Body weight, insulin resistance, and serum adipokine levels 2 years after 2 types of bariatric surgery. Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus? Cost-effectiveness of Roux-en-Y gastric bypass in type 2 diabetes patients. Modified Roux-en-Y gastric bypass for type 2 diabetes mellitus in China. Comparison of short-term outcome of laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: A prospective randomized controlled multicenter SLEEVEPASS study with 6-month follow-up Roux-en-Y gastric bypass and calorie restriction induce comparable time-dependent effects on thyroid hormone function tests in obese female subjects. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial Very Low–Calorie Diet Mimics the Early Beneficial Effect of Roux-en-Y Gastric Bypass on Insulin Sensitivity and β-Cell Function in Type 2 Diabetic Patients Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. Long-long limb Roux-en-Y gastric bypass is more efficacious in treatment of type 2 diabetes and lipid disorders in super-obese patients. Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: a randomized controlled trial. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial The role of bile after Roux-en-Y gastric bypass in promoting weight loss and improving glycaemic control. Omentectomy added to Roux-en-Y gastric bypass surgery: a randomized, controlled trial. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomised, controlled trial. Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Type II Diabetes Mellitus in Chinese Patients with Body Mass Index of 25–35 Long-Term Outcomes of Laparoscopic Roux-en-Y Gastric Bypass in US Veterans Evaluation of Health Status and Quality of Life after Bariatric Surgery: Comparison of Standard Roux-en-Y Gastric Bypass, Vertical Banded Gastroplasty and Laparoscopic Adjustable Silicone Gastric Banding Long‐term results of a randomized clinical trial comparing Roux‐en‐$\hbox{Y}$ gastric bypass with vertical banded gastroplasty Long-term effects of laparoscopic sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28-35 kg/m2 Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass. First Report from the American College of Surgeons Bariatric Surgery Center Network: Laparoscopic Sleeve Gastrectomy has Morbidity and Effectiveness Positioned Between the Band and the Bypass
OBJECTIVE Bariatric surgery reverses obesity-related comorbidities , including type 2 diabetes mellitus . Several studies have already described differences in anthropometrics and body composition in patients undergoing Roux-en-Y gastric bypass compared with laparoscopic adjustable gastric b and ing  , but the role of adipokines in the outcomes after the different types of surgery is not known . Differences in weight loss and reversal of insulin resistance exist between the 2 groups and correlate with changes in adipokines . METHODS Fifteen severely obese women ( mean body mass index [ BMI ] : 46.7 kg/m(2 ) ) underwent 2 types of laparoscopic weight loss surgery ( Roux-en-Y gastric bypass=10 , adjustable gastric b and ing=5 ) .  Weight , waist and hip circumference , body composition , plasma metabolic markers , and lipids were measured at set intervals during a 24-month period after surgery . RESULTS At 24 months , patients who underwent Roux-en-Y were overweight ( BMI 29.7 kg/m(2 ) ) , whereas patients who underwent gastric b and ing remained obese ( BMI 36.3 kg/m(2 ) ) . Patients who underwent Roux-en-Y lost significantly more fat mass than patients who underwent gastric b and ing ( mean difference 16.8 kg , P<.05 ) . Likewise , leptin levels were lower in the patients who underwent Roux-en-Y ( P=.003 ) , and levels correlated with weight loss , loss of fat mass , insulin levels , and Homeostasis Model of Assessment 2 . Adiponectin correlated with insulin levels and Homeostasis Model of Assessment 2 ( r=-0.653 , P=.04 and r=-0.674 , P=.032 , respectively ) in the patients who underwent Roux-en-Y at 24 months . CONCLUSION After 2 years , weight loss and normalization of metabolic parameters were less pronounced in patients who underwent gastric b and ing  compared with patients who underwent Roux-en-Y gastric bypass . Our findings require confirmation in a prospect i ve r and omized trial BACKGROUND The surgical treatment of diabetes had witnessed progressive development and success since the first case of pancreatic transplantation . Although this was a great step , wide clinical application was limited by several factors . Bariatric surgery such as gastric bypass is emerging as a promising option in obese patients with type 2 diabetes . The aim of this article is to explore the current application of gastric bypass in patients with type 2 diabetes and the theoretical bases of gastric bypass as a treatment option for type 1 diabetes . METHODS We performed a MEDLINE search for articles published from August 1955 to December 2008 using the words " surgical treatment of diabetes , " " etiology of diabetes " and " gastric bypass . " RESULTS We identified 3215 studies and selected 72 relevant papers for review . Surgical treatment of diabetes is evolving from complex pancreatic and islets transplantation surgery for type 1 diabetes with critical postoperative outcome and follow-up to a metabolic surgery , including gastric bypass . Gastric bypass ( no immune suppression or graft rejection ) has proven to be highly effective treatment for obese patients and nonobese animals with type 2 diabetes . There are certain shared criteria between types 1 and 2 diabetes , making a selected spectrum of the disease a potential target for metabolic surgery to improve