetes remission within six months in patients with BMI <35 kg/m².

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Within a one-year follow-up, OAGB was associated with improvement of glycemic and metabolic indices.

Metabolic Surgery Outcomes in U.S. Patients with Class I Obesity

Background: Although numerous studies outside the United States (U.S.) have explored weight loss and comorbidity resolution among patients with class I obesity (body mass index [BMI] 30–34.9 kg/m²) after metabolic surgery, few U.S.-based studies have been conducted.

Objective: Our aim was to compare weight loss and comorbidity resolution among U.S. patients with class I obesity, who underwent laparoscopic sleeve gastrectomy (LSG) versus Roux-en-Y gastric bypass (RYGB). Methods: Weight loss and comorbidity data among only patients with class I obesity, who underwent LSG or RYGB, were examined. Between April 2009 and April 2017, 1215 metabolic surgeries were performed with 30 patients meeting the inclusion criteria (17 LSG and 13 RYGB).

Results: Percent total weight loss (%TWL) for LSG peaked at 12 months (20.85%), while RYGB %TWL peaked at 18 months (21.65%). Percent excess weight loss (%EWL) peaked at 12 months after LSG (83.59%) and 18 months after RYGB (98.29%). Overall follow-up was 56.3%, 36.7%, and 43.3% at 12, 18, and 24 months. LSG and RYGB were both successful with regard to resolution of medical comorbidities at 12 months.

Conclusion: RYGB and LSG appear to have similar, successful outcomes among U.S. patients with class I obesity for weight loss and comorbidity resolution.

Bariatric metabolic surgery: An effective treatment of type 2 diabetes

Background:

Bariatric metabolic surgery is evolving as an option for the treatment of type 2 diabetes mellitus (T2DM) in patients with obesity and T2DM, warranting more studies on the efficacy of bariatric metabolic surgery on T2DM.

Objective:

To determine T2DM remission in patients with obesity and T2DM with up to two years follow-up after bariatric metabolic surgery.

Materials and Methods:

A retrospective review of prospectively maintained data was undertaken to identify patients who had T2DM and underwent bariatric surgery at a single centre in 2016. Data collected included age, gender, body mass index (BMI), fasting plasma glucose, haemoglobin A1c, hypertension, (HTN), Obstructive sleep apnea (OSA), initial weight and the weight at intervals of 6, 12, and 24 months. Data on the treatment of T2DM before the surgery was also collected. The criteria of the American Diabetes Association were used for the definition of T2DM remission. Only the data on patients in this study who had more than 12 months’ follow-up information was analysed.

Results:

Two hundred and eighty patients with T2DM were identified. 191 patients had more than 12 months’ follow-up information. Mean age and BMI were 49.58 ± 10.64 years and 44.03 ± 7.86 kg/m² respectively. There were 29 patients on insulin, 21 (10.9%) on insulin only and 8 (4.2%) on insulin and oral hypoglycaemic agents (OHA). One hundred and forty-six patients (76.4%) were on OHA, 134 on a single OHA and 12 on more than one OHA. Twenty-six patients (13.6%) were newly diagnosed with T2DM when they came in for bariatric metabolic surgery. One hundred and fifty-six patients (81.7%) achieved complete remission. 14 (7.3%) of these patients used to be on insulin with or without OHA and 142 (74.3%) were patients either on OHA or no OHA. There were 12 (6.4%) patients in partial remission. There was improvement in 23 (12.04%). Eight patients were on insulin but at lower doses and 15 were on a single OHA. The average percentage of total weight loss at 6, 12 and 24 months was 29.7%, 33.9% and 35.6% respectively. Patients with shorter duration of T2DM had higher remission rates as compared to patients with longer duration (r = −0.874, P = 0.001). There was also a significant resolution of HTN (81.8%) and OSA (82.3%) after bariatric metabolic surgery.

Conclusion:

This study collaborates reports that there is significant remission of T2DM after bariatric metabolic surgery in patients with obesity and T2DM. There is a need for prospective, multi-centre, and long-term studies on bariatric metabolic surgery to treat patients with obesity and T2DM.

Areas of Non-Consensus Around One Anastomosis/Mini Gastric Bypass (OAGB/MGB): A Narrative Review

PURPOSE

One anastomosis/mini gastric bypass (OAGB/MGB) is now an established bariatric and metabolic surgical procedure with good outcomes. Despite two recent consensus statements around OAGB/MGB, there are some issues which are not accepted as consensus and need more long-term data and research.

MATERIAL AND METHODS

After identifying the topic of non-consensus from the two recent OAGB/MGB consensuses, PubMed, Scopus, and Cochrane were searched for articles published by November 2020.

RESULTS

In this study, we evaluated these non-consensus topics around OAGB/MGB and all related articles on these topics were assessed by authors to have an argument on these items.

