Diabetes Remission Outcomes After LRYGBP With Versus Without Fundus Resection
Overview
This randomized controlled trial compared the effects of laparoscopic Roux-en-Y gastric bypass (LRYGBP) with and without gastric fundus resection (FR) on type 2 diabetes mellitus (T2DM) remission in severely obese patients. The study evaluated glycemic control, weight loss, and gut hormone changes over a one-year follow-up, highlighting the potential metabolic benefits of fundus resection.
Background
Gastrointestinal hormones such as GLP-1, PYY, and ghrelin play critical roles in glucose homeostasis and T2DM remission after bariatric surgery. GLP-1 enhances insulin secretion, while ghrelin, produced mainly in the gastric fundus, may have diabetogenic effects. LRYGBP is an effective bariatric procedure, and adding fundus resection may optimize antidiabetic outcomes by reducing ghrelin levels and enhancing neuroendocrine mechanisms. However, previous studies have shown conflicting results regarding the impact of fundus resection on glycemic control and weight loss.
Fundus resection added approximately 18 minutes to operative time.
Both groups showed changes in glycemic parameters and gut hormones (ghrelin, GLP-1, PYY) over 12 months, with fundus resection potentially contributing to greater reductions in ghrelin levels.
HbA1c levels at one year were the primary outcome, assessing diabetes remission efficacy between groups.
Weight loss parameters including BMI and excess weight loss were secondary endpoints, monitored alongside metabolic markers.
The study was limited by a small sample size (24 patients) and recruitment challenges due to the COVID-19 pandemic.
Clinical Implications
Incorporating gastric fundus resection into LRYGBP may enhance early glycemic improvement in obese patients with T2DM, potentially through reduction of ghrelin levels independent of weight loss. Surgeons should weigh the modest increase in operative time against possible metabolic benefits when considering this modification. Further larger-scale studies are warranted to clarify the role of fundus resection in optimizing diabetes remission.
Conclusion
This randomized trial suggests that fundus resection combined with LRYGBP could improve diabetes remission outcomes by modulating gut hormones, particularly ghrelin. While promising, these findings require validation in larger cohorts to establish definitive clinical recommendations.
References
University Hospital of Patras Research Team 2019-2023 -- Outcomes of Diabetes Remission Following LRYGBP With and Without Fundus Resection
