Comparison between sleeve gastrectomy and mini gastric bypass in loss of visceral fat in diabetic patients / By Mohamed Serag Hamad Mohamed El-Mekawy; Supervisors Prof. Dr. Sami Mufeed Saied, Prof. Dr. Hany Maurice Sabry, Dr. Hytham Hassan Mohey, Dr. Noha Wael Arfaat.

Thesis (Ph.D)-Cairo University, 2024.

Bibliography: pages 108-123.

Background: metabolic syndrome is associated with obesity. Visceral fat is accused of harmful effects of metabolic syndrome, which may be reversible with bariatric surgery. OAGB is an effective procedure and safe.
Objectives: to investigate the reduction of visceral fat after sleeve gastrectomy and one anastomosis gastric bypass in diabetic patients. Correlate the effect of reduction to visceral fat on control of diabetes.
Method: prospective, randomized, control study conducted in Kasr EL-Ainy Hospital, Faculty of Medicine, Cairo University, Egypt, from September 2022 to February 2024. Of 48 included diabetic patients, 25 underwent laparoscopic sleeve gastrectomy, and 23 underwent OAGB. Assessment of visceral fat quantity to all patients through Luxembourg Institute of Health calculator. 6 patients from each group were full-filling criteria for CT assessment preoperative and follow-up after six months. Baseline assessment of diabetes condition by HBA1C and follow-up. All patients were followed up by an endocrinologist for control of diabetes and modification of medications. Results: excess BMI loss and total weight loss were statistically insignificant and slightly higher in SG (SG 66.63 ±15.72 OAGB 59.55 ± 9.79, and SG 31.87 ± 5.77 OAGB 30.06 ± 5.41). Both groups had comparable visceral fat reduction by formula and CT assessment. The mean VAT reduction percent by CT is 47.20 ± 24.70 in SG and 49.45 ± 16.65 in OAGB. It is a little bit higher in OAGB without significant statistical value (P-value = 0.937). Statistically significant higher mean HBA1c in the OAGB group preoperative than SG mean 7.87 ± 1.41 and 6.78±0.80, (P-value = 0.003). There is no significant correlation between the percent of total weight loss and the percent of HBA1C reduction (p-value = 0.715). There is no correlation between the percent HBA1c reduction percent of VAT reduction by formula. (P-value = 0.899). There is a significantly higher percentage of HBA1C reduction in the OAGB group than SG 29.41 ± 11.92 to 17.35 ± 6.88 with significant (p-value < 0.001). There is a significant improvement in OAGB in postoperative dependency on diabetic medications, with 95.7% stopped medications to 68% stopped postoperative in SG, which is statistically significant (p-value = 0.014). Both groups have a very high incidence of complete remission. The percentage is statistically insignificant, higher in OAGB at 95.7% than in SG at 92.0%. However, the patients who have not achieved remission are controlled on single oral medication once / day. The remission group has a higher median liver CT density than a group of incomplete remission, 50 and 60, respectively, with statistically significant (P-value = 0.036) other parameters are comparable in both groups. However, % of VAT reduction is higher in remitters than non-remitters with insignificant statistical value. Conclusion: Loss of visceral fat is comparable after OAGB with sleeve gastrectomy. It is better to assess visceral fat radiologically after bariatric surgery. OAGB is better than SG in HBA1C reduction and reduction of postoperative medication. OAGB is effective in diabetes remission with a high individualized metabolic surgery score preoperative.

من المتوقع ان يعيش مليون انسان عالميا فى سمنه عام 3030. السمنه تصيب كل عضووتؤدى الى العديد من المشاكل الصحيه و المضاعفات. هذه دراسه عشوائيه تجريبيه تضم 48 مريض سكر تم تقسيمهم الى 25 خضعوا لتكميم المعده بالمنظار و 23 خضعوا لتحويل معده احادى التوصيل بالمنظار. وتم متابعتهم لاكثر من 6 اشهر، وتم تقييم فقدان الدهون الاحتشائيه الضاره عن طريق معادله و خضع 6 مرضى لاشعه مقطعيه على البطن والحوض بدون صبغه فى كل طرف. وتم متابعة انضباض السكرى بتحليل سكر تراكمى. ووجد تحسن ملحوظ فى السكرى بعد كلا النوعين من الجراحه. وكلا النوعين من الجراحه كان مصحوب بفقدان الدهون الاحتشائيه.

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Text in English and abstract in English.