Loop versus Roux-en-Y duodenojejunal bypass with sleeve gastrectomy for type 2 diabetes: short-term outcomes of a single-center randomized controlled trial

Background: Duodenojejunal bypass with sleeve gastrectomy (DJB-SG) is a novel bariatric surgery composed of sleeve gastrectomy (SG) and duodenojejunal anastomosis. Both loop and Roux-en-Y DJB-SGs were reported to have acceptable hypoglycemic and weight loss outcomes, but it remains unclear which reconstruction method is better regarding therapeutic efficacy and safety for type 2 dia-betes (T2D).Objective: This study was undertaken to prospectively compare the short-term therapeutic outcomes and surgical safety of loop versus Roux-en-Y DJB-SG.Setting: University hospital.Methods: A total of 96 patients with T2D with body mass index of 27.5-40 kg/m2 were randomized in a 1:1 ratio to undergo loop or Roux-en-Y DJB-SG from January 2020 to December 2020. The pri-mary end point was to determine the 1-year T2D remission rate. Additionally, medical cost, operative outcomes, weight loss, metabolic improvement, nutritional status, and gastrointestinal disorders at 1-year follow-up also were determined.Results: The preoperative data were comparable at baseline. The 1-year follow-up rate was 89.6% (43 of 48 patients) for loop DJB-SG and 93.8% (45 of 48 patients) for Roux-en-Y DJB-SG. The T2D remission rates were 93.02% (40 of 43) for loop DJB-SG and 88.89% (40 of 45) for Roux -en-Y DJB-SG at 1-year follow-up. Loop DJB-SG patients exhibited higher total weight loss (30.85% +/- 7.24% versus 26.11% +/- 7.12%), shorter operative times, and less medical cost than Roux-en-Y DJB-SG patients. However, there was no statistical difference regarding lipid profiles, major postoperative complications, nutritional status, and gastrointestinal disorders between the 2 groups.Conclusion: Despite similar hypoglycemic effects, loop DJB-SG was simpler and exhibited better weight loss and less medical cost than Roux-en-Y DJB-SG. Thus, loop DJB-SG was better than Roux-en-Y DJB-SG for T2D. (Surg Obes Relat Dis 2022;18:1277-1285.) (c) 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.