Saturday, July 27, 2019

Laparoscopic Roux-En-Y Gastric Bypass vs Sleeve Gastrectomy for Weight Loss and Type 2 Diabetes

Today, more and more U.S. citizens are  experiencing obesity and type 2 diabetes. Furthermore, obesity and type 2 diabetes among children are also at high levels. Usually, bariatric surgery is used to treat obesity. But some forms of bariatric surgery are being viewed as a viable treatment for type 2 diabetes. Two frequently used bariatric surgery methods in use today, for weight loss, are laparoscopic roux-en-y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG). And both of these surgical methods are also considered to be viable treatments for type 2 diabetes. But one study suggests that gastric bypass surgery may be the most effective treatment, in general, for obesity and type 2 diabetes.

RYGB and LSG are similar in one respect: both surgeries "modify the upper gastrointestinal tract anatomy." And this characteristic appears to make gastric bypass and sleeve gastrectomy more effective at weight loss and type 2 diabetes management than other forms of bariatric surgery.
However, a recent study shows that gastric bypass surgery may be the best choice in most cases. The study was a meta-analysis consisting of 16 randomized controlled trials. Eleven hundred thirty-two overweight or obese patients were included in the analysis.

The investigators concluded that "RYGB is more effective than SG in improving weight loss and short- and mid-term glycaemic and lipid metabolism control in patients with and without T2DM. Therefore, unless contraindicated, RYGB should be the first choice to treat patients with obesity and T2DM ..."

Of course there may be contraindications and other potential issues to consider when deciding on the appropriate surgery. For example, the possibility of reintervention should be kept in mind. One study showed that "[LSG] has significantly lower risk of reintervention in all categories studied when compared with RYGB at 5-year follow-up.

[Indeed,] the long-term safety profile of LSG compared with RYGB should be an essential part of the discussion in patient-centered decision making when choosing between bariatric procedure options." And under the right conditions, LSG could be the best choice. 


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