The Clinical Research Of The Modified Laparoscopic Roux-en-Y Gastric Bypass For Type 2 Diabetes Mellitus

Objective: Type 2 diabetes mellitus (T2DM) has been believed to be one of incurable medical diseases. Although Roux-en-Y gastric bypass (RYGB) is reported to cure T2DM, this treatment is always accompanied by a variety of postoperative malabsorption of nutrients. In China, most of the T2DM patients are non-obese. We designed improved laparoscopic Roux-en-Y gastric bypass (LRYGB). We compared the effects of LRYGB with that of RYGB, through observing the therapeutic effect and postoperative nutritional status, aiming to searching for the best treatment for T2DM patients in our country. Methods: From July 2007 to July 2010, 28 T2DM patients meeting the requirements of this experiment were selected. These patients received one of the 4 types of RYGB surgery, including 3 types of LRYGB and the classic RYGB. The type of surgery was determined randomly by the same operator before the surgery. And the patients were divided into 4 groups according to the surgery.Results: Through follow up visit for one year after the surgery, we observed that all the T2DM patients were cured and clinical effective rate was 100%. However, postoperative complications, nutrition absorption obstacles in particular, and the changes of body mass index (BMI) were different among groups. The BMI in A and B groups was not changed significantly, with the least complications. The BMI in D group decreased significantly, in which group all cases have appeared the symptom of various nutrient deficiency. The rate of controlling blood glucose is faster in C and D groups than that of A and B groups. After 6 month, curative effect can be achieved by all the treatment.Conclusions: In China, non-obese and mild obese patients account for most of the T2DM patients. In these patients, the percentage and distribution of fat is abnormal and abnormal glucose tolerance induced by insulin resistance appears earlier. And early surgical treatment is advocated. LRYGB could not only cure T2DM and abnormal glucose tolerance but also decrease malnutrition complications ultimately. LRYGB is an ideal choice for the treatment of T2DM patients in our country.