Background

Standard Roux-en-Y gastric bypass (RYGB) may not ensure adequate weight loss or improvement of comorbidities in patients with body mass index (BMI) ≥50kg/m2. Objectives: Evaluate if distal RYGB (50cm biliopancreatic and 150cm common channel) improves BMI loss and remission of type 2 diabetes compared to standard RYGB (50cm biliopancreatic and 150cm alimentary limb) in patients with BMI 50-60kg/m2.

Methods

113 patients were randomized to standard (n=57) or distal (n=56) RYGB. Patients and follow-up personnel were blinded. Group comparison was performed using ANCOVA or Fisher’s exact test as appropriate.

Results

At five years, 48 (84%) patients with standard and 44 (79%) with distal RYGB attended follow-up. Mean(SD) BMI loss was 15.3(5.8) kg/m2after standard and 15.5(5.5) kg/m2after distal RYGB (p=0.82).Mean HbA1c level was 5.4(0.7)% after standard and 5.2(0.6)% after distal RYGB (p=0.013). Seven of 10 patients after standard (70%) and 10 of 13 after distal RYGB (77%) achieved complete diabetes remission (p=1.00). Two patients in both groups had partial remission. One patient in each group had unchanged diabetes status; both preoperative insulin users. There was no de-novo diabetes. Mean (95% CI) HbA1c reduction for subjects with diabetes was -1.6(-0.5,-2.5) and -2.1(-1.3,-2.8), respectively (p=0.11).Ten of 12 patients after standard (83%) and seven of eight patients after distal RYGB (88%) had remission of prediabetes (HbA1c:5.7-6.4%), with complete normoglycemia after five years (p=1.00).

Conclusions

We observed comparable BMI loss five years after standard and distal RYGB. Both procedures had high and comparable diabetes and prediabetes remission rates.