Research Advancement of Roux-en-Y Gastric Bypass in Treatment for Type 2 Diabetes Mellitus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHOUYu-long , HANXiao-dong , DIJian-zhong ,  ZHANGPin

Department of General Surgery, The Affiliated Sixth Hospital of Medical School, Shanghai Jiao-tong University, Shanghai 200233, China;

Corresponding author：

ZHANGPin, Email: zpinzyl@126.com

Keywords：

Roux-en-Y gastric bypass; Type 2 diabetes mellitus; Treatment

DOI：

10.7507/1007-9424.20140060

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand the status of Roux-en-Y gastric bypass (RYGB) surgery for treating type 2 diabetes mellitus, and to summarize its effectiveness and existing problems. Method The related literatures which discussed the treatment for type 2 diabetes mellitus by RYGB were reviewed and analyzed. Results The therapeutic effect of RYGB for type 2 diabetes mellitus with obesity was tentatively confirmed.But the underlying mechanism was unclear.And there was no standard length of exclusion of the Roux loop and biliopancreatic loop.Postoperative long-term effect was unknown.Whether RYGB was suitable for non-obese type 2 diabetes mellitus that needed further to be rese-arched. Conclusions The mechanism of RYGB surgery in treatment for type 2 diabetes mellitus is complex.With the progress of basic and clinical research, the improvement of surgical technique, the elucidation of the mechanism, the affirmation of the long-term effect, and there are more benefits in patients with type 2 diabetes mellitus.

Citation： ZHOUYu-long, HANXiao-dong, DIJian-zhong, ZHANGPin. Research Advancement of Roux-en-Y Gastric Bypass in Treatment for Type 2 Diabetes Mellitus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(2): 246-250. doi: 10.7507/1007-9424.20140060 Copy

