Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2020; 26(8): 865-876
Published online Feb 28, 2020. doi: 10.3748/wjg.v26.i8.865
Surgical outcome of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass for resolution of type 2 diabetes mellitus: A systematic review and meta-analysis
Salman Yousuf Guraya, Tim Strate
Salman Yousuf Guraya, Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
Tim Strate, Department of Surgery, Reinbek Hospital, Academic Teaching Hospital of the University of Hamburg, Reinbek D-21465, Germany
Author contributions: Guraya SY designed the research, performed literature search, systematic review, meta-analysis and prepared first and final draft of the article; Strate T reviewed the initial and final results of literature search and contributed in data selection; Both authors approved the final draft.
Conflict-of-interest statement: The authors deny any conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Salman Yousuf Guraya, FRCS (Gen Surg), Director, Full Professor, Surgeon, Vice Dean College of Medicine, Head Surgery Unit, Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates. salmanguraya@gmail.com
Received: September 24, 2019
Peer-review started: September 24, 2019
First decision: November 27, 2019
Revised: December 23, 2019
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: February 28, 2020
Processing time: 156 Days and 18.9 Hours
Abstract
BACKGROUND

Bariatric procedures are considered superior to medical therapies in managing type 2 diabetes mellitus (T2DM). Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used procedures for weight loss and comorbidity resolution worldwide. However, it is not yet known whether the degree of T2DM is influenced by the choice of bariatric procedure.

AIM

To quantitatively compare T2DM resolution over 1-5 years follow-up by LRYGB and LSG in morbidly obese patients.

METHODS

We searched the selected databases for full-text English language clinical studies that compared the effectiveness of LRYGB and LSG for T2DM resolution. Review manager 5.3 was used for data analysis, and the overall effect summary was represented in a forest plot.

RESULTS

From 1,650 titles retrieved by an initial search, we selected nine studies for this research. We found insignificant differences for T2DM resolution by LRYGB and LSG, with an odds ratio of 0.93 (95%CI: 0.64-1.35, Z statistics = 0.38, P = 0.71). Additionally, subset analyses for T2DM resolution showed insignificant differences after 24 mo (χ2 = 1.24, df = 4, P = 0.87, overall Z effect = 0.23), 36 mo (χ2 = 0.41, df = 2, P = 0.81, overall Z effect = 0.51), and 60 mo (χ2 = 4.75, df = 3, P = 0.19, overall Z effect = 1.20) by LRYGB and LSG. This study reports a T2DM remission rate of 82.3% by LRYGB and 80.7% by LSG.

CONCLUSION

This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of follow-up. However, long-term follow-up of 10 years is needed to further substantiate these findings.

Keywords: Morbid obesity; Type 2 diabetes mellitus; Laparoscopic sleeve gastrectomy; Laparoscopic Roux-en-Y gastric bypass

Core tip: Based on our research findings, both laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy can be used for type 2 diabetes mellitus resolution in morbidly obese patients.