Three-year result of efficacy for type 2 diabetes mellitus control between laparoscopic duodenojejunal bypass compared with laparoscopic Roux-en-Y gastric bypass

Purpose: The mechanism by which bariatric surgery facilitates diabetic control is still unknown. Duodenojejunal bypass supports the foregut theory; however, its efficacy when used alone is not yet established. Methods: During the period from January 2008 to December 2009, patients who underwent laparoscopic duodenojejunal bypass [LDJB) or laparoscopic Roux-en-Y gastric bypass [LRYGB) for type 2 diabetes mellitus (T2DM) with or without morbid obesity were included. Patients who had a follow-up for less than 3 years were excluded. Patient baseline characteristics, change of body weight, body mass index (BMI), glycosylated hemoglobin (HbA(1c)), and diabetic treatments were analyzed. Results: In total, 8 LDJB and 20 LRYGB patients were analyzed. The LDJB group had more number of male patients than the LRYGB group (LDJB 75% vs. LRYGB 30%, P = 0.030). Baseline BMI in the LRYGB group was higher than in the LDJB group (LDJB 27.0 +/- 2.5 vs. LRYGB 32.6 +/- 3.4, P < 0.001). Age, DM duration, baseline HbA(1c), and C-peptide levels were similar. Longer operation time was needed to perform LDJB (LDJB 367.5 +/- 120.2 vs. LRYGB 232.9 +/- 4-1.1, P < 0.001), but no differences were observed in the hospital stay and complication rate between the 2 groups. At the third year of follow-up, the T2DM remission rate was observed in 40% of patients in the LRYGB group and 12.5% of patients in the LDJB group. Conclusion: LDJB is not an effective method for controlling T2DM compared with LRYGB. Foregut theory may not be the main mechanism of diabetic control during bariatric surgery.