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Wang J, Chu Y, Hong J, Zhu X, Widjaja J, Yao L. Mid-Term Diabetes Remission Outcome in Patients with BMI ≤ 30 kg/m 2 Following Sleeve Gastrectomy. Obes Surg 2024; 34:1491-1495. [PMID: 38407683 DOI: 10.1007/s11695-024-07112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Bariatric and metabolic surgery is recommended for Asian patients with type 2 diabetes mellitus (T2DM) and BMI ≥ 27.5 kg/m2. However, mid to long-term ·evidence is still lacking. METHODS Patients' data that underwent laparoscopic sleeve gastrectomy (SG) as the primary surgery at the Affiliated Hospital of Xuzhou Medical University were analyzed. Patients with T2DM diagnosed with either fasting blood glucose (FBG) ≥ 7.0 mmol/L or glycosylated hemoglobin (HbA1c) level ≥ 7.0% and 27.5 ≤ BMI ≤ 30 kg/m2 were included. RESULTS 24 patients (7 male and 17 female) were included in this study. With a mean follow-up duration of 4.5 ± 1.1 years, the mean percentage of total weight loss (%TWL) was 14.4 ± 6.7%. Postoperatively, nine patients (37%) still required oral anti-diabetic medications, while no patients used insulin. FBG and HbA1c levels declined to 6.3 ± 1.5 mmol/L and 6.0 ± 1.0%, respectively. Fifteen patients (63%) were with HbA1c levels < 7% and without medication requirements, five patients (21%) were with HbA1c levels < 7% with the help of oral anti-diabetic medication, and four patients (16%) were with HbA1c levels > 7% with the help of oral anti-diabetic medication. CONCLUSIONS Our study provides further evidence that SG could result in both T2DM improvement and remission in patients with BMI ≤ 30 kg/m2. Longer follow-up duration and larger sample will be needed in the future.
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Affiliation(s)
- Jian Wang
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221002, People's Republic of China
| | - Yuxiao Chu
- Center for Obesity and Metabolic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China
| | - Jian Hong
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221002, People's Republic of China
| | - Xiaocheng Zhu
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221002, People's Republic of China
| | - Jason Widjaja
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China.
| | - Libin Yao
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221002, People's Republic of China.
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Zou X, Liu Z, Huang Z, Huang J, Wang X, Chen Y, Yang J, Guan B. Mid-Long-Term Effect of Metabolic Surgery on Type 2 Diabetes in Nonobese Patients: a Meta-analysis. Obes Surg 2023; 33:2493-2508. [PMID: 37405632 DOI: 10.1007/s11695-023-06713-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND This study aimed to perform a meta-analysis regarding the mid-long-term effect (≥ 2-year follow-up) of metabolic surgery on T2DM in non-obese patients. METHODS PubMed, EMBASE and CENTRAL databases were searched for clinical studies from inception to March 2023. Stata 12.0 was used for data aggregation. Sensitivity, subgroup, and meta-regression analyses were performed when feasible. RESULTS This meta-analysis included 18 articles involving 548 patients. A pooled rate of 47.5% of T2DM remission was found after metabolic surgery. To be more specific, 83.5% was obtained for hemoglobin A1c (HbA1c) < 7.0%, 45.1% for HbA1c < 6.5%, and 40.4% for HbA1c < 6.0%. Subgroup analysis showed that one-anastomosis gastric bypass (OAGB) had a higher remission rate (93.9%) than other surgeries. Studies conducted in America had a higher remission rate (61.4%) than in Asia (43.6%). Meta-regression analysis displayed that publication year, number of patients, study design, preoperative age, BMI, and quality assessment score were not significantly associated with T2DM remission rate. Additionally, metabolic surgery could result in significant reductions in BMI (-4.133 kg/m2), weight (-9.874 kg), HbA1c (-1.939%), fasting blood glucose, fasting C-peptide, and fasting insulin. However, metabolic surgery seemed to have poorer glycemic control in non-obese than obese T2DM patients. CONCLUSION A moderate mid-long-term effect of T2DM remission was observed after metabolic surgery in non-obese patients. However, we still need more prospective multi-institutional studies using the same definitions for diabetes and the same surgical technique for the surgery. Without this, the exact role of bariatric surgery in non-obese patients is unanswered.
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Affiliation(s)
- Xiaochun Zou
- School of Health, Dongguan Polytechnic, Dongguan, 523808, China
| | - Zhuan Liu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Ziyan Huang
- School of Nursing, Jinan University, Guangzhou, 510632, China
| | - Jiayun Huang
- School of Nursing, Jinan University, Guangzhou, 510632, China
| | - Xuan Wang
- School of Nursing, Jinan University, Guangzhou, 510632, China
| | - Yanya Chen
- School of Nursing, Jinan University, Guangzhou, 510632, China.