CONCLUSION

There is enough evidence to include OAGB/MGB as an accepted standard bariatric and metabolic surgical procedure. However, long-term data and more research are needed to have a consensus in all aspects including these non-consensus topics.

IFSO Update Position Statement on One Anastomosis Gastric Bypass (OAGB)

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued a position statement on the role of one anastomosis gastric bypass (OAGB) in the field of bariatric/metabolic surgery in 2018 De Luca et al. (Obes Surg. 28(5):1188-206, 2018). This position statement was issued by the IFSO OAGB task force and approved by the IFSO Scientific Committee and IFSO Executive Board. In 2018, the OAGB task force recognized the necessity to update the position statement in the following 2 years since additional high-quality data could emerge. The updated IFSO position statement on OAGB was issued also in response to inquiries to the IFSO by society members, universities, hospitals, physicians, insurances, patients, policy makers, and media. The IFSO position statement on OAGB has been reviewed within 2 years according to the availability of additional scientific evidence. The recommendation of the statement is derived from peer-reviewed scientific literature and available knowledge. The IFSO update position statement on OAGB will again be reviewed in 2 years provided additional high-quality studies emerge.

Effect of Roux-en-Y Gastric Bypass for Patients with Type 2 Diabetes Mellitus and a BMI < 32.5 kg/m2: a 6-Year Study in Chinese Patients

BACKGROUND

Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbidly obese patients to improve type 2 diabetes mellitus (T2DM). Recently, T2DM patients with a lower body mass index (BMI) have been receiving more attention, and these patients could benefit from RYGB.

METHODS

Fifty-two patients with T2DM underwent RYGB between October 2008 and December 2012 in our hospital. Weight, BMI, oral glucose tolerance test (OGTT), insulin release test (IRT), C-peptide release test (CRT), glycosylated hemoglobin (HbA1c), and lipid metabolic parameters were measured at baseline and at 3 and 6 months and 1, 2, 3, 4, 5, and 6 years after surgery.

RESULTS

The mean age of the 52 patients was 46.8 ± 9.5 years, and 57.7% were male. The mean duration of T2DM was 6.5 ± 4.6 years. Compared with the baseline values, weight and BMI were significantly decreased at several time points after surgery. HbA1c decreased from 8.2 ± 1.7% at baseline to 6.5 ± 1.4% at 3 months, 6.5 ± 1.4% at 6 months, 7.2 ± 1.3% at 4 years, and 7.5 ± 1.2% at 6 years. OGTT, OGTT-IRT, and OGTT-CRT improved after surgery. There was a decrease in triglycerides (TGs), total cholesterol (TC), and low-density lipoprotein (LDL) and an increase in high-density lipoprotein (HDL). At 6 years after surgery, 16.7% of patients achieved complete remission of T2DM, and 66.7% achieved improvement in T2DM.

CONCLUSION

RYGB may be a safe and effective treatment for T2DM patients with a BMI < 32.5 kg/m² in China. However, a long-term study without loss to follow-up is necessary for better evaluation.

A Systematic Review of One Anastomosis/Mini Gastric Bypass as a Metabolic Operation for Patients with Body Mass Index ≤ 35 kg/m2

BACKGROUND

One anastomosis/mini gastric bypass (OAGB-MGB) is now an established bariatric procedure for patients suffering from obesity. The purpose of this review is to evaluate the role of this operation in patients with body mass index (BMI) ≤ 35 kg/m².

METHODS

A literature review was performed as per preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

RESULTS

This review reports cumulative results of 376 OAGB-MGB procedures with a mean age of 44.28 years and mean BMI of 29.16 kg/m² (range 22-35). Females represented 67.67% of the patients. The leak rate was 0.27%. The mean follow-up was 32.6 months (6-84 months). The mean operative time was 89.45 min. The median limb length was 120 cm (range 100-200 cm). The mean fasting plasma glucose (FPG) decreased from 196.97 to 103.28 mg/dL. The mean HbA1c came down from 9.13% preoperatively to 6.14% postoperatively. The total cholesterol levels came down from a mean of 197.8 mg/dL preoperatively to 120.6 mg/dL postoperatively. The low-density lipoprotein (LDL) and triglyceride levels came down from 127.7 and 209.3 mg/dL to 81 and 94.8 mg/dL, respectively. Mortality was 0%. Marginal ulceration rate of 6.3% and an anaemia rate of 4.7% were reported. Low albumin was reported in 1 (0.2%) patient. The mean BMI came down to 23.76 kg/m² at 12 months.

CONCLUSIONS

We conclude that there is now satisfactory evidence to consider OAGB-MGB as a safe and effective metabolic procedure for diabetic patients with BMI ≤ 35 kg/m². Randomised studies comparing different bariatric procedures with longer term follow-up are needed.

Postoperative Outcomes and Advantages of Hand-Sewn Laparoscopic One-Anastomosis Gastric Bypass: Experience on 805 Patients

PURPOSE

One-anastomosis gastric bypass (OAGB) is a novel laparoscopic approach. The anastomosis of OAGB can be sewn either with a stapler or manually. The aim of this study is to determine the outcome of hand-sewn OAGB.

