Revisional large gastric pouch with Roux-en-Y gastric bypass for patients with type 2 diabetes and a body mass index less than 35 kg/m2: a cause and effect analysis

Purpose To evaluate the long-term efficacy of large gastric pouch surgery and revisional surgery in patients with a body mass index (BMI) < 35 kg/m(2) and type 2 diabetes mellitus (T2DM). Methods We conducted a retrospective review of patients who underwent laparoscopic Roux-en-Y gastrojejunostomy with a large gastric pouch in our hospital. The clinical pre- and post-surgery data, including BMI, waist circumference, fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), lipid metabolism-related indicators, homoeostatic model assessment of insulin resistance (HOMA-IR), and major complications, were recorded and analyzed. Results Twenty-four patients were included in the analysis, 12 of whom underwent revisional surgery. At their 5-year-follow-up after the primary surgery, the BMI and waist circumference of the patients with T2DM were lower than their baseline values. The BMI, HbA1c, HOMA-IR, FPG and waist circumference also decreased after the revisional surgery. The rates of remission of diabetes after the primary vs. after the revisional surgery were 4.17% vs. 41.70%, respectively (P < 0.05). Conclusion Roux-en-Y gastrojejunostomy with a large gastric pouch is not effective in the long term and, therefore, is unsuitable for Chinese patients with T2DM and a BMI < 35 kg/m(2). Conversely, revisional surgery has a definite effect on these patients.