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, 999077, China.
| | - Jingge Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
| | - Bingsheng Guan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
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Yi X, Zhu L, Zhu S. Predictors of T2DM Remission after Bariatric Surgery in Patients with a BMI < 35 kg/m 2: a Meta-Analysis. Obes Surg 2023; 33:2342-2355. [PMID: 37328645 DOI: 10.1007/s11695-023-06671-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Although a few studies have reported the predictors of postoperative diabetes remission in patients with body mass index (BMI) < 35 kg/m2, the conclusions are still inconsistent. This meta-analysis aimed to evaluate the preoperative clinical factors of type 2 diabetes mellitus (T2DM) remission after bariatric surgery. MATERIALS AND METHODS The PubMed, Embase, and Cochrane Library databases were systematically searched until April 2022. The Newcastle-Ottawa Scale was used for quality assessment. Statistical heterogeneity was assessed with the I2 statistic, followed by subgroup and sensitivity analyses. RESULTS 16 studies involving 932 patients were selected. T2DM remission was negatively correlated with age, duration, insulin use, fasting plasma glucose, fasting insulin, and glycosylated hemoglobin levels. While BMI, body weight, waist circumference, and C-peptide levels were positive predictors of T2DM remission in patients with a BMI < 35 kg/m2. However, there was no significant association between gender, oral hypoglycemic agent, homeostasis model assessment, high-density lipoprotein, low-density lipoprotein, total cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, and remission rate. CONCLUSION Patients with younger age, short diabetes duration, more obesity, better glucose control, and better β cell function were more likely to achieve T2DM remission in patients with a BMI < 35 kg/m2 after bariatric surgery.
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Affiliation(s)
- Xianhao Yi
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Liyong Zhu
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
| | - Shaihong Zhu
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
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Khattab MA, Mohammed ATA, Alqahtani AZM, Alqahtani EZM, Alslim MMA, Alharbi NEA, Alslim RMA, Saleh Z, Atia MAQ, Shanaq AJ, Saleh A. The Role of Ethnic Disparities in the Outcomes of Bariatric Surgery: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e24743. [PMID: 35686257 PMCID: PMC9170373 DOI: 10.7759/cureus.24743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/06/2022] Open
Abstract
Bariatric surgery is increasingly performed over the past decade for the treatment of morbid obesity. It has beneficial effects on weight reduction, along with diabetes remission. Conflicting results have been reported to evaluate the effect of ethics differences on the outcomes of bariatric surgery. We conducted this meta-analysis to outline the effects of ethnic differences on the outcomes of bariatric surgery, including weight reduction, biochemical variables, diabetes, and hypertension remission. A comprehensive literature search was conducted, using PubMed, Web of Science (ISI), Google Scholar, Popline, Global Health Library (GHL), Virtual Health Library (VHL) including Cochrane database, New York Academy of Medicine (NYAM), and System for Information on Grey Literature in Europe (SIGLE) for studies reporting body mass index (BMI), percentage of excess weight loss (%EWL), waist circumference, hypertension, lipid profile, and diabetes variables. We used the National Heart, Lung, and Blood Institute (NHLBI) tool (Bethesda, MD: NHLBI, National Institutes of Health {NIH}) for quality assessment. Comprehensive Meta-Analysis version 2 software (Englewood, NJ: Biostat, Inc.) was applied to perform the meta-analysis of the variables of interest. We included 23 studies of 71,679 subjects, who underwent bariatric surgery. The majority of the included cases were Whites 55,030 (77%), while 705 (1%) were Asians. The percentages of Blacks, African Americans, Hispanics, and Non-Hispanics were 9.3%, 1.3%, 10.4%, and 1%, respectively. BMI showed no significant difference between Whites vs African American and Hispanic vs Non-Hispanic groups (MD: 0.858; 95% CI: 3.408-1.691; p = 0.509 and MD: 0.455; 95% CI: 2.444-1.554; p = 0.663, respectively). The same result was reported for %EWL, comparing Whites vs African Americans. Lipid biochemical variables, diabetes remission, and hypertension control were significantly more seen among the Asian population. In conclusion, we reported a significant ethnic diversity and reduction in waist circumference, hyperlipidemia, and the associated morbidity one year after bariatric surgery in the Asian population. Further, high-quality prospective studies should focus on the social and psychological ethnic differences associated with obesity.
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Changes in Antihypertensive Medication Following Bariatric Surgery. Obes Surg 2022; 32:1312-1324. [PMID: 35083703 DOI: 10.1007/s11695-022-05893-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
Obesity is a leading cause of hypertension (i.e., high blood pressure [BP]). While hypertension can be managed with antihypertensive medication, substantial weight loss can also lower BP, reducing the need for antihypertensive medication. Articles in this review (n = 60) presented data on antihypertensive medication use among adults pre- and postoperatively. Roux-en-Y gastric bypass was the most studied surgical approach followed by Laparoscopic Sleeve Gastrectomy. Antihypertensive medication was discontinued in a large proportion of patients after surgery, and the mean number of antihypertensive medications decreased by approximately one. In almost a third of the studies, over 75% of participants experienced hypertension remission. All articles aside from two reported a decrease in systolic BP, with about 40% reporting a decrease of ≥ 10 mm Hg.