MATERIALS AND METHODS

A total of 805 consecutive patients were retrospectively enrolled in this study. Data collection included change in weight, body mass index (BMI), symptoms, and complications before surgery and continued during annual follow-up visits up to 5 years. Inclusion criteria were patients with a BMI of higher than 40 kg/m2 or higher than 35 kg/m2 with one severe comorbidity. Patients with BMI > 50 kg/m2 were referred to dieticians.

RESULTS

The follow-up rate ranged from 93 to 50% at the 1-year and 5-year visits after surgery, respectively. Mean weight and BMI of patients before surgery were 121.93 kg (± 22.92) and 44.79 kg/m2 (± 6.07), respectively. Mean of annual BMI in 5 years of follow-up were 27.83, 27.26, 28.90, 29.45, and 29.56 kg/m2. Excess weight loss (EWL) in 5 years of follow-up were 85.7%, 89.5%, 78.9%, 77.7%, and 76.0%. Reflux was present in 202 patients (25.1%) before surgery and resolved in 153 cases (75.7%) 1 year after surgery. Procedure-specific early complication was an anastomosis leak in one patient, which led to death. Two cases of malnutrition necessitating reversal and two severe reflux disorders leading to Roux-en-Y bypass surgery were remarkable late complications.

CONCLUSION

Hand-sewn anastomosis could represent an efficient and safe technique in the management of patients undergoing OAGB surgery with acceptable outcomes and rare adverse complications.

Defining remission of type 2 diabetes in research studies: A systematic scoping review

BACKGROUND

Remission has been identified as a top priority by people with type 2 diabetes. Remission is commonly used as an outcome in research studies; however, a widely accepted definition of remission of type 2 diabetes is lacking. A report on defining remission was published (but not formally endorsed) in Diabetes Care, an American Diabetes Association (ADA) journal. This Diabetes Care report remains widely used. It was the first to suggest 3 components necessary to define the presence of remission: (1) absence of glucose-lowering therapy (GLT); (2) normoglycaemia; and (3) for duration ≥1 year. Our aim is to systematically review how remission of type 2 diabetes has been defined by observational and interventional studies since publication of the 2009 report.

METHODS AND FINDINGS

Four databases (MEDLINE, EMBASE, Cochrane Library, and CINAHL) were searched for studies published from 1 September 2009 to 18 July 2020 involving at least 100 participants with type 2 diabetes in their remission analysis, which examined an outcome of type 2 diabetes remission in adults ≥18 years and which had been published in English since 2009. Remission definitions were extracted and categorised by glucose-lowering therapy, glycaemic thresholds, and duration. A total of 8,966 titles/abstracts were screened, and 178 studies (165 observational and 13 interventional) from 33 countries were included. These contributed 266 definitions, of which 96 were unique. The 2009 report was referenced in 121 (45%) definitions. In total, 247 (93%) definitions required the absence of GLT, and 232 (87%) definitions specified numeric glycaemic thresholds. The most frequently used threshold was HbA1c<42 mmol/mol (6.0%) in 47 (20%) definitions. Time was frequently omitted. In this study, a total of 104 (39%) definitions defined time as a duration. The main limitations of this systematic review lie in the restriction to published studies written in English with sample sizes of over 100. Grey literature was not included in the search.

CONCLUSIONS

We found that there is substantial heterogeneity in the definition of type 2 diabetes remission in research studies published since 2009, at least partly reflecting ambiguity in the 2009 report. This complicates interpretation of previous research on remission of type 2 diabetes and the implications for people with type 2 diabetes. Any new consensus definition of remission should include unambiguous glycaemic thresholds and emphasise duration. Until an international consensus is reached, studies describing remission should clearly define all 3 components of remission.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019144619.

Efficiency and risks of one-anastomosis gastric bypass

The single-anastomosis gastric bypass has been proposed as a simpler and efficient weight loss reducing surgery. Postoperative outcomes are comparable to those of contemporary popular procedures. There are, however, controversies regarding the efficiency and risks of one-anastomosis gastric bypass (OAGB). The purpose of this review is to define the role of OAGB in metabolic surgery via its operative outcomes. A review of English language literature was performed using the PubMed database, basing the search on the following keywords: “one-anastomosis gastric bypass” AND “outcomes”. A total of 238 articles were considered for review. Following thorough screening and selection criteria, 7 articles were considered sufficient for assessment. The nature of the available evidence of this technique poses a challenge to OAGB in its establishment as a standard of care procedure. The anatomical configuration following surgery, as well as the metabolic implications of its hypo-absorptive nature, raises controversial and ongoing concerns that are yet to be addressed. Hence, prospective studies with long-term follow-up (>5 years) can bypass these concerns and allow the progression of the clinical practice of OAGB.

