title: Comparison of the effects of Roux-en-Y gastrojejunostomy and LRYGB with small stomach pouch on type 2 diabetes mellitus in patients with BMI<35 kg/m(2).
abstract: BACKGROUND
  
  
  
  OBJECTIVE
  Based on distinct epidemiologic features of Chinese type 2 diabetes mellitus (T2DM) patients, who tend to have abdominal fat deposition, but with normal or mildly overweight epidemiologic features, our center initially had treated T2DM with body mass index (BMI)<35 kg/m² by performing laparoscopic Roux-en-Y gastrojejunostomy since 2008. This procedure is successful in treating abnormal glucose metabolism but not in improving abdominal visceral obesity. However, since 2011, laparoscopic Roux-Y gastric bypass (LRYGB) with a small stomach pouch has been performed at our center, with prominent resolution of abdominal visceral obesity and lower incidences of postoperative complications. The purpose of the present study was to formally compare these different procedures.
  
  
  METHODS
  From 2011 to 2013, 60 patients who met the NIH criteria were recruited and randomly assigned to undergo either laparoscopic Roux-en-Y gastrojejunostomy (n = 30) or LRYGB with a small stomach pouch (n = 30). All of the patients were followed for 12 months, and pre- and postoperative changes in BMI, waist circumference, fasting plasma glucose (FPG), postprandial plasma glucose (PBG), glycated hemoglobin (HbA1c), homoeostatic model assessment (HOMA-IR), the body fat rate and major complications were recorded.
  
  
  RESULTS
  Both procedures were successful in reducing HbA1c, FPG, and PBG levels and HOMA-IR scores. However, LRYGB with a small stomach pouch resulted in a greater reduction in FPG, PBG, and HbA1c levels, and HOMA-IR scores compared with Roux-en-Y gastrojejunostomy. In addition, the reductions in BMI, body fat content, waist circumference, and the incidence of postoperative marginal ulcers in the small-stomach-pouch LRYGB were significant.
  
  
  CONCLUSIONS
  Both procedures are effective treatments for T2DM patients with BMI<35 kg/m². However, the advantages of resolved abnormal glucose metabolism and abdominal visceral obesity and decreased incidences of surgical complications are more obvious for LRYGB with a small gastric pouch. Potentially, LRYGB with a small gastric pouch is more suitable for Chinese diabetic patients with BMI <35 kg/m².
authors.affiliation: Department of General Surgery, Third Xiangya Hospital, Central South University, People's Republic of China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yi
authors.affiliation: Department of General Surgery, Third Xiangya Hospital, Central South University, People's Republic of China.
authors.forename: Juan
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Department of General Surgery, Third Xiangya Hospital, Central South University, People's Republic of China.
authors.forename: Liyong
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Department of General Surgery, Third Xiangya Hospital, Central South University, People's Republic of China.
authors.forename: Pengzhou
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Surgery, Englewood Hospital and Medical Center, New Jersey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Im
authors.affiliation: Department of General Surgery, Third Xiangya Hospital, Central South University, People's Republic of China. Electronic address: zhushaihong@medmail.com.cn.
authors.forename: Shaihong
authors.initials: S
authors.lastname: Zhu
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D018570:Risk Assessment; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
keywords: Abdominal visceral obesity; Insulin resistance; Laparoscopic Roux-en-Y gastric bypass (LRYGB); Stomach pouch; T2DM with BMI<35 kg/m²