or cure diabetes . CONCLUSION Roux-en-Y gastric bypass is a promising option for lifelong treatment of type 2 diabetes . It has the potential to improve or cure a selected spectrum of type 1 diabetes when performed early in the disease . Further animal model studies or r and omized controlled trials are needed to support our conclusion OBJECTIVE To assess the cost-effectiveness of Roux-en-Y gastric bypass for treating  type 2 diabetes mellitus ( T2DM ) in the United States compared with st and ard medical management , using clinical data from a prospect i ve observational study conducted at an academic medical center . STUDY DESIGN Our study used a predictive health economic model ( the CORE Diabetes Model ) to project the long-term costs and clinical effectiveness of Roux-en-Y gastric bypass as a treatment for T2DM using the prospect i ve observational study as the basis for our clinical effectiveness assumptions . METHODS The CORE Diabetes Model used Monte Carlo simulation with tracker variables to estimate the lifetime costs and clinical outcomes of Roux-en-Y gastric bypass compared with st and ard medical management of obese T2DM patients . Sensitivity analyses were performed on key clinical assumptions , discount rates , and shorter time horizons . RESULTS The base-case scenario yielded an incremental cost-effectiveness ratio ( ICER ) of $ 21,973 per quality -adjusted life-year ( QALY ) gained . In sensitivity analyses , shortening the time horizon to 5 and 10 years and excluding the negative impact of increased body mass index on the patient 's quality of life had the greatest adverse impact on the ICERs ( ie , higher cost per QALY ) . CONCLUSIONS Under base-case assumptions , Roux-en-Y gastric bypass is cost-effective in the treatment of T2DM in the United States with an ICER below $ 50,000 per QALY gained . Sensitivity analyses indicated that bariatric surgery is not cost-effective over shorter time horizons , or if the negative quality -of-life impact of increased body mass index is ignored BACKGROUND / AIMS This study aim ed to evaluate the efficacy of modified Roux-en-Y gastric bypass for type 2 diabetes mellitus . METHODOLOGY Forty-five type 2 diabetes mellitus patients underwent modified Roux-en-Y gastric bypass at WeiFang People 's Hospital . Data on patient demographics , fasting plasma glucose ( FPG ) , body mass index ( BMI ) , medication use , remission and hemoglobin A1c ( HbAlc ) were prospect ively collected and analyzed . RESULTS At 6 months after surgery , all of these 45 patients obtained remission or a marked improvement . FPG was in the normal range in 39 ( 86.7 % ) patients stopping medicine treatment for their diabetes . Six patients ( 13.3 % ) had an obvious reduced abnormal FPG and they only required lower drug dosage . No statistically significant differences were found between the obese or non-obese groups ( p=0.311 ) . The mean BMI dropped from 28.9±3.0 kg/m2 to 27.4±2.8 kg/m2 ( p=0.000 ) at the third month and 26.3±2.5 kg/m2 ( p=0.000 ) at the sixth month . HbAlc decreased from their preoperative values of 7.4%±2.2 % to 6.3%±1.5 % ( p=0.000 ) at the third month and 5.1%±0.9 % ( p=0.000 ) at the sixth month . CONCLUSIONS Modified Roux-en-Y gastric bypass was effective in treating  type 2 diabetes mellitus , independent of body mass index Background and Aims : The long-term efficacy of laparoscopic Roux-en-Y gastric bypass in the treatment of morbid obesity has already been demonstrated . Laparoscopic sleeve gastrectomy has shown promising short-term results , but the long-term efficacy is still unclear . The aim of this prospect i ve r and omized multicenter study is to compare the results of Roux-en-Y gastric bypass and sleeve gastrectomy . Material and Methods : A total of 240 morbidly obese patients were r and omized to undergo either Roux-en-Y gastric bypass or sleeve gastrectomy .  The primary end point of study was weight loss , and the secondary end points were resolution of comorbidities and morbidity . The short-term results at 6 months were analyzed . Results : The mean excess weight loss at 6 months was 49.2 % in the sleeve gastrectomy group and 52.9 % in the Roux-en-Y gastric bypass group ( p = 0.086 ) . Type 2 diabetes was resolved or improved in 84.3 % of patients in the sleeve gastrectomy group and 93.3 % in the Roux-en-Y gastric bypass group ( p = 0.585 ) . The corresponding results for arterial hypertension were 76.8 % and 81.9 % ( p = 0.707 ) and for hypercholesterolemia 64.1 % and 69.0 % ( p = 0.485 ) . There was no mortality at 6 months . There was one major complication following sleeve gastrectomy and two after Roux-en-Y gastric bypass ( p = 0.531 ) . Eight sleeve gastrectomy patients and 11 Roux-en-Y gastric bypass patients had minor complications ( p = 0.403 ) . Conclusion : The short-term results of sleeve gastrectomy and Roux-en-Y gastric bypass regarding weight loss , resolution of obesity-related comorbidities and complications were not different at 6 months OBJECTIVE Obesity and weight loss influence thyroid hormone physiology . The effects of weight loss by calorie restriction vs Roux-en-Y gastric bypass ( RYGB ) in obese subjects have not been studied in parallel . We hypothesized that differences in transient systemic inflammation and catabolic state between the intervention types could lead to differential effects on thyroid hormone physiology . DESIGN AND METHODS We recruited 12 lean and 27 obese females with normal fasting glucose ( normal glucose tolerant ( NGT ) ) and 27 obese females with type 2 diabetes mellitus ( T2DM ) for this study . Weight loss was achieved by restrictive treatment ( gastric b and ing or high-protein-low-calorie diet ) or by RYGB .  