Weight loss after one-anastomosis/mini-gastric bypass - The impact of biliopancreatic limb: A retrospective cohort study

Background

One-anastomosis/mini-gastric bypass (OAGB/MGB), as a popular bariatric surgery method, has many advantages; however, the biliopancreatic limb length (BPL) in this surgery is under debate. The aim of the study was to evaluate the effect of BPL on weight-loss outcome after OAGB/MGB.

Materials and Methods

A retrospective cohort study was performed on 653 patients who underwent OAGB/MGB with adjusted BPL based on preoperative body mass index (BMI) and patient's age, between 2010 and 2015 with 12-month follow-ups. Weight-loss outcomes and complications were analyzed in these patients, considering BPL.

Results

Weight, age, sex, and type 2 diabetes mellitus were the most contributory predictors as independent predictors of 12-month excess weight loss, respectively, and BPL was the least contributory predictor.

Conclusion

Tailoring BPL in OAGB/MGB based on patient's age and preoperative BMI seems to have acceptable results.

LSG vs MGB-OAGB-3 Year Follow-up Data: a Randomised Control Trial

AIM

The objective of this study is to compare 3-year follow-up results of one anastomosis gastric bypass (MGB-OAGB) and laparoscopic sleeve gastrectomy (LSG) in terms of weight loss, complications, resolution of comorbidities and quality of life.

MATERIALS AND METHODS

A prospective randomised study of results between 100 LSG patients and 101 MGB-OAGB patients was done from 2012 to 2015. The results were compared regarding operative outcomes, percentage of excess weight loss (%EWL), complications, resolution of comorbidities and quality of life (BAROS score) at 3 years follow-up.

RESULTS

Follow-up was achieved in 93 MGB-OAGB vs 92 LSG patients for 3-year period. The average %EWL for MGB-OAGB vs LSG was 66.48 vs 61.15% at the end of 3 years respectively, which was statistically insignificant. Diabetes remission was seen in 89.13% of MGB-OAGB patients and 81.82% of LSG patients. Remission of hypertension was seen in 74% of MGB-OAGB patients and 72.22% of LSG patients. Bariatric analysis reporting and outcome system (BAROS) with comorbidity in LSG patients and MGB-OAGB patients was 6.03 and 6.96 respectively, whereas in patients without comorbidity, BAROS score was 3.86 in LSG group and 4.34 in MGB-OAGB group.

CONCLUSIONS

In our study, at 36 months follow up, there was no significant difference between LSG and MGB-OAGB in %EWL and remission of HTN. Type 2 diabetes mellitus (T2DM) remission rates were higher after MGB-OAGB as compared to LSG but the difference was statistically insignificant. MGB-OAGB patients with comorbidities have a better quality of life and BAROS score compared to LSG patients.

Mini Gastric Bypass-One Anastomosis Gastric Bypass (MGB-OAGB)-IFSO Position Statement

PREAMBLE

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has played an integral role in educating both the metabolic surgical and the medical community at large about the role of innovative and new surgical and/or endoscopic interventions in treating adiposity-based chronic diseases.The mini gastric bypass is also known as the one anastomosis gastric bypass. The IFSO has agreed that the standard nomenclature should be the mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB). The IFSO commissioned a task force (Appendix 1) to determine if MGB-OAGB is an effective and safe procedure and if it should be considered a surgical option for the treatment of obesity and metabolic diseases.The following position statement is issued by the IFSO MGB-OAGB task force and approved by the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence. It will be reviewed in 2 years.

One Anastomosis Gastric Bypass/Minigastric Bypass in Patients with BMI < 35 kg/m2 and Type 2 Diabetes Mellitus: Preliminary Report

INTRODUCTION

Obesity in the world has been increasing, and the number of diabetic patients will increase by 114%, and the best treatment results are achieved through surgery. Several techniques have been described; the gastric bypass of an anastomosis (MGB/OAGB) has been gaining popularity for its simplicity and good results. We present a prospective study with this technique in 16 mild obesity patients with type 2 diabetes mellitus or peripheral insulin resistance.

OBJECTIVE

To evaluate weight loss as well as metabolic changes by measuring fasting glycemia and Hb A1c after 1 year of follow-up.

MATERIAL AND METHODS

Sixteen patients were operated on with the OAGB/MGB technique from September 2014 to January 2016, with some form of metabolic syndrome, whether DM2, RPI, HBP, or dyslipidemia, including patients in the study with a follow-up of at least 12 months.

RESULTS

There were 13 cases of female sex and 3 of male, average age of 42.9 years, with an average weight of 87.7 kg and BMI of 32.2 kg/m². Metabolic values were fasting glycemia of 193.6 ± 52.9 mg/dl and HbA1c of 8.4% ± 1 (preop) and glycemia posop, 78.8 ± 7.6 mg/dl; HbA1c posop, 6.1 ± 0.2; preop weight, 87.7 ± 14 kg (69-116); weight posop, 66.8 ± 10.5 kg (49-90); BMI preop, 32.2 ± 1.8 (30-34.9); BMI posop, 25.4 ± 1.7 (21.7-27.6); percentage of excess weight lost, 87.6 ± 11.8 (70.9-100) % with 100% remission of diabetes.

