| Background:Many prospective studies and reviews show that Roux-en-Y gastric bypass (LRYGB) can dramatically ameliorate type2diabetes mellitus (T2DM) in morbidly obese patients. The U.S. National Institutes of Health recommends RYGB surgery for obese people with a body mass index (BMI) of at least40, and for people with BMI35and serious coexisting medical conditions such as diabetes, but studies have shown that the risk for metabolic syndrome in Asians starts at a relatively normal level of BMI mainly due to their higher percentage and central distribution of body fats when compared to Caucasians and although BMI is convenient to classify the grade of obesity, it does not seem to be appropriate in selecting the suitable T2DM candidates for metabolic surgery. In the wake of these observations, lowering the BMI cutoffs for surgery will lead to a significant rise in the percentage of obese population eligible for surgery, which will in turn have an enormous impact on the public health policies of individual countries. But there is little evidence supporting the effectiveness of LRYGB in low body mass index (BMI) patients suffering from diabetes.Objective:To explore the effect of RYGB on BMI25-30kg/m2patients suffering from T2DM and further investigate if different gastric pouch size created during RYGB is a key factor influencing the outcomes in diabetic resolution.Methods:study was done on non obese diabetes patients who underwent LRYGB at the Department of General Surgery in the Third Xiangya Hospital, Central South University. Altogether Total40cases were involved; twenty patients with gastric pouch of>50ml (Group A) and twenty patients with gastric pouch of<50ml (Group B).Outcomes of each surgery were evaluated with the help of blood parameters like Oral glucose tolerance test (OGTT) at (0,30,60,120min), HblAC, BMI and waist hip ratio were evaluated preoperatively and following at1month,3months,6months and1year within the group respectively. After the effective outcome these two groups (Group A and Group B) comparative study of blood parameters like Oral glucose tolerance test (OGTT) at (0,30,60,120min), Hb1AC, BMI and waist hip ratio between the groups were done at1month,3months,6months and1year and lastly post operative complications were evaluated.Results:1)In both groups OGTT (A and B) at0minute,30,60, and120min blood glucose level when compared with preoperative value, decreased significantly (P<0.01) at1month,3month,6month and1year postoperatively, but when comparison were made between the groups (A vs. B) no significant difference (p>0.05) was found.HbA1c when compared (Group A and Group B) at1month,3month,6month and1year postoperatively, were significantly decreased in both the groups (P<0.01) but when comparison were made between the groups no significant difference was found (p>0.05).2)In both groups BMI was not significantly reduced during the first month but after3months there was significant difference in BMI(p<0.01) and following months at6month and1year (p<0.05) when compared pre operatively. But Waist hip ratio was also significantly reduced (p<0.01) at1month,3month,6month and1year in both the groups but when compared between two groups there was no significant difference was seen (p>0.05).3) RYGB surgery may be associated with certain complications mainly of jejunal and anastomotic site ulcers and patient having larger gastric pouch was associated with more risk of jejunal and anastomotic ulcers.Conclusions:1)The Roux-en-Y gastric bypass surgery shows improvement of glucose metabolism therefore may be reliable and effective treatment in diabetic patients with BMI25-30kg/m2, but it is also associated with some complications like marginal ulcerations, strictures and bleeding.2) The Roux-en-Y gastric bypass surgery with different stomach pouch has no hypoglycemic differences, indicating that there is no obvious connection between the stomach pouch size and hypoglycemic effects. We speculated that the exclusion of the duodenum and proximal jejunum is closely related to improve glucose metabolism. |
PDF Full Text Request