Fasting serum leptin , TSH , triiodothyronine ( T₃ ) , reverse T₃ ( rT₃ ) , and free thyroxine ( fT₄ ) concentrations were measured at baseline and 3 weeks and 3 months after the start of the interventions . RESULTS Obesity was associated with higher TSH , T₃ , and rT₃ levels and normal fT₄ levels in all the subjects when compared with the controls . After 3 weeks , calorie restriction and RYGB induced a decline in TSH levels and a rise in rT₃ and fT₄ levels . The increase in rT₃ levels correlated with serum interleukin 8 ( IL8 ) and IL6 levels . After 3 months , fT₄ and rT₃ levels returned to baseline levels , whereas TSH and T₃ levels were persistently decreased when compared with baseline levels . No differences in the effects on thyroid hormone parameters between the interventions or between NGT and T2DM subjects were observed at any time point . CONCLUSIONS In summary , weight loss directly influences thyroid hormone regulation , independently of the weight loss strategy used . The effects may be explained by a combination of decreased leptin levels and transient changes in peripheral thyroid hormone metabolism Importance Sleeve gastrectomy is increasingly used in the treatment of morbid obesity , but its long-term outcome vs the st and ard Roux-en-Y gastric bypass procedure is unknown . Objective To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss , changes in comorbidities , increase in quality of life , and adverse events . Design , Setting , and Participants The Swiss Multicenter Bypass or Sleeve Study ( SM-BOSS ) , a 2-group r and omized trial , was conducted from January 2007 until November 2011 ( last follow-up in March 2017 ) . Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers , 217 patients were enrolled and r and omly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period . Interventions Patients were r and omly assigned to undergo laparoscopic sleeve gastrectomy ( n = 107 ) or laparoscopic Roux-en-Y gastric bypass ( n = 110 ) . Main Outcomes and Measures The primary end point was weight loss , expressed as percentage excess body mass index ( BMI ) loss . Exploratory end points were changes in comorbidities and adverse events . Results Among the 217 patients ( mean age , 45.5 years ; 72 % women ; mean BMI , 43.9 ) 205 ( 94.5 % ) completed the trial . Excess BMI loss was not significantly different at 5 years : for sleeve gastrectomy , 61.1 % , vs Roux-en-Y gastric bypass , 68.3 % ( absolute difference , −7.18 % ; 95 % CI , −14.30 % to −0.06 % ; P = .22 after adjustment for multiple comparisons ) . Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass ( 60.4 % ) than after sleeve gastrectomy ( 25.0 % ) . Gastric reflux worsened ( more symptoms or increase in therapy ) more often after sleeve gastrectomy ( 31.8 % ) than after Roux-en-Y gastric bypass ( 6.3 % ) . The number of patients with reoperations or interventions was 16/101 ( 15.8 % ) after sleeve gastrectomy and 23/104 ( 22.1 % ) after Roux-en-Y gastric bypass . Conclusions and Relevance Among patients with morbid obesity , there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass at 5 years of follow-up after surgery . Trial Registration clinical trials.gov Identifier : Marked improvement in glycemic control occurs in patients with type 2 diabetes mellitus shortly after Roux-en-Y gastric bypass surgery ( RYGB )  and before there is major weight loss . The objective of this study was to determine whether the magnitude of this change is primarily due to caloric restriction or is unique to the surgical procedure . We studied eleven subjects who underwent RYGB and fourteen subjects mean-matched for BMI , HbA1c , and diabetes duration who were admitted to our inpatient research unit and given a very low – calorie diet ( VLCD ) of 500 kcal/day with a macronutrient content similar to that consumed by patients after RYGB . Frequently sample d intravenous glucose tolerance tests were performed before and after interventions . Both groups lost an equivalent amount of weight over a mean study period of 21 days . Insulin sensitivity , acute insulin secretion after intravenous glucose administration , and β-cell function as determined by disposition index improved to a similar extent in both groups . Likewise , changes in fasting glucose and fructosamine levels were similar . Based on these data , VLCD improves insulin sensitivity and β-cell function just as well as RYGB in the short term IMPORTANCE Controlling glycemia , blood pressure , and cholesterol is important for patients with diabetes . How best to achieve this goal is unknown . OBJECTIVE To compare Roux-en-Y gastric bypass with lifestyle and intensive medical management to achieve control of comorbid risk factors . DESIGN , SETTING , AND PARTICIPANTS A 12-month , 2-group unblinded r and omized trial at 4 teaching hospitals in the United States and Taiwan involving 120 participants who had a hemoglobin A1c ( HbA1c ) level of 8.0 % or higher , body mass index ( BMI ) between 30.0 and 39.9 , C peptide level of more than 1.0 ng/mL , and type 2 diabetes for at least 6 months . The study began in April 2008 . INTERVENTIONS Lifestyle-intensive medical management intervention and Roux-en-Y gastric bypass surgery . Medications for hyperglycemia , hypertension , and dyslipidemia were prescribed according to protocol and surgical techniques that were st and ardized . MAIN OUTCOMES AND MEASURES Composite goal of HbA1c less than 7.0 % , low-density lipoprotein cholesterol less than 100 mg/dL , and systolic blood pressure less than 130 