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Kehagias D, Lampropoulos C, Georgopoulos N, Habeos I, Kalavrizioti D, Vamvakas SS, Davoulou P, Kehagias I. Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial. Obes Surg 2023; 33:3373-3382. [PMID: 37783932 PMCID: PMC10602944 DOI: 10.1007/s11695-023-06857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Glycemic control, after metabolic surgery, is achieved in two stages, initially with neuroendocrine alterations and in the long-term with sustainable weight loss. The resection of the gastric fundus, as the major site of ghrelin production, is probably related with optimized glucose regulation. The aim of the present study is to investigate whether the modification of laparoscopic Roux-en-Y gastric bypass (LRYGBP) with fundus resection offers superior glycemic control, compared to typical LRYGBP. MATERIALS AND METHODS Participants were 24 patients with body mass index (BMI) ≥40kg/m2 and type II diabetes mellitus (T2DM), who were randomly assigned to undergo LRYGBP and LRYGBP with fundus resection (LRYGBP+FR). Gastrointestinal (GI) hormones [ghrelin, glucagon-like-peptide-1 (GLP-1), peptide-YY (PYY)] and glycemic parameters (glucose, insulin, HbA1c, C-peptide, insulinogenic index, HOMA-IR) were measured preoperatively, at 6 and 12 months during an oral glucose tolerance test (OGTT). RESULTS Ninety-five percent of patients showed complete remission of T2DM after 12 months. LRYGBP+FR was not related with improved glycemic control, compared to LRYGBP. Ghrelin levels were not significantly reduced at 6 and 12 months after LRYGBP+FR. GLP-1 and PYY levels were remarkably increased postprandially in both groups at 6 and 12 months postoperatively (p<0.01). Patients who underwent LRYGBP+FR achieved a significantly lower BMI at 12 months in comparison to LRYGBP (p<0.05). CONCLUSION Fundus resection is not associated with improved glycemic regulation, compared to typical LRYGBP and the significant decrease in BMI after LRYGBP+FR has to be further confirmed with longer follow-up.
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Affiliation(s)
| | | | - Neoklis Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, 26504, Rio, Greece
| | - Ioannis Habeos
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital of Patras, 26504, Rio, Greece
| | - Dimitra Kalavrizioti
- Department of Nephrology and Renal Transplantation, University Hospital of Patras, 26504, Rio, Greece
| | | | - Panagiota Davoulou
- Department of Nephrology and Renal Transplantation, University Hospital of Patras, 26504, Rio, Greece
| | - Ioannis Kehagias
- Department of Surgery, Division of Bariatric and Metabolic Surgery, University Hospital of Patras, 26504, Rio, Greece
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Verras GI, Mulita F, Pouwels S, Parmar C, Drakos N, Bouchagier K, Kaplanis C, Skroubis G. Outcomes at 10-Year Follow-Up after Roux-en-Y Gastric Bypass, Biliopancreatic Diversion, and Sleeve Gastrectomy. J Clin Med 2023; 12:4973. [PMID: 37568375 PMCID: PMC10419540 DOI: 10.3390/jcm12154973] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Morbid obesity is a well-defined chronic disease, the incidence of which is constantly rising. Surgical treatment of morbid obesity has produced superior outcomes compared to conventional weight loss measures. Currently, there is a gap in the literature regarding long-term outcomes. Our single-institution, retrospective cohort study aims to evaluate weight loss outcomes, comorbidity reduction, and adverse effects at 10 years following Roux-en-Y Gastric Bypass (RYGB), Biliopancreatic Diversion (BPD), and Sleeve Gastrectomy (SG). MATERIALS AND METHODS We included all consecutive patients with 10-year follow-up records operated on within our institution. The comparison was carried out on the average percentage of weight and BMI loss. Nausea and vomiting were evaluated through self-reporting Likert scales. Diabetes resolution and nutritional deficiencies were also evaluated. RESULTS A total of 490 patients from 1995 up to 2011 were included in our study. Of these, 322 underwent RYGB, 58 underwent long-limb BPD, 34 underwent laparoscopic RYGB with fundus excision, 47 underwent laparoscopic SG, and 29 underwent laparoscopic RYGB as a revision of prior SG. RYGB and BPD were significantly associated with higher percentages of weight loss (37.6% and 37.5%), but were not found to be independent predictors of weight loss. Nausea and vomiting were associated with SG and laparoscopic RYGB with fundus excision, more so than the other operations. No differences were observed regarding diabetes resolution and nutritional deficiencies. CONCLUSIONS Longer follow-up reports are important for the comparison of outcomes between different types of bariatric operations. BPD and RYGB resulted in superior weight loss, with no observed differences in diabetes resolution and adverse outcomes.
