Background and Aims:
Bariatric surgery is effective in treating obesity and T2DM. However, the impact of limb length is controversial. Recently, an animal experiment using diabetic rats undergoing DJB showed BP-limb plays an important role in the control of weight, glucose tolerance, and bile acids and gut microbiota may be involved in these processes (Miyachi T, et al. Surgery 2016). The aim of this study is to evaluate the impact of sleeve-DJB with long BP-limb on weight loss and glycemic control in obese diabetic patients.

Methods:
Consecutive 21 obese diabetic Japanese patients undergoing sleeve-DJB with long BP-limb (mean limb length: 240cm) were enrolled in the analysis. The 1-year postoperative outcomes regarding weight loss and glycemic control were compared with those in the 21 matched controls for age, BMI, fasting C-peptide, duration of diabetes and insulin usage who underwent our standard sleeve-DJB with a 100cm BP-limb. 

Results
Preoperatively, the mean age, BW and BMI were 45.1±9.6 years, 107.7±18.8 kg and 38.4±6.1 kg/m2, respectively. The mean FPG, A1c, fasting C-peptide, duration of diabetes were 176±63 mg/dL, 8.7±1.2 %, 3.0±1.0 ng/mL and 9.6±4.9 years, respectively. Nineteen patients (45.2%) were treated with insulin. At POY1, the mean %TWL in the long BP and the standard group were 27.2±7.3 % and 27.6±8.2 %, respectively. The HbA1c / diabetes remission rate (A1c <6% without medication) in the long BP and the standard group were 6.1±0.8 % / 52% and 6.1±1.0 % / 33%, respectively.

Conclusions:
Sleeve-DJB with long BP-limb appears to result in a distinctive anti-diabetic effect without additional weight loss that could be beneficial for the metabolic outcomes of the surgery.

IMPACT OF SLEEVE-DJB (DUODENOJEJUNAL BYPASS) WITH LONG BILIOPANCREATIC LIMB ON WEIGHT LOSS AND GLYCEMIC CONTROL IN OBESE DIABETIC PATIENTS: A CASE MATCHED STUDY