mm Hg . RESULTS All 120 patients received the intensive lifestyle-medical management protocol and 60 were r and omly assigned to undergo Roux-en-Y gastric bypass . After 12-months , 28 participants ( 49 % ; 95 % CI , 36%-63 % ) in the gastric bypass group and 11 ( 19 % ; 95 % CI , 10%-32 % ) in the lifestyle-medical management group achieved the primary end points ( odds ratio [ OR ] , 4.8 ; 95 % CI , 1.9 - 11.7 ) . Participants in the gastric bypass group required 3.0 fewer medications ( mean , 1.7 vs 4.8 ; 95 % CI for the difference , 2.3 - 3.6 ) and lost 26.1 % vs 7.9 % of their initial body weigh compared with the lifestyle-medical management group ( difference , 17.5 % ; 95 % CI , 14.2%-20.7 % ) . Regression analyses indicated that achieving the composite end point was primarily attributable to weight loss . There were 22 serious adverse events in the gastric bypass group , including 1 cardiovascular event , and 15 in the lifestyle-medical management group . There were 4 perioperative complications and 6 late postoperative complications . The gastric bypass group experienced more nutritional deficiency than the lifestyle-medical management group . CONCLUSIONS AND RELEVANCE In mild to moderately obese patients with type 2 diabetes , adding gastric bypass surgery to lifestyle and medical management was associated with a greater likelihood of achieving the composite goal . Potential benefits of adding gastric bypass surgery to the best lifestyle and medical management strategies of diabetes must be weighed against the risk of serious adverse events . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00641251 BACKGROUND Super-obese patients can achieve adequate weight loss with long limb Roux-en-Y gastric bypass ( RYGB ) . These patients , however , might need longer intestinal limbs to control co-morbidities such as type 2 diabetes , lipid disorders , hypertension , sleep apnea , and gastroesophageal reflux disorder . METHODS A total of 105 patients with a body mass index of > or = 50 kg/m(2 ) were r and omly divided into 2 similar groups regarding sex , age , and number of co-morbidities . All underwent laparoscopic Roux-en-Y gastric bypass .  In group 1 , the length of the biliary limb was 50 cm and the length of the Roux limb was 150 cm . In group 2 , the length of the biliary limb was 100 cm and the length of the Roux limb was 250 cm . RESULTS The follow-up for both group was 48 months . Diabetes was controlled in 58 % of group 1 and in 93 % of group 2 ( P < 0.05 ) . Lipid disorders improved in 57 % of group 1 and in 70 % of group 2 ( P < 0.05 ) . No statistical difference was found in the control or improvement of hypertension , sleep apnea , or gastroesophageal reflux disorder . The excess weight loss was faster in group 1 but was similar in both groups at 48 months ( 70 % in group 1 and 74 % in group 2 ) , with no statistical difference . CONCLUSION Patients with longer biliary and Roux limbs achieved greater type 2 diabetes control , greater lipid disorder improvement , and showed a trend toward faster excess weight loss AIMS The aim of this study was to evaluate the effect of laparoscopic Roux-en-Y gastric bypass ( RYGB ) surgery compared with usual care with and without Exenatide therapy in obese people with type 2 diabetes mellitus ( T2DM ) and hypertension . METHODS 108 obese T2DM with hypertension were enrolled and r and omly allocated to usual care ( group A ) , usual care plus Exenatide ( group B ) , and RYGB surgery ( group C ) . Demographic characteristics , metabolic parameters and cardiac structure/function along with inflammatory cytokines were measured and compared before and after 12 months . RESULTS At 12 months , diabetes remission had occurred in no patients in groups A and B versus 90 % in group C , and there was a significant decrease in requirement of antihypertensive drugs in group C compared with groups A and B ( P<0.05 ) . Other parameters ( body mass index , hemoglobin A1c , homeostasis model assessment of insulin resistance , lipids ) , inflammation index ( high sensitivity C-reactive protein , tumor necrosis factor-α , high molecular weight adiponectin ) and cardiac structure ( left ventricular mass index ) were significantly improved in groups B and C , but patients in group C had the greatest degree of improvement ( P<0.05 ) . CONCLUSION RYGB surgery improves a number of parameters including cardiovascular function in obese hypertensive people with T2DM . This is likely to be due to , at least in part , an improvement in the abnormal metabolic panel and to reduced inflammation Importance Laparoscopic sleeve gastrectomy for treatment of morbid obesity has increased substantially despite the lack of long-term results compared with laparoscopic Roux-en-Y gastric bypass . Objective To determine whether laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass are equivalent for weight loss at 5 years in patients with morbid obesity . Design , Setting , and Participants The Sleeve vs Bypass ( SLEEVEPASS ) multicenter , multisurgeon , open-label , r and omized clinical equivalence trial was conducted from March 2008 until June 2010 in Finl and . The trial enrolled 240 morbidly obese patients aged 18 to 60 years , who were r and omly assigned to sleeve gastrectomy or gastric bypass with a 5-year follow-up period ( last follow-up , October 14 , 2015 ) . Interventions Laparoscopic sleeve gastrectomy ( n = 121 ) or laparoscopic Roux-en-Y gastric bypass ( n = 119 ) . Main Outcomes and Measures The primary end point was weight loss evaluated by percentage excess weight loss . Prespecified equivalence margins for the