1.	Yang W, Lu J, Weng J, et al.Prevalence of diabetes among men and women in China[J].N Engl J Med, 2010, 362(12):1090-1101.
2.	Pories WJ, Swanson MS, MacDonald KG, et al.Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus[J].Ann Surg, 1995, 222(3):339-350.
3.	Buchwald H, Oien DM.Metabolic/bariatric surgery worldwide 2011[J].Obes Surg, 2013, 23(4):427-436.
4.	Pu YD, Li JQ, Cao ZY, et al.Clinical observation of gastric bypass in treatment of type 2 diabetes[J].Chin Med J (Engl), 2012, 125(11):1899-1902.
5.	Proczko-Markuszewska M, Stefaniak T, Kaska L, et al.Impact of Roux-en-Y gastric bypass on regulation of diabetes type 2 in morbidly obese patients[J].Surg Endosc, 2012, 26(8):2202-2207.
6.	Peterli R, Steinert RE, Woelnerhanssen B, et al.Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy:a randomized, prospective trial[J].Obes Surg, 2012, 22(5):740-748.
7.	Falkén Y, Hellström PM, Holst JJ, et al.Changes in glucose homeostasis after Roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery:role of gut peptides[J].J Clin Endocrinol Metab, 2011, 96(7):2227-2235.
8.	Mingrone G, Panunzi S, De Gaetano A, et al.Bariatric surgery versus conventional medical therapy for type 2 diabetes[J].N Engl J Med, 2012, 366(17):1577-1585.
9.	Schauer PR, Kashyap SR, Wolski K, et al.Bariatric surgery versus intensive medical therapy in obese patients with diabetes[J].N Engl J Med, 2012, 366(17):1567-1576.
10.	Ahima RS, Sabri A.Bariatric surgery:metabolic benefits beyond weight loss[J].Gastroenterology, 2011, 141(3):793-795.
11.	中华医学会糖尿病学分会, 中华医学会外科学分会.手术治疗糖尿病专家共识[J].中华糖尿病杂志, 2011, 3(3):205-208.
12.	Nett PC.Bariatric and metabolic surgery[J].J Ther Umsch, 2013, 70(2):119-122.
13.	Anderwald CH, Tura A, Promintzer-Schifferl M, et al.Alterations in gastrointestinal, endocrine, and metabolic processes after bariatric Roux-en-Y gastric bypass surgery[J].Diabetes Care, 2012, 35(12):2580-2587.
14.	Attiah MA, Halpern CH, Balmuri U, et al.Durability of Roux-en-Y gastric bypass surgery:a meta-regression study[J].Ann Surg, 2012, 256(2):251-254.
15.	Buchwald H, Estok R, Fahrbach K, et al.Trends in mortality in bariatric surgery:a systematic review and meta-analysis[J].Surgery, 2007, 142(4):621-632.
16.	Csendes A, Burgos AM, Braghetto I.Classification and management of leaks after gastric bypass for patients with morbid obesity:a prospective study of 60 patients[J].Obes Surg, 2012, 22(6):855-862.
17.	Sjöström L, Lindroos AK, Peltonen M, et al.Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery[J].N Engl J Med, 2004, 351(26):2683-2693.
18.	Flum DR, Belle SH, King WC, et al.Perioperative safety in the longitudinal assessment of bariatric surgery[J].N Engl J Med, 2009, 361(5):445-454.
19.	Santry HP, Gillen DL, Lauderdale DS.Trends in bariatric surgical procedures[J].JAMA, 2005, 294(15):1909-1917.
20.	Champion JK, Williams M.Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass[J].Obes Surg, 2003, 13(4):596-600.