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Papadia FS, Carlini F, Rubartelli A, Battistini M, Cordera R, Adami GF, Camerini G. Diabetes Resolution at 10 Years After Biliopancreatic Diversion in Overweight and Class 1 Obese Patients with Type 2 Diabetes. Obes Surg 2022; 32:845-851. [PMID: 35013895 PMCID: PMC8866270 DOI: 10.1007/s11695-021-05870-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
Background Long-term anti-diabetic effects of BPD in overweight or class 1 obese T2DM patients were investigated reporting the results at 10 years after BPD performed in severely non-obese T2DM patients. Material and Methods Thirty T2DM patients with BMI lower than 35 kg/m2 were investigated at 1, 5, and 10 years after BPD, and the results are compared with those of 30 T2DM patients followed for 10 years on pharmacological and/or behavioral conventional therapy. Results Mean levels of fasting blood glucose (FBG) and serum glycated hemoglobin (HbA1C) showed a marked reduction 1 year after BPD, values remaining slightly above the diabetic range throughout the entire follow-up. T2DM remission was observed in about 50% of the cases at 5 and 10 years after the operation. In 16 patients (53%), severe BPD-related complications developed, in ten cases requiring a surgical revision of the operation. In the BPD group, one patient died for malignant lymphoma and two patients after surgical revision. Within the control group, during the 10-year follow-up, no changes in the diabetic status were observed, being the FBG and HbA1C mean values higher than those recorded in the BPD patients at any follow-up time. All T2DM subjects of the control group were alive at the end of the 10-year follow-up. Conclusion Despite satisfactory long-term metabolic outcomes, these data indicate that BPD should be used with caution as a metabolic procedure in the treatment of T2DM in overweight or class 1obese patients. Graphical abstract ![]()
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Affiliation(s)
| | - Flavia Carlini
- Department of Surgery, University of Genova, Genova, Italy
| | | | - Micaela Battistini
- Department of Internal Medicine, University of Genova, 8, Viale Benedetto XV, 16132, Genova, Italy
| | - Renzo Cordera
- Department of Internal Medicine, University of Genova, 8, Viale Benedetto XV, 16132, Genova, Italy
| | - Gian Franco Adami
- Department of Internal Medicine, University of Genova, 8, Viale Benedetto XV, 16132, Genova, Italy.
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7
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Luo P, Cao Y, Li P, Wang G, Song Z, Li W, Su Z, Zhou H, Yi X, Fu Z, Sun X, Tang H, Cui B, Yu Q, Zhu L, Zhu S. Insulin Resistance Remission Following Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy in Chinese Type 2 Diabetes Mellitus Patients With a Body Mass Index of 27.5-32.5 kg/m 2. Front Physiol 2021; 12:772577. [PMID: 34819878 PMCID: PMC8606571 DOI: 10.3389/fphys.2021.772577] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Insulin resistance (IR) is closely associated with the pathogenesis of type 2 diabetes mellitus (T2DM). However, remission of insulin sensitivity after bariatric surgery in patients with T2DM and a body mass index (BMI) of 27.5–32.5 kg/m2 has not been fully elucidated. Methods: Thirty-six T2DM patients with a BMI of 27.5–32.5 kg/m2 were prospectively consecutively recruited for laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG). Hyperinsulinemic euglycemic clamp, oral glucose tolerance test (OGTT), and other indicators were tested at baseline and 6 months postoperative. Glucose disposal rate (GDR), time to reach euglycemia, homeostatic model assessment of IR, quantitative insulin sensitivity check index (QUICKI), triglyceride glucose (TyG) index, 30-min insulinogenic index (IGI30), and disposition index (DI) were calculated at baseline and 6 months after surgery. The criterion for remission in T2DM patients was the achievement of the triple composite endpoint. Results: Anthropometric and glucolipid metabolism parameters significantly improved following surgery. The GDR increased significantly from baseline to 6 months after LRYGB (from 4.28 ± 1.70 mg/kg/min to 8.47 ± 1.89 mg/kg/min, p < 0.0001) and LSG (from 3.18 ± 1.36 mg/kg/min to 7.09 ± 1.69 mg/kg/min, p < 0.001). The TyG index decreased after surgery (RYGB group, from 9.93 ± 1.03 to 8.60 ± 0.43, p < 0.0001; LSG group, from 10.04 ± 0.79 to 8.72 ± 0.65, p = 0.0002). There was a significant reduction in the IGI30 (RYGB group, from 2.04 ± 2.12 to 0.83 ± 0.47, p = 0.005; LSG group, from 2.12 ± 1.73 to 0.92 ± 0.66, p = 0.001). The mean DI significantly increased from 1.14 ± 1.35 to 7.11 ± 4.93 in the RYGB group (p = 0.0001) and from 1.25 ± 1.78 to 5.60 ± 4.58 in the LSG group (p = 0.003). Compared with baseline, HOMR-IR, QUICKI, area under the curve-C-peptide release test (AUC-CRT), and AUC-OGTT were significantly changed at 6 months postoperative. Overall, 52.63% of patients in the LRYGB group versus 29.41% of patients in the LSG group achieved the triple composite endpoint. Conclusion: Both LRYGB and LSG effectively induced remission of IR in patients with T2DM and a BMI of 27.5–32.5 kg/m2.
