MGB vs Sleeve Gastrectomy Random Trial

Sleeve Gastrectomy Versus Mini-Gastric Bypass for the Treatment of Non-Morbid Obese Diabetic Patients: a Randomized Trial 

Presenter: W. J. Lee (Min-Sheng General Hospital, Taoyuan, Taiwan) 

Co-authors: J. Chen1, K. Ser 

Min-Sheng General Hospital, Taoyuan, Taiwan 

Background 

Bariatric Surgery leads to a dramatic improvement in morbid obesity associated type 2 Diabetes Mellitus (T2DM) but the mechanism remains speculative. 

This study compared the laparoscopic sleeve gastrectomy (LSG) and Mini-Gastric Bypass (MGB) in the treatment of type 2 Diabetes Mellitus, and to test the “fore-gut” hypothesis. 

Methods 
Patients aged 30 to 60 years, with poorly controlled type 2 Diabetes Mellitus (HbA1C > 7.5%) and BMI between 35 and 25 were included and randomized to laparoscopic sleeve gastrectomy and Mini-Gastric Bypass. 

The end point is type 2 Diabetes Mellitus resolution, defined by fasting plasma glucose < 126 mg/dl and HbA1C < 6.5%. 

Results 

40 patients with a mean BMI 29 (24-34), age 45 (34-58) and HbA1C of 10.0% (8.0-15) were randomized to either laparoscopic sleeve gastrectomy (n = 20) or Mini-Gastric Bypass (n = 20). 

All procedures were successfully carried out with no deaths or major complication in either group. 

Minor complication occurred in 4 patients (10%). 

There was no difference in basic and peri-operative clinical parameters between the two groups. 

Minimum follow-up was 12 months (from 14 to 28 months). 

After surgery, both groups experienced a rapid decrease in fasting plasma glucose and insulin at 1st week. 

Body weight rapidly decreased up to 6 months and stabilized to 12 months in both groups. 

However, type 2 Diabetes Mellitus resolution rate 
was significantly better in Mini-Gastric Bypass than 
laparoscopic sleeve gastrectomy 
(MGB = 90% vs SG = 50%, p < 0.05). 

The type 2 Diabetes Mellitus resolution rates in laparoscopic sleeve gastrectomy for those with pre-operative C-peptide < 3, 3-6 and > 6 ng/ml were 1/7( 14.3%), 7/11(63.6%) and 2/2(100%); p < 0.05, separately. 

Conclusion 

Although both are effective for type 2 Diabetes Mellitus with BMI < 35, Mini-Gastric Bypass is more effective than laparoscopic sleeve gastrectomy. 

C-peptide > 3 ng/ml is the most important predictor for a successful treatment for laparoscopic sleeve gastrectomy. 

Duodenum exclusion does play a role in surgical treatment of low BMI type 2 Diabetes Mellitus patients.





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http://sites.google.com/a/clos.net/mini/mgb-vs-sleeve-gastrectomy-random-trial


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Sleeve Gastrectomy Versus Mini-Gastric Bypass for the Treatment of Non-Morbid Obese Diabetic Patients: a Randomized Trial 

Presenter: W. J. Lee (Min-Sheng General Hospital, Taoyuan, Taiwan) 

Co-authors: J. Chen1, K. Ser 

Min-Sheng General Hospital, Taoyuan, Taiwan 

Background 

Bariatric Surgery leads to a dramatic improvement in morbid obesity associated type 2 Diabetes Mellitus (T2DM) but the mechanism remains speculative. 

This study compared the laparoscopic sleeve gastrectomy (LSG) and Mini-Gastric Bypass (MGB) in the treatment of type 2 Diabetes Mellitus, and to test the “fore-gut” hypothesis. 

Methods 
Patients aged 30 to 60 years, with poorly controlled type 2 Diabetes Mellitus (HbA1C gt 7.5%) and BMI between 35 and 25 were included and randomized to laparoscopic sleeve gastrectomy and Mini-Gastric Bypass. 

The end point is type 2 Diabetes Mellitus resolution, defined by fasting plasma glucose lt 126 mg/dl and HbA1C lt 6.5%. 

Results 

40 patients with a mean BMI 29 (24-34), age 45 (34-58) and HbA1C of 10.0% (8.0-15) were randomized to either laparoscopic sleeve gastrectomy (n = 20) or Mini-Gastric Bypass (n = 20). 

All procedures were successfully carried out with no deaths or major complication in either group. 

Minor complication occurred in 4 patients (10%). 

There was no difference in basic and peri-operative clinical parameters between the two groups. 

Minimum follow-up was 12 months (from 14 to 28 months). 

After surgery, both groups experienced a rapid decrease in fasting plasma glucose and insulin at 1st week. 

Body weight rapidly decreased up to 6 months and stabilized to 12 months in both groups. 

However, type 2 Diabetes Mellitus resolution rate 
was significantly better in Mini-Gastric Bypass than 
laparoscopic sleeve gastrectomy 
(MGB = 90% vs SG = 50%, p  0.05). 

Conclusion 

Although both are effective for type 2 Diabetes Mellitus with BMI lt 35, Mini-Gastric Bypass is more effective than laparoscopic sleeve gastrectomy. 

C-peptide g 3 ng/ml is the most important predictor for a successful treatment for laparoscopic sleeve gastrectomy. 

Duodenum exclusion does play a role in surgical treatment of low BMI type 2 Diabetes Mellitus patients.

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