Obes Surg. 2026 Apr 6. doi: 10.1007/s11695-026-08646-w. Online ahead of print.
ABSTRACT
BACKGROUND: Obesity and type 2 diabetes mellitus (T2DM) are interconnected metabolic diseases that pose major public health challenges worldwide. Metabolic and bariatric surgery (MBS) has emerged as a disease-modifying intervention that addresses obesity-related metabolic dysfunction beyond glycemic control alone, including cardiovascular benefits, comorbidity resolution, and mortality reduction. One anastomosis gastric bypass (OAGB) is a bariatric-metabolic procedure with a single-anastomosis surgical configuration that combines restrictive and malabsorptive mechanisms. This study evaluates the efficacy of laparoscopic OAGB in achieving glycemic control and weight loss in patients with T2DM over a 10-year follow-up period.
METHODS: A retrospective analysis of prospectively collected data was performed on 127 consecutive patients (mean age 48.2 years, mean BMI 38.2 kg/m², mean diabetes duration 9.45 years) with T2DM who underwent laparoscopic OAGB between January and December 2015 at Tashkent State Medical University. Forty-seven patients (37%) were insulin-dependent preoperatively. Primary outcomes included complete diabetes remission according to American Diabetes Association (ADA) 2021 criteria (HbA1c < 6.5%, fasting plasma glucose < 100 mg/dL, no antidiabetic medications for ≥ 12 months). Secondary outcomes included excess weight loss (%EWL), total weight loss (%TWL), and evaluation of predictors of metabolic response. Patients were followed for 10 years postoperatively with 100% retention.
RESULTS: Mean excess weight loss was 96.3 ± 18.7% at 10 years, with mean total weight loss of 33.3 ± 6.2%. Complete remission of T2DM was achieved in 120 patients (94.5%). Seven patients (5.5%) demonstrated significant metabolic improvement with reduced medication requirements. All patients requiring preoperative insulin therapy successfully discontinued insulin postoperatively. HbA1c levels decreased rapidly after surgery and remained within the target range throughout the 10-year follow-up. Patients with shorter disease duration (3-5 years) achieved faster metabolic remission. Complete T2DM remission was achieved in all 68 patients younger than 50 years of age. Preoperative C-peptide < 2.0 ng/mL was the strongest predictor of non-remission (6/7 non-remitters, p < 0.001). No major perioperative complications or mortality were reported, and sustained metabolic benefits were maintained throughout the 10-year follow-up period.
CONCLUSIONS: Laparoscopic OAGB represents an effective bariatric-metabolic surgical option for patients with obesity and T2DM, offering durable weight loss and glycemic control with high remission rates maintained at 10 years. The procedure's favorable safety profile and metabolic efficacy support its consideration as an option in the surgical management of obesity-related type 2 diabetes mellitus.
PMID:41941044 | DOI:10.1007/s11695-026-08646-w