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Affiliation(s)
- Georgios-Ioannis Verras
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Sjaak Pouwels
- Department of General, Abdominal and Minimally Invasive Surgery, Helios Klinikum, 47805 Krefeld, Germany;
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, 5022 Tiburg, The Netherlands
| | - Chetan Parmar
- The Wittington Hospital NHS Trust, London N19 5NF, UK;
| | - Nikolas Drakos
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Konstantinos Bouchagier
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Charalampos Kaplanis
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - George Skroubis
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
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Kehagias D, Georgopoulos N, Habeos I, Lampropoulos C, Mulita F, Kehagias I. The role of the gastric fundus in glycemic control. Hormones (Athens) 2023; 22:151-163. [PMID: 36705877 DOI: 10.1007/s42000-023-00429-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE Ghrelin, one of the most studied gut hormones, is mainly produced by the gastric fundus. Abundant evidence exists from preclinical and clinical studies underlining its contribution to glucose regulation. In the following narrative review, the role of the gastric fundus in glucose regulation is summarized and we investigate whether its resection enhances glycemic control. METHODS An electronic search was conducted in the PubMed® database and in Google Scholar® using a combination of medical subject headings (MeSH). We examined types of metabolic surgery, including, in particular, gastric fundus resection, either as part of laparoscopic sleeve gastrectomy (LSG) or modified laparoscopic gastric bypass with fundus resection (LRYGBP + FR), and the contribution of ghrelin reduction to glucose regulation. RESULTS Fourteen human studies were judged to be eligible and included in this narrative review. Reduction of ghrelin levels after fundus resection might be related to early glycemic improvement before significant weight loss is achieved. Long-term data regarding the role of ghrelin reduction in glucose homeostasis are sparse. CONCLUSION The exact role of ghrelin in achieving glycemic control is still ambiguous. Data from human studies reveal a potential contribution of ghrelin reduction to early glycemic improvement, although further well-designed studies are needed.
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Affiliation(s)
- Dimitrios Kehagias
- Department of General Surgery, General University Hospital of Patras, 26504, Rio, Greece.
| | - Neoklis Georgopoulos
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, 26504, Rio, Greece
| | - Ioannis Habeos
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital of Patras, 26504, Rio, Greece
| | | | - Francesk Mulita
- Department of General Surgery, General University Hospital of Patras, 26504, Rio, Greece
| | - Ioannis Kehagias
- Division of Bariatric and Metabolic Surgery, Department of Surgery, General University Hospital of Patras, 26504, Rio, Greece
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Redpath TL, Livingstone MBE, Dunne AA, Boyd A, le Roux CW, Spector AC, Price RK. Methodological issues in assessing change in dietary intake and appetite following gastric bypass surgery: A systematic review. Obes Rev 2021; 22:e13202. [PMID: 33527664 PMCID: PMC8244068 DOI: 10.1111/obr.13202] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/20/2020] [Accepted: 12/13/2020] [Indexed: 12/23/2022]
Abstract
Gastric bypass surgery is an effective long-term treatment for individuals with severe obesity. Changes in appetite, dietary intake, and food preferences have all been postulated to contribute to postoperative body weight regulation, however, findings are inconsistent. The aim of this systematic review was to evaluate the current literature on changes in dietary intake and appetite following gastric bypass surgery, in the context of the methodology used and the analysis, interpretation, and presentation of results. Four databases were systematically searched with terms related to "gastric bypass surgery," "appetite," and "dietary intake," and 49 papers (n = 2384 patients after gastric bypass) were eligible for inclusion. The evidence indicated that only a reduction in overall energy intake and an increase in postprandial satiety are maintained beyond 6-month post-surgery, whereas relative macronutrient intake and premeal hunger remain unchanged. However, available data were limited by inconsistencies in the methods, analysis, presentation, and interpretation of results. In particular, there was a reliance on data collected by subjective methods with minimal acknowledgment of the limitations, such as misreporting of food intake. There is a need for further work employing objective measurement of appetite and dietary intake following gastric bypass surgery to determine how these mechanisms may contribute to weight regulation in the longer term.