CONCLUSION

The results show the benefits of MGB/OAGB in mild obese diabetic patients.

Retrospective cohort study of 925 OAGB procedures. The UK MGB/OAGB collaborative group

BACKGROUND

Mini-One Anastomosis Gastric Bypass is a new operation that provides comparable outcomes to the common bariatric procedures. Revisional surgery is still needed after a number of MGB-OAGB procedures. The aim of this study is to report the causes and management of these revisions.

METHODS

From 2010 to 2018, 925 MGB-OAGB operations were performed at 7 bariatric units across the United Kingdom and included in this retrospective cohort study. The data was retrospectively collected and analysed. The primary end point was the identification of the causes and management of revisions. Follow up ranged from 6 months to 3 years.

RESULTS

Twenty-two patients [2.3%] required revisional surgery after MGB-OAGB. Five patients [0.5%] developed severe diarrhoea managed by shortening the bilio-pancreatic limb to 150 cm. Four patients [0.4%] developed afferent loop syndrome and bile reflux was reported in another 3 [0.3%] cases; all were managed by either conversion to Roux en Y Gastric Bypass or a Braun anastomosis. Postoperative bleeding was controlled laparoscopically in 3 patients [0.3%]. Liver decompensation that was reported in 2 patients [0.2%] was treated by shortening the BPL in one patient and a reversal to normal anatomy in another. The liver failure resolved in both patients. Other indications for revision included two gastro-jejunal stenosis [0.2%], one perforated ulcer [0.1%], one patient [0.1%] with excessive weight loss and one case [0.1%] of protein malnutrition. None of the 22 patients undergoing revisional surgery after MGB-OAGB died. Lost to follow up rate was 0.2%.

CONCLUSION

Complications requiring revisional surgery after MGB-OAGB are uncommon [2.3%] and the majority can be managed by bilio-pancreatic limb shortening, the addition of a Braun side-to-side anastomosis or conversion to RYGB. Bilio-pancreatic limb length of 200 cm or more resulted in serious complications of liver failure, protein malnutrition, excessive weight loss and diarrhoea.

The Complications of Bariatric Surgery Patients with Type 2 Diabetes in the World: A Systematic Review and Meta-Analysis

BACKGROUND

In this Meta-analysis, we aimed to quantify the incidence of complications of different methods of bariatric surgery on diabetic patients.

INTRODUCTION

Type 2 Diabetes Mellitus (T2DM) is increasing worldwide specifically in obese cases. Additionally, obesity worsens T2DM. Complications of each bariatric surgery method were assessed separately; but, a meta-analysis of these complications and comparison between procedures in T2DM patients have not been investigated previously. The result of this study will help surgeons to choose the most appropriate surgical technique, considering individual conditions for a diabetic patient.

METHODS

We searched PubMed, Scopus, and ISI for original papers including bariatric surgical procedures for diabetic population and the reported consequences. Data analyses were done using Stata software.

RESULTS

Mortality percentage between diabetic and non-diabetic patients was statistically nonsignificant (P = 0.987). Early and late complications were higher in diabetic group in comparison with non-diabetic (6.0% vs. 1.8%, P = 0.024 and 0.6% vs. 0.3%, P = 0.04, respectively). Most prevalent findings in malabsorptive (7.8%, P < 0.001) and restrictive procedures (80%, P < 0.001) were major complications and hypoglycemic episodes, respectively.

CONCLUSION

As our study showed, most of the complications are not necessarily higher in diabetic population but dependent on the method of surgery.

Laparoscopic metabolic surgery for the treatment of type 2 diabetes in Asia: a scoping review and evidence-based analysis

BACKGROUND

Laparoscopic metabolic surgery has been previously shown to be an effective treatment for obese patients with type 2 diabetes (T2DM). The objective of this scoping review is to determine the impact of metabolic surgery for the treatment of type 2 diabetes in Asia and perform an evidence-based analysis.

METHODS

We performed a literature search in PubMed for research on laparoscopic metabolic surgery for the treatment of T2DM in Asia region. We classified the included studies based on the Oxford Center for Evidence Based Medicine guidelines. And performed and evidence analysis.

RESULTS

In total, 205 articles were identified. 62.9% of the studies were from East Asia. The evidence of 26 studies are level I, 59 are level II. Laparoscopic sleeve gastrectomy (LSG) was the most commonly reported surgical procedure (63.1%) in Asia. The number of laparoscopic metabolic surgery for T2DM in Asian countries has increased rapidly over the last 8 years. We identified 16 studies which showed that laparoscopic metabolic surgery is an effective and safe treatment for T2DM in patients with a BMI of > 25 kg/m2 to < 35 kg/m2 in Asia.