21.	Praveen Raj P, Senthilnathan P, Kumaravel R, et al.Concomitant laparoscopic ventral hernia mesh repair and bariatric surgery:a retrospective study from a tertiary care center[J].Obes Surg, 2012, 22(5):685-689.
22.	Carucci LR, Turner MA, Shaylor SD.Internal hernia following Roux-en-Y gastric bypass surgery for morbid obesity:evaluation of radiographic findings at small-bowel examination[J].Radiology, 2009, 251(3):762-770.
23.	Laurenius A, Olbers T, Näslund I, et al.Dumping syndrome follo-wing gastric bypass:validation of the dumping symptom rating scale[J].Obes Surg, 2013, 23(6):740-755.
24.	Banerjee A, Ding Y, Mikami DJ, et al.The role of dumping syndrome in weight loss after gastric bypass surgery[J].Surg Endosc, 2013, 27(5):1573-1578.
25.	Halperin F, Goldfine AB.Metabolic surgery for type 2 diabetes:efficacy and risks[J].Curr Opin Endocrinol Diabetes Obes, 2013, 20(2):98-105.
26.	Buchwald H, Estok R, Fahrbach K, et al.Weight and type 2 diabetes after bariatric surgery:systematic review and meta-analysis[J].Am J Med, 2009, 122(3):248-256.e5.
27.	American Society for Metabolic and Bariatric Surgery Clinical Issues Committee.American Society for Metabolic and Bariatric Surgery position statement on global bariatric healthcare[J].Surg Obes Relat Dis, 2011, 7(6):669-671.
28.	郑成竹, 刘沛."2010中国糖尿病手术治疗高峰论坛暨专家共识大会"会议纪要[J].中国实用外科杂志, 2010, 30(7):576-577.
29.	Carrasco F, Rojas P, Csendes A, et al.Changes in ghrelin concen-trations one year after resective and non-resective gastric bypass:associations with weight loss and energy and macronutrient intakes[J].Nutrition, 2012, 28(7-8):757-761.
30.	To VT, Hüttl TP, Lang R, et al.Changes in body weight, glucose homeostasis, lipid profiles, and metabolic syndrome after restrictive bariatric surgery[J].Exp Clin Endocrinol Diabetes, 2012, 120(9):547-552.
31.	Camastra S, Gastaldelli A, Mari A, et al.Early and longer term effects of gastric bypass surgery on tissue-specific insulin sensitivity and beta cell function in morbidly obese patients with and without type 2 diabetes[J].Diabetologia, 2011, 54(8):2093-2102.
32.	Perugini RA, Malkani S.Remission of type 2 diabetes mellitus following bariatric surgery:review of mechanisms and presentation of the concept of 'reversibility'[J].Curr Opin Endocrinol Diabetes Obes, 2011, 18(2):119-128.
33.	Laferrère B.Effect of gastric bypass surgery on the incretins[J].Diabetes Metab, 2009, 35(6 Pt 2):513-517.
34.	Shin AC, Zheng H, Pistell PJ, et al.Roux-en-Y gastric bypass surgery changes food reward in rats[J].Int J Obes (Lond), 2011, 35(5):642-651.
35.	Tichansky DS, Glatt AR, Madan AK, et al.Decrease in sweet taste in rats after gastric bypass surgery[J].Surg Endosc, 2011, 25(4):1176-1181.
36.	Zheng H, Shin AC, Lenard NR, et al.Meal patterns, satiety, and food choice in a rat model of Roux-en-Y gastric bypass surgery[J].Am J Physiol Regul Integr Comp Physiol, 2009, 297(5):1273-1282.