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Affiliation(s)
- Tamsyn L Redpath
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, UK
| | | | - Aoibheann A Dunne
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, UK
| | - Adele Boyd
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, UK
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Alan C Spector
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, Florida, USA
| | - Ruth K Price
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, UK
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Mahawar KK, Kumar P, Parmar C, Graham Y, Carr WRJ, Jennings N, Schroeder N, Balupuri S, Small PK. Small Bowel Limb Lengths and Roux-en-Y Gastric Bypass: a Systematic Review. Obes Surg 2016; 26:660-71. [PMID: 26749410 DOI: 10.1007/s11695-016-2050-2] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There is currently no consensus on the combined length of small bowel that should be bypassed as biliopancreatic or alimentary limb for optimum results with Roux-en-Y gastric bypass. A number of different limb lengths exist, and there is significant variation in practice amongst surgeons. Inevitably, this means that some patients have too much small bowel bypassed and end up with malnutrition and others end up with a less effective operation. Lack of standardisation poses further problems with interpretation and comparison of scientific literature. This systematic review concludes that a range of 100-200 cm for combined length of biliopancreatic or alimentary limb gives optimum results with Roux-en-Y gastric bypass in most patients.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
| | - Parveen Kumar
- Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Chetan Parmar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Yitka Graham
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.,Department of Pharmacy, Health and Well-Being, University of Sunderland, Sunderland, SR1 3SD, UK
| | - William R J Carr
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Neil Jennings
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | | | - Shlok Balupuri
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Peter K Small
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
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Outcome in body-contouring surgery after massive weight loss: A prospective matched single-blind study. J Plast Reconstr Aesthet Surg 2015; 68:1410-6. [PMID: 26162995 DOI: 10.1016/j.bjps.2015.05.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/23/2015] [Accepted: 05/31/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Body-contouring (BC) procedures after massive weight loss (MWL) are extensive and numerous. Currently, inconsistent data exist regarding quality-of-life (QoL) scales, and long-term analysis is lacking. The aim of this study was to investigate the long-term outcome of patients who elect to have BC procedures after MWL. METHODS Post-bariatric patients and patients who had dietary weight loss with no history of bariatric surgery (BS) (BC group) were included. Patients after BS with similar demographic characteristics but no BC procedures served as the control group (BS group). The results were compared with severely obese patients who have not yet undergone BS or BC surgery (obese group). Outcome measures include the type of BC surgery with the rates of the associated procedures and outcome satisfaction evaluated after the Moorehead-Ardelt questionnaire (range -3.0 to +3.0). RESULTS Fifty-six female and 10 male Caucasian patients with a mean age of 50 years (14 years) who underwent BC procedures between February 1999 and October 2009 were included. Of those, 23 patients completed the survey in 2014 (20 female and three male patients, mean age of 53 years (14 years)) at a final follow-up of 8 years (3 years). Two years (range 1-3 years) after MWL, a total of 51 BC procedures were performed. The most frequent interventions were abdominoplasty (n = 20), followed by rectus plication and liposuction (n = 7 and n = 6, respectively). QoL scores revealed a high overall patient satisfaction in the BC group, which was comparable with the BS group (n = 23). The obese group (n = 17) had a significantly lower overall QoL and lower health-related QoL (HRQoL) subdomains compared with the BC and BS group. CONCLUSION BC procedures lead to high and durable patient satisfaction. However, the appropriate management of expectations before surgery is mandatory.
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