CONCLUSIONS

Our results suggest that laparoscopic metabolic surgery might be an effective and safe treatment for T2DM patients with BMI < 35 kg/m2, and that LSG is the most commonly performed surgical procedure for this in Asia.

From diabetes remedy to diabetes remission; could single-anastomosis gastric bypass be a safe bridge to reach target in non-obese patients?

BACKGROUND/AIMS

Type 2 diabetes mellitus (T2DM) is considered a chronic progressive incurable metabolic disease. Single-anastomosis gastric bypass (SAGB) has proved to be effective in obese patients, yet its impact on non-obese diabetics is not extensively studied. The aim is to determine the anthropometric and glycemic outcomes of SAGB as a proposed line of treatment for T2DM patients with body mass index (BMI) 25-30 kg/m².

METHODS

From November 2013 to March 2016, a prospective study has been conducted at Ain-Shams University Hospitals on 17 consecutive patients who have undergone SAGB. The demographic and anthropometric data, as well as the relevant laboratory results, were reported. Complete T2DM remission is considered if glycosylated hemoglobin (HbA1c) <6 % for at least 1 year without medication, whereas partial remission is considered if HbA1c<6.5%.

RESULTS

The mean age was 42.6 ±13.8 years, mean BMI was 26.7 ± 2.3 kg/m² and mean duration of DM was 6.3 ± 2.7 years. The mean baseline values of HbA1c, FPG (fasting plasma glucose), and 2-hours postprandial glucose (2-H PPG) were 9.9%, 176.3 mg/dl, and 310.3 mg/dl respectively. These values significantly dropped at the 18^th month to reach 5.8%, 93.4 mg/dl, and 156.2 mg/dl, with 13/17 patients became off-treatment (complete remission rate 76.4%).

CONCLUSION

T2DM patients with BMI 25-30 kg/m² are considered the most controversial group. SAGB is an efficient metabolic procedure and could be integrated into the treatment algorithm of T2DM. Such line of treatment opens new horizons to change the concept of treatment from diabetes remedy to diabetes remission.

American Society for Metabolic and Bariatric Surgery review of the literature on one-anastomosis gastric bypass

The following review is being published by the American Society for Metabolic and Bariatric Surgery in response to numerous inquiries made to the Society by patients, physicians, society members, hospitals, and others regarding one-anastomosis gastric bypass as a primary treatment for obesity or metabolic disease. The review is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The review is not intended as, and should not be construed as, stating or establishing a local, regional, or national standard of care.

Outcomes of Omega Loop Gastric Bypass, 6-Years Experience of 1520 Cases

BACKGROUND

Omega loop gastric bypass (OLGB) has been viewed with skepticism after the failure of the "old Mason loop." During the past 15 years, a growing number of authors worldwide approved that OLGB is a safe and effective procedure, which appears clearly from the operative outcome and long-term follow-up of consecutive cohort studies of patients who underwent OLGB. The aim of this study is to evaluate the outcomes of OLGB at the bariatric center of our university hospital between 2009 and 2015.

METHODS

The data of 1520 patients who underwent OLGB from November 2009 to December 2015 at our center were reviewed. Mean age was 37.15 years, mean preoperative BMI was 46.8 ± 6.6 kg/m², mean preoperative weight was 127.4 ± 25.3 kg, and 62.7% were women. Diabetes mellitus (DM) affected 683 (44.9%) of the 1520 patients, whereas 773 of the 1520 patients (50.9%) presented with hypertension. The mean operative time was 35 min.

RESULTS

The 1-year postoperative BMI mean decreased to 29.6 ± 3.1 kg/m², and at the 3-year follow-up, it was 27.5 ± 3.4 kg/m². The mean of weight decreased to 81.3 ± 16.7 kg and to 78.9 ± 16.9 kg at the 1-year and the 3-year follow-up, respectively. Mortality rate was 0.1%. Overall complications were 9.3%; 0.8% required reoperations. Early complications were encountered in 50 patients (3.3%), and the late complications rate was (6.1%).

CONCLUSIONS

In this study, greater excess weight loss was observed with OLGB which appeared to be a short, simple, low-risk, effective, and durable bariatric procedure.

Comparison of safety and effectiveness between laparoscopic mini-gastric bypass and laparoscopic sleeve gastrectomy: A meta-analysis and systematic review

BACKGROUND

The laparoscopic mini-gastric bypass is a newly emerged surgical procedure in recent years. Owe to safe and simple process and effective outcomes, laparoscopic mini-gastric bypass has quickly become one of the most popular procedures in some countries. The safety and effectiveness of laparoscopic mini-gastric bypass versus laparoscopic sleeve gastrectomy remain unclear.