37.	Ley RE.Obesity and the human microbiome[J].Curr Opin Gas-troenterol, 2010, 26(1):5-11.
38.	Mozes S, Bujnáková D, Sefcíková Z, et al.Intestinal microflora and obesity in rats[J].Folia Microbiol (Praha), 2008, 53(3):225-228.
39.	Kashyap SR, Bhatt DL, Wolski K, et al.Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes:analysis of a randomized control trial comparing surgery with intensive medical treatment[J].Diabetes Care, 2013, 36(8):2175-2182.
40.	Orci L, Chilcott M, Huber O.Short versus long Roux-limb length in Roux-en-Y gastric bypass surgery for the treatment of morbid and super obesity:a systematic review of the literature[J].Obes Surg, 2011, 21(6):797-804.
41.	Teeple EA, Teich S, Schuster DP, et al.Early metabolic improve-ment following bariatric surgery in morbidly obese adolescents[J].Pediatr Blood Cancer, 2012, 58(1):112-116.
42.	Aarts EO, van Wageningen B, Janssen I MC, et al.Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity[J].J Obes, 2012, 2012:193705.
43.	Jiménez A, Perea V, Corcelles R, et al.Metabolic effects of bariatric surgery in insulin-sensitive morbidly obese subjects[J].Obes Surg, 2013, 23(4):494-500.
44.	De Flines J, Franck M, Rorive M, et al.Metabolic surgery:an increasing place in the management of diabetes[J].Rev Med Suisse, 2012, 8(351):1621-1624, 1626-1627.
45.	Fujioka K, DiBaise JK, Martindale RG.Nutrition and metabolic complications after bariatric surgery and their treatment[J].JPEN J Parenter Enteral Nutr, 2011, 35(5 Suppl):52S-59S.
46.	Gianotti L, Braga M.Revising concepts of artificial nutrition in contemporary surgery:from energy and Nitrogen to immuno-meta-bolic support[J].Nutr Hosp, 2011, 26(1):56-67.
47.	Rubino F, Kaplan LM, Schauer PR, et al.The diabetes surgery summit consensus conference:recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus[J].Ann Surg, 2010, 251(3):399-405.
48.	Shimizu H, Timratana P, Schauer PR, et al.Review of metabolic.
49.	surgery for type 2 diabetes in patients with a BMI < 35 kg/m²[J]. J Obes, 2012, 2012:147256.
50.	Reis CE, Alvarez-Leite JI, Bressan J, et al.Role of bariatric-metabolic surgery in the treatment of obese type 2 diabetes with body mass index < 35 kg/m²:a literature review[J].Diabetes Technol Ther, 2012, 14(4):365-372.
51.	Fried M, Ribaric G, Buchwald JN, et al.Metabolic surgery for the treatment of type 2 diabetes in patients with BMI < 35 kg/m²:an integrative review of early studies[J].Obes Surg, 2010, 20(6):776-790.
52.	谢锦桃, 刘军, 伍远征, 等.2011年美国糖尿病协会糖尿病诊疗标准执行纲要解读[J].中国全科医学, 2011, 14(18):1993-1997.
53.	王存川, 翟贺宁.规范与务实-促进我国肥胖症与代谢病外科的健康发展[J].中华胃肠外科杂志, 2012, 15(11):1102-1105.
54.	Huang CK, Shabbir A, Lo CH, et al.Laparoscopic Roux-en-Y gastric bypass for the treatment of typeⅡdiabetes mellitus in Chi-nese patients with body mass index of 25-35[J].Obes Surg, 2011, 21(9):1344-1349.

