Analysis of the Efficacy and the Long-term Metabolic and Nutritional Status of Sleeve Gastrectomy with Transit Bipartition Compared to Roux-en-Y Gastric Bypass in Obese Rats.

PURPOSE: Sleeve gastrectomy with transit bipartition (SG-TB) could be an attractive alternative to Roux-en-Y gastric bypass (RYGB) on weight loss and improvement of comorbidities in patients with obesity. However, there is little long-term data. Translational research on a rat model could allow long-term projection to assess efficacy and safety of SG-TB. The aim of this research was to evaluate the long-term efficacy and safety of SG-TB compared to RYGB and SHAM in rat model. MATERIALS AND METHODS: Ninety-four male obese Wistar rats were distributed into 3 groups: SG-TB (n = 34), RYGB (n = 32), and SHAM (control group, n = 28). The percentage of total weight loss (%TWL), coprocalorimetry, glucose and insulin tolerance test, insulin, GLP-1, PYY, and GIP before and after surgery were assessed. The animals were followed over 6 months (equivalent to 16 years in humans). RESULTS: At 6 months, %TWL was significantly greater(p = 0.025) in the SG-TB group compared to the RYGB group. There was no difference between the groups (p = 0.86) in malabsorption 15 and 120 days postoperatively. Glucose tolerance was significantly improved (p = 0.03) in the SG-TB and RYGB groups compared to the preoperative state. Insulin secretion, at 3 months, was significantly more important in the SG-TB group (p = 0.0003), compared to the RYGB and SHAM groups. GLP-1 secretion was significantly increased in the SG-TB and RYGB groups compared to the preoperative state (p = 0.001) but similar between SG-TB and RYGB animals (p = 0.72). CONCLUSION: In a rat model, at long term compared to RYGB, SG-TB provides greater and better-maintained weight loss and an increased insulin secretion without impairing nutritional status.

Weight Loss, Type 2 Diabetes, and Nutrition in 355 Patients with Obesity Undergoing Sleeve Gastrectomy with Transit Bipartition: Two-Year Outcomes.

INTRODUCTION: This study examined whether 355 obese patients with type 2 diabetes (T2D) of varying duration and severity experienced equivalent weight loss and T2D remission following a newer sleeve gastrectomy (SG) procedure - SG with transit bipartition (SG-TB). METHODS: Primary outcomes were changes in body mass index (BMI), total weight loss (TWL), excess BMI loss (EBMIL), A1C, and diabetes medication use through 24 months. RESULTS: Between December 2015 and December 2019, 399 patients who underwent SG-TB reached the 2-year time point. Follow-up was possible in 355 patients (89.0%): 206 females (58.0%), mean age 51.5 years (24.0-73.0), BMI 34.0 kg/m2 (28.0-50.5), and T2D duration 12.0 years (4.0-37.0). At 2 years, total sample respective mean TWL and EBMIL were 20.2 ± 6.1% (95% CI: 19.5, 20.8) and 87.7 ± 35.2% (84.1, 91.4) corresponding to mean BMI change of 7.0 ± 2.7 kg/m2 (6.7, 7.3) (p < 0.001). T2D duration and severity subgroups experienced comparable BMI and A1C change from baseline (p < 0.001); 281 (79.2%) maintained complete remission. ANOVA showed significant mean increases in vitamin D, calcium, and albumin: overall complication rate, 10.2%; no mortality. DISCUSSION/CONCLUSION: In 355 patients with obesity who underwent SG-TB, excellent weight loss, T2D, and nutritional outcomes were seen at 2-year follow-up regardless of preoperative T2D duration and severity.

Effects of Sleeve Gastrectomy with Transit Bipartition on Glycemic Variables, Lipid Profile, Liver Enzymes, and Nutritional Status in Type 2 Diabetes Mellitus Patients.

BACKGROUND: Sleeve gastrectomy with transit bipartition (SG + TB) surgery is an effective treatment modality for the patients with type 2 diabetes mellitus (T2DM). Here, we aimed to present the 1-year follow-up data of our patients with T2DM who underwent SG + TB. METHODS: We evaluated the follow-up results of 45 patients and evaluated the remission status of T2DM. Additionally, biochemical variables including lipid status, liver function and nutritional status were presented. RESULTS: A total of 40 T2DM remissions occurred among the 45 patients (88.8%). The complete remission was present in 35 of the patients at the end of the postoperative first year. The lipid profile markers improved following the first postoperative month. The levels of the liver enzyme alanine aminotransferase (ALT) decreased after the first postoperative month, while aspartate aminotransferase (AST) levels did not alter significantly during the follow-up period. We did not observe a change regarding albumin and vitamin B12 levels following the surgery. CONCLUSION: SG + TB is a convenient and therapeutic method for the treatment of T2DM, along with the improvement in lipid profile and liver enzyme levels.

Laparoscopic Ileal Interposition with Diverted Sleeve Gastrectomy Versus Laparoscopic Transit Bipartition with Sleeve Gastrectomy for Better Glycemic Outcomes in T2DM Patients.

BACKGROUND: Metabolic procedures provide better outcomes for obese patients with type 2 diabetes mellitus. Our aim was to compare the glycemic regulation in patients that have undergone the laparoscopic ileal interposition with diverted sleeve gastrectomy (II-DSG), laparoscopic transit bipartition with sleeve gastrectomy (TB-SG), and laparoscopic sleeve gastrectomy (LSG) throughout a 12-month follow-up period retrospectively. METHODS: This study considered patients with T2DM who underwent metabolic procedures. The postoperative changes in the glucose, C-peptide, HbA1c, HOMA-IR, insulin, cholesterol, body mass index, and total weight loss (TWL) were compared retrospectively. The intended outcome was to reach a long lasting fasting blood glucose (FBG) <126 mg/dl. A multivariate regression analysis was applied to define the predictive markers in glucose regulation. RESULTS: Present study consisted of 83 patients with a mean age of 47.25 ± 6.58 years, mean preoperative BMI of 37.36 ± 2.71 kg/m2, and mean outcomes in the HbA1C and FBG of 9.05 ± 1.33% and 237 ± 15 mg/dl, respectively. There were similar correlations in BMI and total weight loss (TWL). At 12-month follow up period, compared to LSG group, TB-SG and II-DSG groups have higher remission proportions (35.3, 67.9, 54.7, respectively, p < 0.05) with similar TWL% (22.35, 27.14, 23.16%) outcomes. The II-DSG and TB-SG results drew closer together toward the end of this study interval unlike the LSG group. CONCLUSION: Our results showed that II-DSG and TB-SG ensured significant regression rates during the follow-up period. Since the TB-SG achieved these outcomes by finite anastomoses and intervening segments, it was considered to be a superior procedure compared to II-DSG and LSG procedures.