clinical significance of weight loss differences between gastric bypass and sleeve gastrectomy were −9 % to + 9 % excess weight loss . Secondary end points included resolution of comorbidities , improvement of quality of life ( QOL ) , all adverse events ( overall morbidity ) , and mortality . Results Among 240 patients r and omized ( mean age , 48 [ SD , 9 ] years ; mean baseline body mass index , 45.9 , [ SD , 6.0 ] ; 69.6 % women ) , 80.4 % completed the 5-year follow-up . At baseline , 42.1 % had type 2 diabetes , 34.6 % dyslipidemia , and 70.8 % hypertension . The estimated mean percentage excess weight loss at 5 years was 49 % ( 95 % CI , 45%-52 % ) after sleeve gastrectomy and 57 % ( 95 % CI , 53%-61 % ) after gastric bypass ( difference , 8.2 percentage units [ 95 % CI , 3.2%-13.2 % ] , higher in the gastric bypass group ) and did not meet criteria for equivalence . Complete or partial remission of type 2 diabetes was seen in 37 % ( n = 15/41 ) after sleeve gastrectomy and in 45 % ( n = 18/40 ) after gastric bypass ( P > .99 ) . Medication for dyslipidemia was discontinued in 47 % ( n = 14/30 ) after sleeve gastrectomy and 60 % ( n = 24/40 ) after gastric bypass ( P = .15 ) and for hypertension in 29 % ( n = 20/68 ) and 51 % ( n = 37/73 ) ( P = .02 ) , respectively . There was no statistically significant difference in QOL between groups ( P = .85 ) and no treatment-related mortality . At 5 years the overall morbidity rate was 19 % ( n = 23 ) for sleeve gastrectomy and 26 % ( n = 31 ) for gastric bypass ( P = .19 ) . Conclusions and Relevance Among patients with morbid obesity , use of laparoscopic sleeve gastrectomy compared with use of laparoscopic Roux-en-Y gastric bypass did not meet criteria for equivalence in terms of percentage excess weight loss at 5 years . Although gastric bypass compared with sleeve gastrectomy was associated with greater percentage excess weight loss at 5 years , the difference was not statistically significant , based on the prespecified equivalence margins . Trial Registration clinical trials.gov Identifier : Gastric bypass leads to the remission of  type 2 diabetes  independently of weight loss . Our hypothesis is that changes in bile flow due to the altered anatomy may partly explain the metabolic outcomes of the operation . We prospect ively studied 12 patients undergoing gastric bypass and six patients undergoing gastric b and ing over a 6-wk period . Plasma fibroblast growth factor (FGF)19 , stimulated by bile acid absorption in the terminal ileum , and plasma bile acids were measured . In canine and rodent models , we investigated changes in the gut hormone response after altered bile flow . FGF19 and total plasma bile acids levels increased after gastric bypass compared with no change after gastric b and ing . In the canine model , both food and bile , on their own , stimulated satiety gut hormone responses . However , when combined , the response was doubled . In rats , drainage of endogenous bile into the terminal ileum was associated with an enhanced satiety gut hormone response , reduced food intake , and lower body weight . In conclusion , after gastric bypass , bile flow is altered , leading to increased plasma bile acids , FGF19 , incretin . and satiety gut hormone concentrations . Elucidating the mechanism of action of gastric bypass surgery may lead to novel treatments for type 2 diabetes BACKGROUND Excess visceral adipose tissue predicts for incipient diabetes mellitus and cardiovascular disease . Human data are mixed regarding the benefits of selective visceral adipose tissue reduction . We investigated the effects of omentectomy added to laparoscopic Roux-en-Y gastric bypass on glucose homeostasis and lipids , inflammatory markers , and adipokines 90 days postoperatively in nondiabetic patients at the Legacy Good Samaritan Hospital and Oregon Health and Science University ( Portl and , OR ) . METHODS A single-blind , r and omized study of laparoscopic Roux-en-Y gastric bypass plus omentectomy versus laparoscopic Roux-en-Y gastric bypass alone in 28 subjects ( 7 men and 21 women ) . The groups were matched at baseline for gender , age , and body mass index ( BMI ) . The eligibility criteria included age ≥18 years , BMI ≥40 and < 50 kg/m(2 ) without co-morbid conditions or BMI ≥35 and < 50 kg/m(2 ) with co-morbid conditions . The primary outcome measures were changes in the fasting plasma glucose , insulin , and homostatic model assessment of insulin resistance . The secondary measures were BMI and the high-sensitivity C-reactive protein , tumor necrosis factor-α , interleukin , total and high-molecular-weight adiponectin , fibrinogen , and plasminogen activator inhibitor-1 levels . RESULTS After surgery , the BMI decreased significantly in both groups and was not different at the follow-up point . Although many outcome parameters improved with weight loss in both groups postoperatively , only the omentectomy group experienced statistically significant decreases in fasting glucose ( P < .05 ) , total ( P = .004 ) and very-low-density lipoprotein ( P = .001 ) cholesterol , and an increase in the high-molecular-weight/total adiponectin ratio ( P = .013 ) . CONCLUSIONS Omentectomy added to laparoscopic Roux-en-Y gastric bypass results in favorable changes in glucose homeostasis , lipid levels , and adipokine profile at 90 days postoperatively . These data support the hypothesis that selective ablation of visceral adipose tissue conveys metabolic benefits in nondiabetic humans BACKGROUND The short-term benefits of bariatric surgery are well documented ; however , few reports with data beyond 