Glycemic Control in Obese Type 2 Diabetic Patients Treated with Laparoscopic Sleeve Gastrectomy and Transit Bipartition

BACKGROUND Type 2 diabetes mellitus (T2DM) and obesity are significant health challenges linked to increased morbidity and mortality. Laparoscopic sleeve gastrectomy with transit bipartition (LSG+TB) has shown promise in improving glycemic control. This study aimed to evaluate the outcomes of obese patients with T2DM treated with LSG+TB, focusing on variations in surgical techniques. MATERIAL AND METHODS This retrospective study analyzed obese T2DM patients who underwent LSG+TB at a single center. Data on preoperative and postoperative hemoglobin A1c (HbA1c) levels, body mass index (BMI), sex, and surgical technique details were collected. Changes in HbA1c levels were assessed at 3 and 12 months after surgery based on variations in stapler line distance, common channel length, and anastomotic loop diameter. RESULTS A total of 420 patients were included. Baseline BMI of patients with stapler line distances of 6 cm, 8 cm, and 10 cm from the pylorus was 40.06, 34.87, and 30.42, respectively (P<0.001). The average percentage of excess weight loss at 1 year was 68.11%. Significant reductions in HbA1c were observed across all groups, with greater reductions in the 6 cm group compared to the 8 cm and 10 cm groups (P=0.019). Common channel length and anastomotic loop diameter showed no significant impact on HbA1c levels. CONCLUSIONS LSG+TB effectively improves glycemic control in obese T2DM patients. A 6 cm stapler line distance from the pylorus is associated with superior HbA1c reduction and comparable safety to longer distances.