METHODS

A systematic literature search was performed in PubMed, Embase, Cochrane library from inception to May 20, 2017. The methodological quality of Randomized Controlled Trials and non-Randomized Controlled Trials were, respectively, assessed by Cochrane Collaboration's tool for assessing risk of bias and Newcastle-Ottawa scale. The meta-analysis was performed by RevMan 5.3 software.

RESULTS

Patients receiving mini-gastric bypass had a lot of advantageous indexes than patients receiving sleeve gastrectomy, such as higher 1-year EWL% (excess weight loss), higher 5-year EWL%, higher T2DM remission rate, higher hypertension remission rate, higher obstructive sleep apnea (OSA) remission rate, lower osteoarthritis remission rate, lower leakage rate, lower overall late complications rate, higher ulcer rate, lower gastroesophageal reflux disease (GERD) rate, shorter hospital stay and lower revision rate. No significant statistical difference was observed on overall early complications rate, bleed rate, vomiting rate, anemia rate, and operation time between mini-gastric bypass and sleeve gastrectomy.

CONCLUSION

Mini-gastric bypass is a simpler, safer, and more effective bariatric procedure than laparoscopic sleeve gastrectomy. Due to the biased data, small sample size and short follow-up time, our results may be unreliable. Large sample and multicenter RCT is needed to compare the effectiveness and safety between mini-gastric bypass and sleeve gastrectomy. Future study should also focus on bile reflux, remnant gastric cancer, and long term effectiveness of mini-gastric bypass.

Time to Glycemic Control - an Observational Study of 3 Different Operations

BACKGROUND

Medical treatment fails to provide adequate control for many obese patients with type 2 diabetes mellitus (T2DM). A comparative observational study of bariatric procedures was performed to investigate the time at which patients achieve glycemic control within the first 30 postoperative days following sleeve gastrectomy (SG), mini-gastric bypass (MGB), and diverted sleeve gastrectomy with ileal transposition (DSIT).

METHODS

Included patients had a body mass index (BMI) ≥30 kg/m²; T2DM for ≥3 years, HbA_1C > 7 % for ≥3 months, and no significant weight change (>3 %) within the prior 3 months. Surgical procedures performed were SG (n = 49), MGB (n = 93), and DSIT (n = 109). The primary endpoint was the day within the first postoperative month on which mean fasting capillary glucose levels reached <126 mg/dL. Multivariate logistic regression analysis was used to identify predictors of glycemic control.

RESULTS

The cohort included 251 patients with a mean BMI of 36.04 ± 5.76 kg/m²; age, 52.84 ± 8.52 years; T2DM duration, 13.09 ± 7.54 years; HbA_1C, 8.82 ± 1.58 %. On the morning of surgery, mean fasting plasma glucose was 177.63 ± 51.3 mg/dL; on day 30, 131.35 ± 28.7 mg/dL (p < 0.05). Mean fasting plasma glucose of <126 mg/dL was reached in the DSIT group (124.36 ± 20.21 mg/dL) on day 29, and in the MGB group (123.61 ± 22.51 mg/dL), on day 30. The SG group did not achieve target mean capillary glucose level within postoperative 30 days.

CONCLUSION

During the first postoperative month, glycemic control (<126 mg/dL) was achieved following DSIT and MGB, but not SG. Preoperative BMI and postprandial C-peptide levels were independent predictors of early glycemic control following DSIT.

Is Mini-Gastric Bypass a Rational Approach for Type-2 Diabetes?

PURPOSE OF REVIEW

Morbid obesity and type-2 diabetes mellitus (T2DM) are both major public health problems. Bariatric surgery is a proven and effective treatment for these conditions; laparoscopic Roux-en-Y gastric bypass (RYGB) is currently the gold-standard treatment. One-anastomosis gastric bypass (OAGB) is described as a simpler, safer, and non-inferior alternative to RYGB to treat morbid obesity. Concerning T2DM, experts of the OAGB procedure report promising metabolic results with good long-term remission of T2DM; however, heterogeneity within the literature prompted us to analyze this issue.

RECENT FINDINGS

OAGB has gained popularity given its safety and long-term efficacy. Concerning the effect of OAGB for the treatment of T2DM, most reports involve non-controlled single-arm studies with heterogeneous methodologies and a few randomized controlled trials. However, this available literature supports the efficacy of OAGB for remission of T2DM in obese and non-obese patients. Two years after OAGB, the T2DM remission and improvement rate increased from 67 to 100%. The results were improved and stable in the long term. The 5-year T2DM remission rate increased from 82 to 84.4%. OAGB is non-inferior compared with RYGB and even superior to other accepted bariatric procedures, such as sleeve gastrectomy and adjustable gastric banding. OAGB is an efficient, safe, simple, and reversible procedure to treat T2DM. The literature reveals interesting results for T2DM remission in non-obese patients. High-level comparative studies are required to support these data.