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Affiliation(s)
- Ping Luo
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Yaoquan Cao
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Pengzhou Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Guohui Wang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Song
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhihong Su
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Hui Zhou
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xianhao Yi
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhibing Fu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xulong Sun
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Haibo Tang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Beibei Cui
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Qianqian Yu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
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8
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Du D, Wang L, Chen W, Sang Q, Zheng X, Lian D, Zhang N. Weight loss is the deciding factor to predict the outcome of RYGB in obese Chinese with a BMI < 35 kg/m 2. Asian J Surg 2021; 45:1682-1687. [PMID: 34642048 DOI: 10.1016/j.asjsur.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/16/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure for bariatric surgery that leads to sustained weight loss and amelioration of obesity-related comorbidities. OBJECTIVES To verify long-term efficacy and safety and to investigate the influence of early weight loss on post-RYGB long-term weight maintenance in obese Chinese with body mass index (BMI) < 35 kg/m2. METHODS All patients were followed up for evaluating the variations in their BMI, percentage of excess weight loss (%EWL), and total body percentage weight loss (%TWL). Linear regression models were applied to evaluate the effects of early weight loss on successful weight maintenance. Optimal cutoff values were analyzed via plotting the receiver operative characteristic (ROC) curve. RESULTS In the current study, 143 patients were recruited. Preoperative BMI and weight were recorded as 32.24 (29.39-33.12) kg/m2, and 88.90 ± 9.52 kg, respectively. At 1, 3, and 5 years, successful weight loss i.e., greater than 25% TWL was attained by 46.85%, 37.76%, and 37.06% of patients, respectively. The obtained data revealed that %TWL at 0.5 years was considerably associated with %TWL for up to 5 years (P-value <0.001). Based on the ROC curve, %TWL of 24.39% at 0.5 years best predicted effective weight loss at 5 years (sensitivity 71.70%, specificity 82.22%). CONCLUSION RYGB is a safe and effective approach for weight loss and %TWL at 6 months might be used for predicting weight maintenance up to 5 years post-RYGB in obese Chinese with a BMI <35 kg/m2.
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Affiliation(s)
- Dexiao Du
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Liang Wang
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Weijian Chen
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Qing Sang
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Xuejing Zheng
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Dongbo Lian
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Nengwei Zhang
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
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9
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Najjari K, Talebpour M, Mahmoudabadi HZ, Elyasinia F, Abolhasani M, Ashrafi A, Maralani MS, Mehdinavaz A, Kor F. Effect of Laparoscopic Sleeve Gastrectomy vs. OAGB on Thyroid Function Tests in Patients with Morbid Obesity and Subclinical or Clinical Hypothyroidism. Obes Surg 2021; 31:4808-4814. [PMID: 34387825 DOI: 10.1007/s11695-021-05646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE As one of the major problems for the health sector, morbid obesity is associated with many hormonal dysfunctions, including thyroid hormone disorders. Few studies have been performed on improving subclinical and clinical hypothyroidism following bariatric surgery. Therefore, we designed and conducted this study to evaluate the effect of various types of bariatric surgery on thyroid hormone levels and to assess the change of levothyroxine requirement in these patients. METHODS The data of all patients who underwent either sleeve gastrectomy (SG) or one-anastomosis gastric bypass (OAGB) surgery in the 5 years from 2016 to 2020 at our hospital were analyzed retrospectively. RESULTS From 1486 patients (792 cases of SG and 694 cases of OAGB), 281 patients had preoperative abnormal thyroid function tests: subclinical hypothyroidism (102 patients) and clinical hypothyroidism (179 patients). The T4 level did not change significantly in any of the groups and subgroups. However, the TSH level at the end of the sixth month after SG and OAGB in both groups significantly lowered. Nevertheless, there is no significant difference between the effect of SG and OAGB surgical procedures on the rate of TSH and T4 alterations in both subclinical and clinical hypothyroid patients. In the sixth month after surgery, 49% of clinically hypothyroid patients in the SG group (n = 179) reduced or stopped taking the medication. CONCLUSION Whereas bariatric surgery reduces TSH levels, it does not significantly alter T4 levels. Furthermore, there is no apparent difference between subclinical and clinical hypothyroidism and different types of bariatric surgery.