10 years exist . Those that have been published have described only open procedures . We present our 10-year follow-up results with  laparoscopic Roux-en-Y gastric bypass with h and -sewn gastrojejunal anastomosis in a group private practice . METHODS We performed an institutional review board-approved retrospective review of a prospect ively maintained data base , combined with office visits and telephone question naires , for patients who underwent laparoscopic Roux-en-Y gastric bypass between February 1998 and April 1999 . RESULTS A total of 242 patients underwent surgery from February 1998 to April 1999 . The office follow-up rate was 33 % at 2 years and 7 % at 10 years . An additional 19 % had telephone follow-up at 10 years . The mean excess weight loss was 57 % at 10 years . Of the 242 patients , 65 ( 33.2 % ) failed to achieve an excess weight loss of > 50 % ; 86 ( 35 % ) had ≥1 complication during follow-up . However , 83 % , 87 % , 67 % , and 76 % of patients with diabetes , hypertension , dyslipidemia , and obstructive sleep apnea , respectively , experienced improvement or resolution . The internal hernia rate was 16 % , and the gastrojejunal stenosis rate was 4.9 % . No surgery-related deaths occurred . Of the 242 patients , 136 ( 51 % ) had nutritional testing at least once after postoperative year 1 . Of these 136 patients , only 24 ( 18 % ) had remained nutritionally intact during follow-up . CONCLUSION The obstacles to follow-up have continued to impede the collection of accurate long-term data . Of the 26 % of patients with data , laparoscopic Roux-en-Y gastric bypass provided sustainable weight loss and resolution of co-morbidities . However , nutritional deficiencies presented sporadically over time and underscore the importance of routine testing BACKGROUND Conventional treatments for patients with type 2 diabetes are often inadequate . We aim ed to assess outcomes of diabetes control and treatment risks 2 years after adding Roux-en-Y gastric bypass to intensive lifestyle and medical management . METHODS We report 2-year outcomes of a 5-year r and omised trial ( the Diabetes Surgery Study ) at four teaching hospitals ( three in the USA and one in Taiwan ) . At baseline , eligible participants had to have HbA1c of at least 8·0 % ( 64 mmol/mol ) , BMI between 30·0 and 39·9 kg/m(2 ) , and type 2 diabetes for at least 6 months , and be aged 30 - 67 years . We r and omly assigned participants to receive either intensive lifestyle and medical management alone ( lifestyle and medical management ) , or lifestyle and medical management plus st and ard Roux-en-Y gastric bypass surgery ( gastric bypass ) . Staff from the clinical centres had access to data from individual patients , but were masked to other patients ' data and aggregated data until the 2-year follow-up . Drugs for hyperglycaemia , hypertension , and dyslipidaemia were prescribed by protocol . The primary endpoint was achievement of the composite treatment goal of HbA1c less than 7·0 % ( 53 mmol/mol ) , LDL cholesterol less than 2·59 mmol/L , and systolic blood pressure less than 130 mm Hg at 12 months ; here we report the composite outcome and other pre-planned secondary outcomes at 24 months . Analyses were done on an intention-to-treat basis , with multiple imputations for missing data . This study is registered with Clinical Trials.gov , number NCT00641251 , and is still ongoing . FINDINGS Between April 21 , 2008 , and Nov 21 , 2011 , we r and omly assigned 120 eligible patients to either lifestyle and medical management alone ( n=60 ) or with the addition of gastric bypass ( n=60 ) . One patient in the lifestyle and medical management group died ( from pancreatic cancer ) , thus 119 were included in the primary analysis . Significantly more participants in the gastric bypass group achieved the composite triple endpoint at 24 months than in the lifestyle and medical management group ( 26 [ 43 % ] vs eight [ 14 % ] ; odds ratio 5·1 [ 95 % CI 2·0 - 12·6 ] , p=0·0004 ) , mainly through improved glycaemic control ( HbA1c < 7·0 % [ 53 mmol/mol ] in 45 [ 75 % ] vs 14 [ 24 % ] ; treatment difference -1·9 % ( -2·5 to -1·4 ) ; p=0·0001 ) . 46 clinical ly important adverse events occurred in the gastric bypass group and 25 in the lifestyle and medical management group ( mainly infections in both groups [ four in the lifestyle and medical management group , eight in the gastric bypass group ] ) . With a negative binomial model adjusted for site , the event rate for the gastric bypass group was non-significantly higher than the lifestyle and medical management group by a factor of 1·67 ( 95 % CI 0·98 - 2·87 , p=0·06 ) . Across both years of the study , the gastric bypass group had seven serious falls with five fractures , compared with three serious falls and one fracture in the lifestyle and medical management group . All fractures happened in women . Many more nutritional deficiencies occurred in the gastric bypass group ( mainly deficiencies in iron , albumin , calcium , and vitamin D ) , despite protocol use of nutritional supplements . INTERPRETATION The addition of gastric bypass to lifestyle and medical management in patients with type 2 diabetes improved diabetes control , but adverse events and nutritional deficiencies were more frequent . Larger and longer studies are needed to investigate whether the benefits and risk of gastric bypass for type 2 diabetes can be balanced . FUNDING Covidien , National Institutes of Health , National Institute of Diabetes and Digestive and Kidney Diseases Nutrition Obesity Research Centers , and the National Center for Advancing Translational Sciences Background Laparoscopic Roux-en-Y gastric bypass ( LRYGB ) can dramatically ameliorate  type 2 diabetes mellitus ( T2DM ) in morbidly obese patients . However , there is little evidence supporting the effectiveness of LRYGB in low body mass index ( BMI ) patients . The study was design ed to evaluate the safety and results of LRYGB for achieving T2DM remission in patients with BMI in the range of 25–35 kg/m2 . Methods Twenty-two patients ( two men and 20 women ) with T2DM underwent LRYGB .  