Surgical outcome of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass for resolution of type 2 diabetes mellitus: A systematic review and meta-analysis

BACKGROUND: Bariatric procedures are considered superior to medical therapies in managing type 2 diabetes mellitus (T2DM). Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used procedures for weight loss and comorbidity resolution worldwide. However, it is not yet known whether the degree of T2DM is influenced by the choice of bariatric procedure. AIM: To quantitatively compare T2DM resolution over 1-5 years follow-up by LRYGB and LSG in morbidly obese patients. METHODS: We searched the selected databases for full-text English language clinical studies that compared the effectiveness of LRYGB and LSG for T2DM resolution. Review manager 5.3 was used for data analysis, and the overall effect summary was represented in a forest plot. RESULTS: From 1,650 titles retrieved by an initial search, we selected nine studies for this research. We found insignificant differences for T2DM resolution by LRYGB and LSG, with an odds ratio of 0.93 (95%CI: 0.64-1.35, Z statistics = 0.38, P = 0.71). Additionally, subset analyses for T2DM resolution showed insignificant differences after 24 mo (χ(2) = 1.24, df = 4, P = 0.87, overall Z effect = 0.23), 36 mo (χ(2) = 0.41, df = 2, P = 0.81, overall Z effect = 0.51), and 60 mo (χ(2) = 4.75, df = 3, P = 0.19, overall Z effect = 1.20) by LRYGB and LSG. This study reports a T2DM remission rate of 82.3% by LRYGB and 80.7% by LSG. CONCLUSION: This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of follow-up. However, long-term follow-up of 10 years is needed to further substantiate these findings.