Combined non-alcoholic fatty liver disease and type 2 diabetes in severely obese patients-medium term effects of sleeve gastrectomy versus Roux-en-Y-gastric bypass on disease markers

Franck Billmann; Sherehan El Shishtawi; Tom Bruckner; Mostafa ElSheikh; Beat Peter Müller-Stich; Adrian Billeter

doi:10.21037/hbsn-21-71

Combined non-alcoholic fatty liver disease and type 2 diabetes in severely obese patients-medium term effects of sleeve gastrectomy versus Roux-en-Y-gastric bypass on disease markers

Hepatobiliary Surg Nutr. 2022 Dec;11(6):795-807. doi: 10.21037/hbsn-21-71.

Authors

Franck Billmann^#¹, Sherehan El Shishtawi^#¹, Tom Bruckner², Mostafa ElSheikh³, Beat Peter Müller-Stich¹, Adrian Billeter¹

Affiliations

¹ Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
² Institut für Medizinische Biometrie und Informatik, Universität Heidelberg, Heidelberg, Germany.
³ Department of General Surgery, El-Gharbia Govenorate, Tanta, El gash St. Medical Campus, The Faculty of Medicine, Tanta, Egypt.

^# Contributed equally.

Abstract

Background: We aimed to evaluate the medium-term efficacy of sleeve gastrectomy (SG) vs. Roux-en-Y gastric bypass (RYGB) on remission of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM).

Methods: We identified severely obese patients [body mass index (BMI) >35 kg/m²] with NAFLD (as defined by the Longitudinal Assessment of Bariatric Surgery Study) and T2DM (as defined by the American Association of Clinical Endocrinologists and the American College of Endocrinology) who underwent SG or RYGB in a single university surgical centre. The cohorts were match-paired and data were analysed after at least 3 years of follow up. The key outcomes measured were: (I) the improvement of liver function tests and NAFLD markers; (II) glycemic control and insulin resistance.

Results: Ninety-six patients were investigated; 44 (45.8%) were women. The mean pre-operative BMI was 45.2 kg/m² in the SG and 42.0 kg/m² in the RYGB group. SG and RYGB both significantly reduced serum liver enzyme concentrations. NAFLD markers resolved 2 years after SG in all patients. In contrast, only 78% and 80% of patients achieved remission of NAFLD 2 and 3 years after RYBG respectively. Both procedures resulted in comparable rates of remission of T2DM.

Conclusions: Bariatric surgery with SG may be preferable to RYGB for obese patients with NAFLD and T2DM based on the rates of remission of markers of these co-morbidities. However, our results need to be confirmed in prospective trials. Understanding the metabolic effects of specific bariatric surgical procedures may facilitate the development of a personalised approach to weight-loss surgery.

Keywords: Bariatric surgery; gastric bypass; morbid obesity complications; non-alcoholic fatty liver disease (NAFLD); sleeve gastrectomy (SG); transaminases; type 2 diabetes mellitus (T2DM).