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Affiliation(s)
- Khosrow Najjari
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Talebpour
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fezzeh Elyasinia
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Sports Medicine Research Center, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ashrafi
- Golestan Hospital, Jundishapour University of Medical Sciences, Ahvaz, Iran
| | | | | | - Farhad Kor
- Department of Surgery, Golestan University of Medical Sciences, Gorgan, Iran.
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10
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Tu Y, Bao Y, Zhang P. Metabolic surgery in China: present and future. J Mol Cell Biol 2021; 13:mjab039. [PMID: 34240190 PMCID: PMC8697345 DOI: 10.1093/jmcb/mjab039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/27/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Obesity and its related complications comprise a serious public health problem worldwide, and obesity is increasing in China. Metabolic surgery is a new type of treatment with unique advantages in weight loss and obesity-related metabolic complications. The pathogenesis of obesity is complex and not yet fully understood. Here, we review the current efficacy and safety of metabolic surgery, as well as recent progress in mechanistic studies and surgical procedures in China. The exciting and rapid advances in this field provide new opportunities for patients with obesity and strike a balance between long-term effectiveness and safety.
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Affiliation(s)
- Yinfang Tu
- Department of Endocrinology and Metabolism, Shanghai
Jiao Tong University Affiliated Sixth People’s HospitalShanghai Diabetes
Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of
Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic
Disease, Shanghai 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai
Jiao Tong University Affiliated Sixth People’s HospitalShanghai Diabetes
Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of
Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic
Disease, Shanghai 200233, China
- Department of Endocrinology and Metabolism, Jinshan
District Central Hospital of Shanghai Sixth People's
Hospital, Shanghai 201599, China
| | - Pin Zhang
- Department of Bariatric and Metabolic Surgery,
Shanghai Jiao Tong University Affiliated Sixth People’s
Hospital, Shanghai 200233, China
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11
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Ismail M, Nagaraj D, Rajagopal M, Ansari H, Iyyankutty K, Nair M, Hegde A, Rekha PD. Is weight regaining significant post laparoscopic Roux-en-Y gastric bypass surgery? - A 5-year follow-up study on Indian patients. J Minim Access Surg 2021; 17:159-164. [PMID: 33723179 PMCID: PMC8083740 DOI: 10.4103/jmas.jmas_108_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Laparoscopic Roux-en-Y gastric bypass (RYGB) has been proven to induce significant weight loss and remission of related co-morbidities in patients with morbid obesity. The long-term follow-up data show weight regain or failure to achieve complete remission of type 2 diabetes mellitus (T2DM) in some patients. In this study, we report weight loss patterns and remission of T2DM in patients with morbid obesity during a 5-year follow-up after RYGB. Objective The objective was to evaluate outcomes during the follow-up on excess weight loss (EWL) and remission of T2DM after laparoscopic RYGB among Indian patients. Setting The study was conducted in a tertiary care hospital, Kerala, India. Materials and Methods This is a retrospective study in patients who underwent surgery between 2007 and 2010. The patient demographics, pre- and post-operative body mass index (BMI), co-morbidities and EWL were recorded from the medical records. These data were compared between pre-operative and follow-up intervals till 5 years using statistical approaches. Results The study included 157 patients (91 males and 66 females) having a mean pre-operative BMI of 47.91 ± 7.01 kg/m2. A significant reduction in the BMI was observed at each follow-up point (P < 0.01) till 5 years after the surgery. The mean percentage of EWL increased from 34.57% ± 12.62% to 71.50% ± 15.41% from 3 months to 5 years after the surgery. Twelve per cent (n = 19) of patients achieved normal BMI (<25 mg/kg2) by 3rd year after the surgery. However, the remission of T2DM was achieved in >50% of patients within a year of surgery. During the 5th year, weight regain (1-22 kg) was observed in 36.70% (n = 58) patients, and recurrence of T2DM was observed in two patients. Conclusions The long-term durability of RYGB in the study population was satisfactory with significant weight loss and remission of T2DM.
