Overview
In patients with type 2 diabetes, Roux-en-Y gastric bypass (RYGB), which excludes a portion of the stomach and the proximal intestine from the alimentary circuit, improves glucose metabolism more rapidly and more extensively than is expected from weight loss. The mechanisms of this unique effect of gastrointestinal exclusion appear to be complex and have not yet been clarified. A recent study unveil that intestinal uptake of ingested glucose is diminished by RYGB and restricted to the common limb, where food meets bile and other digestive fluids, resulting in an overall decrease of post prandial blood glucose excursion. the hypothesize that reducing the length of the common limb, which is rarely measured and highly variable in clinical practice, may significantly affect the metabolic outcome of gastrointestinal surgical procedures. The aim of the present study is to compare the impact of two variants of Roux-en-Y gastric bypass with a short common limb, the long alimentary limb or the long biliary limb Roux-en-Y gastric bypass, on type 2 diabetes remission in severely obese patients.
Eligibility
Inclusion Criteria:
- BMI ≥ 35 kg/m2
- All patient with type 2 diabetes
- Patients who were candidates for obesity surgery in accordance with French recommendation
Exclusion Criteria:
- Severe cognitive or mental disorders
- patient who have already undergone obesity surgery
- Severe and non-stabilised eating disorders
- The likely inability of the patient to participate in lifelong medical follow-up
- Alcohol or psychoactive substances dependence
- The absence of identified prior medical management of obesity
- Diseases that are life-threatening in the short and medium term;
- Contraindications to general anaesthesia.