1. Yang W, Lu J, Weng J, et al.Prevalence of diabetes among men and women in China[J].N Engl J Med, 2010, 362(12):1090-1101.
2. Pories WJ, Swanson MS, MacDonald KG, et al.Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus[J].Ann Surg, 1995, 222(3):339-350.
3. Buchwald H, Oien DM.Metabolic/bariatric surgery worldwide 2011[J].Obes Surg, 2013, 23(4):427-436.
4. Pu YD, Li JQ, Cao ZY, et al.Clinical observation of gastric bypass in treatment of type 2 diabetes[J].Chin Med J (Engl), 2012, 125(11):1899-1902.
5. Proczko-Markuszewska M, Stefaniak T, Kaska L, et al.Impact of Roux-en-Y gastric bypass on regulation of diabetes type 2 in morbidly obese patients[J].Surg Endosc, 2012, 26(8):2202-2207.
6. Peterli R, Steinert RE, Woelnerhanssen B, et al.Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy:a randomized, prospective trial[J].Obes Surg, 2012, 22(5):740-748.
7. Falkén Y, Hellström PM, Holst JJ, et al.Changes in glucose homeostasis after Roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery:role of gut peptides[J].J Clin Endocrinol Metab, 2011, 96(7):2227-2235.
8. Mingrone G, Panunzi S, De Gaetano A, et al.Bariatric surgery versus conventional medical therapy for type 2 diabetes[J].N Engl J Med, 2012, 366(17):1577-1585.
9. Schauer PR, Kashyap SR, Wolski K, et al.Bariatric surgery versus intensive medical therapy in obese patients with diabetes[J].N Engl J Med, 2012, 366(17):1567-1576.
10. Ahima RS, Sabri A.Bariatric surgery:metabolic benefits beyond weight loss[J].Gastroenterology, 2011, 141(3):793-795.
11. 中华医学会糖尿病学分会, 中华医学会外科学分会.手术治疗糖尿病专家共识[J].中华糖尿病杂志, 2011, 3(3):205-208.
12. Nett PC.Bariatric and metabolic surgery[J].J Ther Umsch, 2013, 70(2):119-122.
13. Anderwald CH, Tura A, Promintzer-Schifferl M, et al.Alterations in gastrointestinal, endocrine, and metabolic processes after bariatric Roux-en-Y gastric bypass surgery[J].Diabetes Care, 2012, 35(12):2580-2587.
14. Attiah MA, Halpern CH, Balmuri U, et al.Durability of Roux-en-Y gastric bypass surgery:a meta-regression study[J].Ann Surg, 2012, 256(2):251-254.
15. Buchwald H, Estok R, Fahrbach K, et al.Trends in mortality in bariatric surgery:a systematic review and meta-analysis[J].Surgery, 2007, 142(4):621-632.
16. Csendes A, Burgos AM, Braghetto I.Classification and management of leaks after gastric bypass for patients with morbid obesity:a prospective study of 60 patients[J].Obes Surg, 2012, 22(6):855-862.
17. Sjöström L, Lindroos AK, Peltonen M, et al.Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery[J].N Engl J Med, 2004, 351(26):2683-2693.
18. Flum DR, Belle SH, King WC, et al.Perioperative safety in the longitudinal assessment of bariatric surgery[J].N Engl J Med, 2009, 361(5):445-454.
19. Santry HP, Gillen DL, Lauderdale DS.Trends in bariatric surgical procedures[J].JAMA, 2005, 294(15):1909-1917.
20. Champion JK, Williams M.Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass[J].Obes Surg, 2003, 13(4):596-600.
21. Praveen Raj P, Senthilnathan P, Kumaravel R, et al.Concomitant laparoscopic ventral hernia mesh repair and bariatric surgery:a retrospective study from a tertiary care center[J].Obes Surg, 2012, 22(5):685-689.
22. Carucci LR, Turner MA, Shaylor SD.Internal hernia following Roux-en-Y gastric bypass surgery for morbid obesity:evaluation of radiographic findings at small-bowel examination[J].Radiology, 2009, 251(3):762-770.
23. Laurenius A, Olbers T, Näslund I, et al.Dumping syndrome follo-wing gastric bypass:validation of the dumping symptom rating scale[J].Obes Surg, 2013, 23(6):740-755.
24. Banerjee A, Ding Y, Mikami DJ, et al.The role of dumping syndrome in weight loss after gastric bypass surgery[J].Surg Endosc, 2013, 27(5):1573-1578.
25. Halperin F, Goldfine AB.Metabolic surgery for type 2 diabetes:efficacy and risks[J].Curr Opin Endocrinol Diabetes Obes, 2013, 20(2):98-105.
26. Buchwald H, Estok R, Fahrbach K, et al.Weight and type 2 diabetes after bariatric surgery:systematic review and meta-analysis[J].Am J Med, 2009, 122(3):248-256.e5.
27. American Society for Metabolic and Bariatric Surgery Clinical Issues Committee.American Society for Metabolic and Bariatric Surgery position statement on global bariatric healthcare[J].Surg Obes Relat Dis, 2011, 7(6):669-671.
28. 郑成竹, 刘沛."2010中国糖尿病手术治疗高峰论坛暨专家共识大会"会议纪要[J].中国实用外科杂志, 2010, 30(7):576-577.
29. Carrasco F, Rojas P, Csendes A, et al.Changes in ghrelin concen-trations one year after resective and non-resective gastric bypass:associations with weight loss and energy and macronutrient intakes[J].Nutrition, 2012, 28(7-8):757-761.