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Affiliation(s)
- Mohamed Ismail
- Department of General, Laparoscopic and Bariatric Surgery, Moulana Hospital, Perinthalmanna, Kerala, India
| | - Dileep Nagaraj
- Department of General, Laparoscopic and Bariatric Surgery, Moulana Hospital, Perinthalmanna, Kerala, India
| | - Mahesh Rajagopal
- Department of General, Laparoscopic and Bariatric Surgery, Moulana Hospital, Perinthalmanna, Kerala, India
| | - Hafiz Ansari
- Department of General, Laparoscopic and Bariatric Surgery, Moulana Hospital, Perinthalmanna, Kerala, India
| | - Kingsly Iyyankutty
- Department of General, Laparoscopic and Bariatric Surgery, Moulana Hospital, Perinthalmanna, Kerala, India
| | - Megha Nair
- Yenepoya Research Centre, Yenepoya University, Mangalore, Karnataka, India
| | - Aparna Hegde
- Yenepoya Research Centre, Yenepoya University, Mangalore, Karnataka, India
| | - P D Rekha
- Yenepoya Research Centre, Yenepoya University, Mangalore, Karnataka, India
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Wu Z, Wu L, Dai X, Zhao W, Yu X, Song Z, Yang B, Huang Z. [Therapeutic effect of laparoscopic Roux-en-Y gastric bypass in non-obese patients with type 2 diabetes]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1044-1048. [PMID: 32895162 DOI: 10.12122/j.issn.1673-4254.2020.07.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery for treatment of type 2 diabetes (T2D) in patients with a body mass index (BMI) < 27.5 kg/m2. METHODS We retrospectively analyzed the data of patients who underwent LRYGB surgery from March, 2012 to June, 2018 in the General Hospital of Guangzhou Military Command and Jinshazhou Hospital of Guangzhou University of Chinese Medicine. The changes in the parameters of glucose metabolism and physical indicators of the patients in the first, second and third years after the surgery were analyzed in patients in low BMI group and high BMI group. RESULTS All the 74 patients underwent LRYGB successfully without conversion to open surgery. One year after the surgery, fasting blood glucose (FBG), HbA1c, postprandial blood glucose, fasting insulin, HOMA-IR, fasting C-peptide, BMI, body weight and waistline were significantly improved compared with their preoperative values in low BMI group (P < 0.05). At 2 years after the operation, FBG, HbA1c, postprandial blood glucose, HOMA-IR, BMI, body weight and waistline were significantly improved compared with the preoperative values in low BMI group (P < 0.05). In the third year, FBG, HOMA-IR, fasting C-peptide, body weight and waistline were significantly improved compared with the preoperative values in low BMI group (P < 0.05). There was no significant difference in the parameters of glucose metabolism and islet function between low BMI group and high BMI group at different stages. No serious complications occurred in these patients after the surgery. CONCLUSIONS LRYGB is effective for treatment of T2D in Chinese patients with a BMI < 27.5. After the surgery, the patient show reduced waistline without significant weight loss. The long-term results of the surgery still require further investigations with a larger samples and longer follow-up.
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Affiliation(s)
- Zhuangwei Wu
- Special Medical Service Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Liangping Wu
- Department of Thyroid and Diabetes Surgery, Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510168, China
| | - Xiaojiang Dai
- Department of Thyroid and Diabetes Surgery, Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510168, China
| | - Weiguo Zhao
- Department of Thyroid and Diabetes Surgery, Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510168, China
| | - Xiang Yu
- Special Medical Service Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Zhigao Song
- Center for Translational Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Baolin Yang
- Department of Thyroid and Diabetes Surgery, Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510168, China
| | - Zonghai Huang
- Special Medical Service Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
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Chen X, Zhang C, Liu W, Zhang J, Zhou Z. Laparoscopic Sleeve Gastrectomy-Induced Decreases in FT3 and TSH are Related to Fasting C-Peptide in Euthyroid Patients with Obesity. Diabetes Metab Syndr Obes 2020; 13:4077-4084. [PMID: 33149647 PMCID: PMC7605608 DOI: 10.2147/dmso.s277486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/09/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Laparoscopic sleeve gastrectomy (LSG) is one of the most effective therapies to treat obesity. However, whether LSG affects thyroid function remains elusive. Due to a lack of longitudinal research, we explored changes in thyroid function in euthyroid patients with obesity before and after LSG. METHODS In total, 109 participants (59 obese patients, 30 normal controls and 20 overweight subjects) were recruited from the Second Xiangya Hospital of Central South University (CSU). All patients underwent LSG, and metabolic indicators and free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were evaluated at baseline, 6 and 12 months postoperatively. RESULTS Compared to the normal control group, the concentrations of FT4 were decreased and TSH were increased in the obese group at baseline. Thyroid hormone levels in all participants were within the normal range during the 12 months after LSG. The concentrations of FT3 (4.83 ± 0.06 vs 5.03 ± 0.08, P = 0.023) and TSH (1.67 ± 0.11 vs 2.25 ± 0.18, P = 0.000) significantly decreased from baseline to 12 months postoperatively, while the concentrations of FT4 significantly increased (17.40 ± 0.52 vs 15.80 ± 0.32, P = 0.004). The decrease in fasting C-peptide (FCP) was related to the decline in FT3 and TSH during 12 months after LSG. CONCLUSION Obesity is closely related to thyroid function. LSG promoted a significant decrease in FT3 and TSH and a significant increase in FT4 in euthyroid patients with obesity after LSG. The decline in FCP may be involved in the decrease in FT3 and TSH after LSG.
