Laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy: which has a place in the treatment of diabetes in morbidly obese patients?

Laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) are two bariatric procedures approved for the management of morbidly obese patients. According to a meta-analysis of all obese patients who underwent bariatric procedures, 11% also had type 2 diabetes mellitus (T2DM) before surgery, and improvement or resolution of this co-morbidity was highlighted in many of the studies. However, the mechanism(s) of action underlying such an effect with the various types of bariatric procedure remain unclear. Also, in terms of weight loss, the most efficient operations are those that come with a high rate of morbidity. This means that the choice of procedure is best done after a multidisciplinary team discussion with the patient in an effort to predict the beneficial effects and risks of each possible procedure. However, for years now, the bariatric team at Montpellier Hospital has preferred either LSG or LGBP as the treatment of choice for morbidly obese patients with T2DM, given the higher rates of failure with LAGB over time compared with the excellent results achieved by both LSG and LGBP in many studies.