30. To VT, Hüttl TP, Lang R, et al.Changes in body weight, glucose homeostasis, lipid profiles, and metabolic syndrome after restrictive bariatric surgery[J].Exp Clin Endocrinol Diabetes, 2012, 120(9):547-552.
31. Camastra S, Gastaldelli A, Mari A, et al.Early and longer term effects of gastric bypass surgery on tissue-specific insulin sensitivity and beta cell function in morbidly obese patients with and without type 2 diabetes[J].Diabetologia, 2011, 54(8):2093-2102.
32. Perugini RA, Malkani S.Remission of type 2 diabetes mellitus following bariatric surgery:review of mechanisms and presentation of the concept of 'reversibility'[J].Curr Opin Endocrinol Diabetes Obes, 2011, 18(2):119-128.
33. Laferrère B.Effect of gastric bypass surgery on the incretins[J].Diabetes Metab, 2009, 35(6 Pt 2):513-517.
34. Shin AC, Zheng H, Pistell PJ, et al.Roux-en-Y gastric bypass surgery changes food reward in rats[J].Int J Obes (Lond), 2011, 35(5):642-651.
35. Tichansky DS, Glatt AR, Madan AK, et al.Decrease in sweet taste in rats after gastric bypass surgery[J].Surg Endosc, 2011, 25(4):1176-1181.
36. Zheng H, Shin AC, Lenard NR, et al.Meal patterns, satiety, and food choice in a rat model of Roux-en-Y gastric bypass surgery[J].Am J Physiol Regul Integr Comp Physiol, 2009, 297(5):1273-1282.
37. Ley RE.Obesity and the human microbiome[J].Curr Opin Gas-troenterol, 2010, 26(1):5-11.
38. Mozes S, Bujnáková D, Sefcíková Z, et al.Intestinal microflora and obesity in rats[J].Folia Microbiol (Praha), 2008, 53(3):225-228.
39. Kashyap SR, Bhatt DL, Wolski K, et al.Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes:analysis of a randomized control trial comparing surgery with intensive medical treatment[J].Diabetes Care, 2013, 36(8):2175-2182.
40. Orci L, Chilcott M, Huber O.Short versus long Roux-limb length in Roux-en-Y gastric bypass surgery for the treatment of morbid and super obesity:a systematic review of the literature[J].Obes Surg, 2011, 21(6):797-804.
41. Teeple EA, Teich S, Schuster DP, et al.Early metabolic improve-ment following bariatric surgery in morbidly obese adolescents[J].Pediatr Blood Cancer, 2012, 58(1):112-116.
42. Aarts EO, van Wageningen B, Janssen I MC, et al.Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity[J].J Obes, 2012, 2012:193705.
43. Jiménez A, Perea V, Corcelles R, et al.Metabolic effects of bariatric surgery in insulin-sensitive morbidly obese subjects[J].Obes Surg, 2013, 23(4):494-500.
44. De Flines J, Franck M, Rorive M, et al.Metabolic surgery:an increasing place in the management of diabetes[J].Rev Med Suisse, 2012, 8(351):1621-1624, 1626-1627.
45. Fujioka K, DiBaise JK, Martindale RG.Nutrition and metabolic complications after bariatric surgery and their treatment[J].JPEN J Parenter Enteral Nutr, 2011, 35(5 Suppl):52S-59S.
46. Gianotti L, Braga M.Revising concepts of artificial nutrition in contemporary surgery:from energy and Nitrogen to immuno-meta-bolic support[J].Nutr Hosp, 2011, 26(1):56-67.
47. Rubino F, Kaplan LM, Schauer PR, et al.The diabetes surgery summit consensus conference:recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus[J].Ann Surg, 2010, 251(3):399-405.
48. Shimizu H, Timratana P, Schauer PR, et al.Review of metabolic.
49. surgery for type 2 diabetes in patients with a BMI < 35 kg/m²[J]. J Obes, 2012, 2012:147256.
50. Reis CE, Alvarez-Leite JI, Bressan J, et al.Role of bariatric-metabolic surgery in the treatment of obese type 2 diabetes with body mass index < 35 kg/m²:a literature review[J].Diabetes Technol Ther, 2012, 14(4):365-372.
51. Fried M, Ribaric G, Buchwald JN, et al.Metabolic surgery for the treatment of type 2 diabetes in patients with BMI < 35 kg/m²:an integrative review of early studies[J].Obes Surg, 2010, 20(6):776-790.
52. 谢锦桃, 刘军, 伍远征, 等.2011年美国糖尿病协会糖尿病诊疗标准执行纲要解读[J].中国全科医学, 2011, 14(18):1993-1997.
53. 王存川, 翟贺宁.规范与务实-促进我国肥胖症与代谢病外科的健康发展[J].中华胃肠外科杂志, 2012, 15(11):1102-1105.
54. Huang CK, Shabbir A, Lo CH, et al.Laparoscopic Roux-en-Y gastric bypass for the treatment of typeⅡdiabetes mellitus in Chi-nese patients with body mass index of 25-35[J].Obes Surg, 2011, 21(9):1344-1349.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research Advancement of Roux-en-Y Gastric Bypass in Treatment for Type 2 Diabetes Mellitus

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