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Affiliation(s)
- Xi Chen
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha410011, Hunan, People’s Republic of China
| | - Chunlan Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha410011, Hunan, People’s Republic of China
| | - Wei Liu
- Department of Metabolic Surgery, Department of Biliopancreatic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan410011, People’s Republic of China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha410011, Hunan, People’s Republic of China
- Correspondence: Jingjing Zhang National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Changsha410011, Hunan, People’s Republic of China Email
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha410011, Hunan, People’s Republic of China
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Rubio-Almanza M, Hervás-Marín D, Cámara-Gómez R, Caudet-Esteban J, Merino-Torres JF. Does Metabolic Surgery Lead to Diabetes Remission in Patients with BMI < 30 kg/m 2?: a Meta-analysis. Obes Surg 2019; 29:1105-1116. [PMID: 30604080 DOI: 10.1007/s11695-018-03654-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bariatric surgery has demonstrated to be effective in remission of type 2 diabetes in obese patients, but it is unclear in non-obese patients. The aim of this study is to investigate if metabolic surgery is effective in diabetes resolution in patients with BMI < 30 kg/m2. MATERIALS AND METHODS A systematic review was performed and the content of the PubMed, Ovid, and the Cochrane Library databases covering the period January 2008 to April 2018 was searched. Studies with metabolic surgery performed in patients with type 2 diabetes, BMI < 30 kg/m2 and a follow-up ≥ 6 months were included. Type 2 diabetes remission rate and metabolic parameters changes were measured. A meta-analysis was conducted with the selected studies. RESULTS Twenty-six studies were included in the meta-analysis (1105 patients). The mixed-effects meta-analysis model for overall diabetes remission rate produced an estimate of 43% (95% IC 34-53%, p < 0.001). Moderator effects of the variables race, preoperative HbA1c, BMI, months of follow-up, duration of diabetes, and age on diabetes remission were also assessed, with no significant effects being found in any of them. A reduction in BMI (- 3.57 kg/m2), fasting blood glucose (- 55.93 mg/dL) and HbA1c (- 2.08%) was observed after surgery. CONCLUSIONS Metabolic surgery could be effective in remission of type 2 diabetes in BMI < 30 kg/m2 patients but randomized and long-term studies are necessary. The scientific community should agree in a single definition of type 2 diabetes remission, in order to know the real effect of metabolic surgery in this group of patients.
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Affiliation(s)
- Matilde Rubio-Almanza
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain.
- Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética Clínica, Instituto de Investigación Sanitaria La Fe (Health Research Institute La Fe), Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain.
| | - David Hervás-Marín
- Biostatistics Unit, Instituto de Investigación Sanitaria La Fe (Health Research Institute La Fe), Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Rosa Cámara-Gómez
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
- Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética Clínica, Instituto de Investigación Sanitaria La Fe (Health Research Institute La Fe), Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jana Caudet-Esteban
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
- Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética Clínica, Instituto de Investigación Sanitaria La Fe (Health Research Institute La Fe), Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Juan Francisco Merino-Torres
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
- Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética Clínica, Instituto de Investigación Sanitaria La Fe (Health Research Institute La Fe), Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
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Tu Y, Wang L, Wei L, Xu Y, Han X, Han J, Yu H, Zheng C, Bao Y, Jia W. Cost-Utility of Laparoscopic Roux-en-Y Gastric Bypass in Chinese Patients with Type 2 Diabetes and Obesity with a BMI ≥ 27.5 kg/m2: a Multi-Center Study with a 4-Year Follow-Up of Surgical Cohort. Obes Surg 2019; 29:3978-3986. [DOI: 10.1007/s11695-019-04069-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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16
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Ribeiro R, Pouwels S, Parmar C, Pereira J, Manaças L, Guerra A, Borges N, Ribeiro J, Viveiros O. Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision Cases. Obes Surg 2019; 29:3665-3671. [PMID: 31267476 DOI: 10.1007/s11695-019-04051-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND One of the most important complications of the one anastomosis gastric bypass (OAGB) is enterobilio acid reflux (EBAR). We report the concept of the long pouch Roux-en-Y gastric bypass (LPRYGB) meaning a Roux-en-Y with a long pouch and a 100-cm alimentary limb to avoid EBAR, with a long biliopancreatic limb to increase metabolic effects. METHODS A total of 300 LPRYGB cases in a 4-year period, with a 90% follow-up rate, were analysed. Anthropometric, technical feasibility, morbidity, weight loss and comorbidity outcomes were analysed. RESULTS The percentage total weight loss (%TWL) was 30.5% at 4 years of follow-up (32.3% in primary and 28.3% in revisions). Six intra-operative (2%) and 28 postoperative complications (9.3%) were seen. Out of this 28 complications, 11 (3.6%) were late complications. Reoperations were performed in 15 patients (5.0%). Clinically relevant EBAR was present in 3 cases only (1%) 4 years after the operation. CONCLUSIONS The LPRYGB combines the main advantages of the OAGB (light restriction and moderate malabsorption) with the anti-reflux effect from the Roux-en-Y diversion.