Data on patient demographics , BMI , co-morbidities , and details of diabetes mellitus , including disease duration , family history , medication use , and remission , were prospect ively collected and analyzed . Results The mean age was 47 years ( range , 28–63 years ) , mean BMI was 30.81 ( range , 25.00–34.80 kg/m2 ) , and mean duration of T2DM onset was 6.57 years ( range , 1–20 years ) . Sixteen ( 72.27 % ) patients had a family history of T2DM . There was no mortality , but two ( 9 % ) patients experienced complications : an early gastrojejunostomy hemorrhage and frequent loose stools that required revision surgery . At 12 months , 14 ( 63.6 % ) patients showed T2DM remission , six ( 27.3 % ) showed glycemic control , and two ( 9.1 % ) showed improvement . The group achieving remission had a higher BMI ( p = 0.001 ) , younger age ( p = 0.002 ) , and shorter duration of diabetes ( p = 0.001 ) . These three factors may be predictors of diabetes resolution at 12 months . Conclusion Early intervention in low- BMI patients yields better remission rates because age , BMI , and duration of T2DM predict glycemic outcomes Background The objective of this study is to evaluate the long-term outcomes following  laparoscopic Roux-en-Y gastric bypass ( LREYGB ) in veteran patients . The VA bariatric population differs from its counterpart in the private sector by the predominance of a male population , a higher percentage of patients from a lower socioeconomic background , a higher mean age , and a higher rate of obesity-related comorbidities . Methods A retrospective review with prospect ively collected data was used to analyze postoperative changes of comorbidities and percent of excess weight loss ( % EWL ) in consecutive patients who underwent LREYGB between August 2003 and September 2006 . Results Among 70 patients , 73 % were men with a mean age of 52 years ( 29–66 years ) . Average preoperative weight and body mass index were 310 lbs ( 224–397 lbs ) and 46 kg/m2 ( 36–60 kg/m2 ) , respectively . The incidence of major and minor complications was 1.4 % and 15.7 % , respectively . There were no mortalities . Follow-up ( f/u ) was possible in all patients . At a mean f/u rate of 39 months , % EWL was 56 % . At 1 , 3 , and 5 years , % EWL was 61 % , 53 % , and 59 % , respectively . Thirty-five patients ( 50 % ) had type 2 diabetes mellitus ( T2DM ) . Glycosylated hemoglobin concentrations returned to normal levels in 91 % of patients and improved in an additional 6 % of T2DM cases . Only 7 % of patients are still maintained on antidiabetic medications . In patients with more than 1 year f/u , most other comorbidities were improved or resolved . Conclusions Long-term f/u of LREYGB in veteran patients demonstrated significant and durable weight loss ( 56 % EWL ) with marked improvements in comorbidities especially T2DM Background : This study is a trial to compare the effects and outcomes of three different  bariatric procedures performed in two centers .  St and ard Roux-en-Y gastric bypass was performed by Dr. Norman Samuels in Fort Lauderdale ( Florida ) ; vertical b and ed gastroplasty and laparoscopic adjustable silicone gastric b and ing were done in Hallein ( Salzburg ) by Dr. Emanuel Hell and Dr. Karl Miller . Methods : In a prospect i ve comparative study 30 matched patients from each group were followed to assess post-operative improvement in health status and quality of life , to compare the three different techniques . The  Bariatric Analysis and Reporting Outcome System ( BAROS  ) as described by Oria and Moorehead has been used for evaluation . Results : The observation time was at least 3 years ( 3 to 8 years ) in each individual case . A significant increase in quality of life and health status in 75 % of the surgically-treated patients was observed when compared with a non-operated control group of morbidly obese patients . Conclusions : By utilizing BAROS it has been found possible to compare the results of different procedures done by different surgeons with different techniques , utilizing patients from different cultures and with different language s. The results of this comparative study favor the st and ard gastric bypass for the treatment of morbid obesity . This operation is superior to purely gastric restrictive procedures in weight loss and improvement of quality of life The long‐term results of Roux‐en‐$\hbox{Y}$ gastric bypass ( gastric bypass ) and vertical b and ed gastroplasty ( VBG ) from r and omized studies have not been described in detail Background To compare long term effects of two bariatric procedures for Chinese type 2 diabetes mellitus ( T2DM ) patients with a body mass index ( BMI ) of 28 - 35 kg/m2 . Methods Sixty four T2DM patients with Glycated hemoglobin A1c ( HbA1c ) ≧ 7.0 % were r and omly assigned to receive laparoscopic sleeve gastrectomy ( SG ) or Roux-en-Y gastric bypass ( RYGB ) procedure . Weight , percentage of excess weight loss ( % EWL ) , BMI , waist circumference , HbA1c , fasting blood glucose ( FBG ) , and C-peptide were measured . Serum lipid levels were also measured during three-year