title: Five-Year-Results of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Weight Loss and Type 2 Diabetes Mellitus.
abstract: Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) has been designated as a novel bariatric surgery procedure. This combination of sleeve gastrectomy and proximal intestinal bypass theoretically offers an effective and prolonged anti-diabetes effect. This is a follow-up of our institution's previous report on the short-term effects of LSG-DJB on type 2 diabetes mellitus (T2DM), which a 68.7 % remission (HbA1c <6 % without diabetes medication) rate 1 year after surgery. The aforementioned result was comparable to the reported remission rates of laparoscopic Roux-en-Y gastric bypass. However, the durability of remission remains unknown.
  
  
  
  The objective of this study is to investigate the medium-term (up to 5 years) effects of LSG-DJB on weight loss and T2DM.
  
  
  
  In this analysis, consecutive 120 patients (female to male ratio = 61:59, mean age = 44.8 years) with T2DM who underwent LSG-DJB from April 2007 to November 2013 and were followed up beyond 1 year were included. The preoperative mean body weight and BMI were 105.7 kg and 38.5 kg/m2, respectively. The mean HbA1c and fasting blood glucose values were 8.9 % and 194 mg/dL, respectively. The mean duration of T2DM was 7.3 years. Fifty-five patients (46 %) were being treated with insulin prior to surgery.
  
  
  
  The follow-up rate was 97.5 % at 1 year, 73.3 % at 3 years, and 50.0 % at 5 years. The mean body weight was 74.9 kg at 1 year, 76.8 kg at 3 years, and 72.8 kg at 5 years (p < 0.001, compared to the baseline). The mean percent of total body weight loss (%TWL) was 28.9, 28.6, and 30.7 % at 1, 3, and 5 years, respectively. Remission of T2DM was achieved at 63.6, 55.3, and 63.6 % at 1, 3, and 5 years, respectively. Among those who achieved diabetes remission at 1 year, 10.8 % of them experienced recurrence during the subsequent follow-up period.
  
  
  
  Although recurrence of T2DM is observed in some patients over time, LSG-DJB is an effective procedure for achieving significant weight loss and improvement of glycemic control, and the effects seem to be durable up to 5 years.
authors.affiliation: Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan. yosuke_seki@hotmail.com.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Seki
authors.affiliation: Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kasama
authors.affiliation: Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Haruta
authors.affiliation: Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Center for Clinical Research, Okinawa Prefectural Chubu Hospital, Okinawa, Japan.
authors.forename: Renzo
authors.initials: R
authors.lastname: Yokoyama
authors.affiliation: Weight Management and Bariatric-Metabolic Surgery Center, St. Luke's Medical Center, Quezon, City, Philippines.
authors.forename: Jose Paolo Cabreira
authors.initials: JP
authors.lastname: Porciuncula
authors.affiliation: Department of Surgery, Yotsuya Medical Cube, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Umezawa
authors.affiliation: Department of Surgery, Yotsuya Medical Cube, Tokyo, Japan.
authors.forename: Yoshimochi
authors.initials: Y
authors.lastname: Kurokawa
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D004334:Drug Administration Schedule; D004386:Duodenum / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D007581:Jejunoileal Bypass / Q000009:adverse effects / Q000379:methods*; D007583:Jejunum / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012074:Remission Induction; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Asian; Diabetes; Duodenojejunal bypass; Japanese; Medium-term; Sleeve gastrectomy