Volume 24, Issue 105, November - December, 2020

Comparative study between Single Anastmosis Duodeno-ileal Bypass and one anastomosis-gastric bypass as regard remission of type-2 DM after application of DIAREM Scoring System

Alaa Abbas Sabry Moustafa¹, Moheb sharaby Eskandaros¹, Abdallah Hamed Ebrahim¹, Hany Khairy Mansour², Mina Mamdouh Nagi Ghali^1♦

¹Department of General Surgery, Faculty of Medicine-Ain Shams University, Arab republic of Egypt
²Department of Internal Medicine and Endocrinology, Faculty of Medicine-Ain Shams University, Arab republic of Egypt

^♦Corresponding author
Mina Mamdouh Nagi Ghali, Mobile: 01285413110; Email: n_billatos@yahoo.com

ABSTRACT

Background: Accumulating evidence obviously supports the superiority of weight loss surgery over non-surgical treatments for management of morbidly obese patients in terms of outcomes as sustained weight loss, improved quality of life and prevention, reduction, or resolution of co-morbidities (e.g., Type 2 Diabetes Mellitus, dyslipidemia), as well as reduced overall mortality. Objective: To compare Type 2 DM remission as well as the metabolic effects of 2 types of bariatric surgery; Single Anastomosis Duodeno-ileal Bypass-Sleeve (SADI-S) and One Anastomosis-Gastric bypass (OAGB), in the first year postoperative follow up in relation to DiaRem Scoring system. Methodology: This is a prospective randomized clinical trial study conducted in Ain-Shams University Hospitals bariatric surgery unit. The study started in March 2018 and ended in July 2020 - 2 years and 4 months - over 40 patients with minimal follow-up of 16 months. The 40 patients were divided equally into 2 groups (Group A: underwent O.A.G.B., Group B: underwent S.A.D.I-S). Results: Our study found that resolution of DM in SADIS patients initially occurred in 75% after 12 months increased to 80% after 15 months. However, in MGB patients it was 60% after 12 months and reached 65% after 15 months. Remission rates of SADIS patients under oral therapy is about 100% while MGB patients it was 92.3%, whereas patients under insulin therapy the number markedly goes down with shift to oral therapy or marked decrease in insulin requirements to control D.M. Conclusion: No statistical significant difference between both groups as regard remission of DM The main determinant noticed during the study influencing remission is the duration of DM and preoperative C-peptide level-in addition to HBA1C level. We recommend OAGB as a metabolic surgery for patients with early onset DM type II with BMI ranging from 30-40. The study needs to be repeated over larger sample size and longer duration to determine the long term effects of metabolic surgery.

Keywords: Single anastomosis duodeno-ileal bypass-sleeve, one anastomosis-gastric bypass

Medical Science, 2020, 24(106), 4098-4107

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