postoperative follow-up visits . Results Fifty five patients completed the 36-month follow-up . Both groups had similar baseline anthropometric and biochemical measures . At the end point , 22 patients ( 78.6 % ) in SG group and 23 patients ( 85.2 % ) in RYGB group achieved complete remission of diabetes mellitus with HbA1c < 6.0 % ( P = 0.525 ) and without taking diabetic medications , and 25 patients in each group ( 89.3 % vs. 92.6 % ) gained successful treatment of diabetes with HbA1c≦6.5 % ( P = 0.100 ) . Change in HbA1c , FBG and C peptide were comparable in the two groups . The RYGB group had significantly greater weight loss than the SG group [ percentage of total weight loss ( % TWL ) of 31.0 % vs. 27.1 % ( P = 0.049 ) , % EWL of 92.3 % vs. 81.9 % ( P = 0.003 ) , and change in BMI of 11.0 vs. 9.1 kg/m2(P = 0.017 ) , respectively ] . Serum lipids in each group were also greatly improved . Conclusion In this three-year study , SG had similar positive effects on diabetes and dyslipidemia compared to RYGB in Chinese T2DM patients with BMI of 28 - 35 kg/m2 . Longer term follow-ups and larger sample studies are needed to confirm these outcomes , however BACKGROUND Laparoscopic gastric bypass is a technically dem and ing operation , especially when h and -sewing is required . Robotics may help facilitate the performance of this difficult operation . This study was undertaken to compare a single surgeon 's results using the daVinci Surgical System with those using traditional laparoscopic Roux-en-Y gastric bypass ( LRYGB ) when the techniques were learned simultaneously . METHODS From July 2004 to April 2005 , the new laparoscopic fellow 's first 50 patients were r and omized to undergo either LRYGB or totally robotic laparoscopic Roux-en-Y gastric bypass ( TRRYGB ) .  Data were collected on patient age , gender , body mass index ( BMI ) , co-morbidities , operative time , complication rates , and length of stay . Student 's t test with unequal variances was used for statistical analysis . RESULTS No significant differences in age , gender , co-morbidities , complication rates , or length of stay were found between the two groups . The mean operating time was significantly shorter for TRRYGB than for LRYGB ( 130.8 versus 149.4 minutes ; P = 0.02 ) , with a significant difference in minutes per BMI ( 2.94 versus 3.47 min/ BMI ; P = 0.02 ) . The largest difference was in patients with a BMI > 43 kg/m(2 ) , for whom the difference in procedure time was 29.6 minutes ( 123.5 minutes for TRRYGB versus 153.2 minutes for LRYGB ; P = 0.009 ) and a significant difference in minutes per BMI ( 2.49 versus 3.24 min/ BMI ; P = 0.009 ) . CONCLUSION Our data indicate that the use of the daVinci Surgical System for TRRYGB is safe and feasible . The operating room time is shorter with the use of the robotic system during a surgeon 's learning curve , and that decrease is maximized in patients with a larger BMI . TRRYGB may be a better approach to gastric bypass when h and -sewing is required , especially early in a surgeon 's experience Objective : To assess the safety and effectiveness of the laparoscopic sleeve gastrectomy ( LSG )  as compared to the laparoscopic adjustable gastric b and ( LAGB ) , the laparoscopic Roux-en-Y gastric bypass ( LRYGB ) and the open Roux-en-Y gastric bypass ( ORYGB ) for the treatment of obesity and obesity-related diseases . Background : LSG is a newer procedure being done with increasing frequency . However , limited data are currently available comparing LSG to the other established procedures . We present the first prospect i ve , multiinstitutional , nationwide , clinical ly rich , bariatric-specific data comparing  sleeve gastrectomy to the adjustable gastric b and , and the gastric bypass . Methods : This is the initial report analyzing data from the American College of Surgeons — Bariatric Surgery Center Network accreditation program , and its prospect i ve , longitudinal , data collection system based on st and ardized definitions and collected by trained data review ers . Univariate and multivariate analyses compare 30-day , 6-month , and 1-year outcomes including morbidity and mortality , readmissions , and reoperations as well as reduction in body mass index ( BMI ) and weight-related comorbidities . Results : One hundred nine hospitals su bmi tted data for 28,616 patients , from July , 2007 to September , 2010 . The LSG has higher risk-adjusted morbidity , readmission and reoperation/intervention rates compared to the LAGB , but lower reoperation/intervention rates compared to the LRYGB and ORYGB . There were no differences in mortality . Reduction in BMI and most of the weight-related comorbidities after the LSG also lies between those of the LAGB and the LRYGB/ORYGB . Conclusion : LSG has morbidity and effectiveness positioned between the LAGB and the LRYGB/ORYGB for data up to 1 year . As obesity is a lifelong disease , longer term comparative effectiveness data are most critical , and are yet to be determined
Bariatric surgery leads to marked and long-lasting weight reduction .
A large proportion of patients undergoing bariatric surgery have DM2 .
Glycemic control improves in the months after laparoscopic adjustable gastric b and ing , but it improves more rapidly and completely after laparoscopic Roux-en-Y gastric bypass surgery .
Thus , both types of surgery are capable of improving or even curing DM2 , but the mechanisms may differ
OBJECTIVE To systematic ally review the literature pertaining to the reversal of  type 2 diabetes mellitus ( DM2 ) after Roux-en-Y gastric bypass and adjustable gastric b and ing .