The Effects of One-Anastomosis Gastric Bypass on Glucose Metabolism in Goto-Kakizaki Rats

BACKGROUND

The improvement in glucose metabolism after bariatric surgery is well established. The aim of this study was to investigate the hormones and glycemic control in diabetes after a one-anastomosis gastric bypass (OAGB) variant in an animal model of non-obese type 2 diabetes mellitus.

METHODS

Thirty-six Goto-Kakizaki rats were randomly assigned to undergo one of the following procedures: OAGB (18 rats) or sham intervention (18 rats). Each group was subdivided into three additional groups according to the time of surgery (early-12 weeks; intermediate-16 weeks; and late-20 weeks). Weight, fasting glycemia, glucose tolerance test (OGTT), and hormone levels (glucagon, insulin, glucagon-like peptide-1 [GLP-1], and glucose-dependent insulinotropic peptide [GIP]) were measured.

RESULTS

All rats maintained their weight. The OGTT showed a significant improvement in glycemic levels in rats with OAGB in all time groups (p < 0.002, for all groups at 60 min). Insulin levels decreased significantly in all animals with OAGB, but glucagon levels increased (glucagon paradoxical response). GLP-1 and GIP increased in rats with OAGB at all times, but was only statistically significant in the early surgery group of GLP-1 (p < 0.005).

CONCLUSION

OAGB in a non-obese diabetic rat model improves glycemic control, with a significant decrease in glucose and insulin levels. This reduction without weight loss suggests a surgically induced enhancement of pancreatic function. It appears that this improvement occurs, although the GLP-1 levels were significantly increased only in the early stages. The paradoxical response of glucagon should be further evaluated.

Outcomes of One Anastomosis Gastric Bypass in 472 Diabetic Patients

BACKGROUND

The positive impact of Roux-en-Y gastric bypass (RYGB) on metabolic syndrome and glycemic control has been proven in obese patients. One anastomosis gastric bypass (OAGB) is a simple, effective and easy to learn procedure. OAGB provides encouraging results for the treatment of diabetes obese patients, but does it have the ability to be an alternative procedure to RYGB in the treatment of these patients? The aim of this study is to evaluate the outcomes of OAGB on diabetic obese patients at the bariatric centre of our university hospital. By extension, we evaluated the possibility of BMI and the preoperative antidiabetic medication usage to be predictive factors for postoperative diabetes resolution.

METHODS

This is a retrospective single-centre study of 472 diabetic patients who underwent OAGB from November 2009 to December 2015. All patients were followed-up for at least 1 year, and up to 3 years, where available. Weight, HbA1c, and anti-diabetic medications were recorded at baseline, 3, 6, 12, 24 and 36 months.

RESULTS

A total of 472 patients have been followed-up for 1 year and 361 for 3 years. The mean BMI decreased from 46.8 ± 7.2 to 29.5 ± 2.8 kg/m² and HbA1c from 9.6 ± 1.3 to 5.7 ± 1.5% at the 12-month follow-up. At the 3-year follow-up, the mean BMI was 32.1 ± 3.3 and HbA1c mean was 5.8 ± 0.9%. Diabetes remission was achieved by 84.1% of patients.

CONCLUSIONS

OAGB can be an excellent alternative to RYGB for the treatment of diabetes and obesity. Pre-operative medications may be used to predict postoperative diabetes remission, but not BMI.

Postoperative effects of laparoscopic sleeve gastrectomy in morbid obese patients with type 2 diabetes

Background

Laparoscopic Sleeve Gastrectomy has become one of the most popular bariatric surgery types and helps treating not only obesity but also endocrinological diseases related to obesity. Therefore we aimed to evaluate the effects of laparoscopic sleeve gastrectomy on the treatment of type 2 diabetes.

Methods

All patients, who underwent morbid obesity surgery during 2013–2014 and had a HbA1c >6 % were included in this prospective study. Demographical data, usage of oral antidiabetic drugs or insulin were recorded, and laboratory findings as HbA1c and fasting plasma glucose were evaluated preoperatively and postoperatively at the 6th and 12th months. Diabetes remission criteria were used to assess success of the surgical treatment.

Results

Totally 88 patients were included in this study. 55 patients were using oral antidiabetic drugs and 33 patients were using insulin. At the 6th month complete remission was observed in 80 (90.9 %), partial remission in 3 (3.4 %) and persistent diabetes in 5 (5.6 %) patients. At the 12th month complete remission was observed in 84 (95.4 %), partial remission in 1 (1.1 %) and persistent diabetes in 3 (3.4 %) patients.

Conclusions

This study indicated that laparoscopic sleeve gastrectomy surgery achieved a complete remission of diabetes in 95.4 % patients having type 2 diabetes during a 1 year fallow up period. However, complete remission of type 2 diabetes has been reported as 80 % during long term fallow up in the literature. In our opinion this rate may change with longer follow up periods and studies involving more patients suffering type 2 diabetes.