SASI compared with SG-JJB for obese diabetic rats: an experimental comparative study on weight reduction, glycemic control, and postoperative complications

To compare the weight loss, glycemic control, and complication rates of three surgical procedures-sleeve gastrectomy combined with single-anastomosis sleeve ileal bypass (SASI), sleeve gastrectomy with jejuno-jejunal bypass (SG-JJB), and sleeve gastrectomy (SG) alone-in obese diabetic rat models. Forty-two obese diabetic rats that were successfully modeled were randomly divided into the SASI group (14 rats), the SG-JJB group (13 rats), and the SG group (15 rats). During the postoperative observation period, 2 rats in the SASI group, 1 rat in the SG-JJB group, and 3 rats in the SG group died or dropped out, leaving 12 rats per group (36 rats in total). The rats were observed for 6 months after surgery, and body weight, food intake, fasting blood glucose (FBG), and blood glucose levels during OGTT and ITT were measured before and at 1, 2, 3, 4, 5 and 6 months after surgery. Oral glucose tolerance test (OGTT) and insulin resistance test (ITT) were performed at 1 month and 6 months after surgery. The occurrence of postoperative complications was recorded. At each time point after surgery, the body weight, food intake, FBG, blood glucose levels during OGTT and ITT in the SASI group and SG-JJB group were significantly lower than those before surgery ( P < 0.05). During postoperative months 1–5, food intake in the SASI and SG-JJB groups was significantly lower than that in the SG group ( P < 0.05); however, this between-group difference gradually narrowed over time. By month 6, there was no significant difference in food intake among the three groups ( P > 0.05). Repeated measures variance analysis of OGTT and ITT data showed that the group effect, time effect, and interaction effect were all statistically significant (all P < 0.001). Postoperatively, the SG-JJB and SASI groups showed marked and sustained reductions in all OGTT and ITT time-point glucose values and AUC at both 1 and 6 months, which were significantly lower than preoperative levels ( P < 0.05) and lower than the SG group ( P < 0.001). The total incidence of complications in the SASI group and SG-JJB group was 25.00%, while that in the SG group was 16.67%, with no significant difference between the groups ( P > 0.05). In the rat model of obesity combined with diabetes, both SASI and SG-JJB showed better weight loss and metabolic improvement effects compared to SG alone. However, the study had very low statistical power to detect differences between SASI and SG-JJB, and the non-significant findings between these two procedures cannot be interpreted as comparable efficacy. Their short-term safety remains uncertain because of early postoperative deaths/dropouts, and the long-term mechanisms and complication profiles of these procedures require further investigation.