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Affiliation(s)
- Rui Ribeiro
- Clínica de Santo António, Metabolic Patient Multidisciplinary Centre, Reboleira, Lisbon, Portugal
| | - Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, P.O. Box 432, 2501 CK, The Hague, The Netherlands.
| | | | - João Pereira
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Leonor Manaças
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Anabela Guerra
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Nuno Borges
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - João Ribeiro
- Clínica de Santo António, Metabolic Patient Multidisciplinary Centre, Reboleira, Lisbon, Portugal
| | - Octávio Viveiros
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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The Effect of Bariatric Surgery on Asian Patients with Type 2 Diabetes Mellitus and Body Mass Index < 30 kg/m2: a Systematic Review and Meta-analysis. Obes Surg 2019; 29:2492-2502. [DOI: 10.1007/s11695-019-03861-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Albaugh VL, Banan B, Antoun J, Xiong Y, Guo Y, Ping J, Alikhan M, Clements BA, Abumrad NN, Flynn CR. Role of Bile Acids and GLP-1 in Mediating the Metabolic Improvements of Bariatric Surgery. Gastroenterology 2019; 156:1041-1051.e4. [PMID: 30445014 PMCID: PMC6409186 DOI: 10.1053/j.gastro.2018.11.017] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/19/2018] [Accepted: 11/01/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Bile diversion to the ileum (GB-IL) has strikingly similar metabolic and satiating effects to Roux-en-Y gastric bypass (RYGB) in rodent obesity models. The metabolic benefits of these procedures are thought to be mediated by increased bile acids, although parallel changes in body weight and other confounding variables limit this interpretation. METHODS Global G protein-coupled bile acid receptor-1 null (Tgr5-/-) and intestinal-specific farnesoid X receptor null (FxrΔ/E) mice on high-fat diet as well as wild-type C57BL/6 and glucagon-like polypeptide 1 receptor deficient (Glp-1r-/-) mice on chow diet were characterized following GB-IL. RESULTS GB-IL induced weight loss and improved oral glucose tolerance in Tgr5-/-, but not FxrΔ/E mice fed a high-fat diet, suggesting a role for intestinal Fxr. GB-IL in wild-type, chow-fed mice prompted weight-independent improvements in glycemia and glucose tolerance secondary to augmented insulin responsiveness. Improvements were concomitant with increased levels of lymphatic GLP-1 in the fasted state and increased levels of intestinal Akkermansia muciniphila. Improvements in fasting glycemia after GB-IL were mitigated with exendin-9, a GLP-1 receptor antagonist, or cholestyramine, a bile acid sequestrant. The glucoregulatory effects of GB-IL were lost in whole-body Glp-1r-/- mice. CONCLUSIONS Bile diversion to the ileum improves glucose homeostasis via an intestinal Fxr-Glp-1 axis. Altered intestinal bile acid availability, independent of weight loss, and intestinal Akkermansia muciniphila appear to mediate the metabolic changes observed after bariatric surgery and might be manipulated for treatment of obesity and diabetes.
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Affiliation(s)
- Vance L. Albaugh
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Babak Banan
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph Antoun
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Yanhua Xiong
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Yan Guo
- Department of Cancer Biology, Vanderbilt University, Nashville, TN
| | - Jie Ping
- Department of Cancer Biology, Vanderbilt University, Nashville, TN
| | - Muhammed Alikhan
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Naji N. Abumrad
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
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Wang T, Shen Y, Qiao Z, Wang Y, Zhang P, Yu B. Comparison of Diabetes Remission and Micronutrient Deficiency in a Mildly Obese Diabetic Rat Model Undergoing SADI-S Versus RYGB. Obes Surg 2019; 29:1174-1184. [PMID: 30610678 DOI: 10.1007/s11695-018-03630-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has launched a huge challenge to classic Roux-en-Y gastric bypass (RYGB). Our objective was to compare diabetes remission and micronutrient deficiency in a mildly obese diabetic rat model undergoing SADI-S versus RYGB. METHODS Thirty adult male mildly obese diabetic rats were randomly assigned to sham (S), SADI-S, and RYGB groups. Body weight, food intake, fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), plasma insulin, GLP-1, and ghrelin levels were measured at indicated time points. Meanwhile, insulin sensitivity and pancreatic β cell function were assessed during OGTT. Finally, plasma micronutrient evaluation and islet β cell mass analysis were performed after all animals were sacrificed. RESULTS As compared to sham, the SADI-S and RYGB groups achieved almost equivalent efficacy in caloric restriction and FPG control without excessive weight loss. During OGTT, the SADI-S and RYGB groups also provided comparable effects on glycemic excursion, insulin sensitivity, and β cell function; however, only rats in the RYGB group showed significant changes in gut hormones, whereas the three groups were found to exhibit no significant difference in β cell mass. In addition, only vitamin E in the RYGB group was deficient as compared with the SADI-S and S groups. CONCLUSION In mildly obese diabetic rat, SADI-S and RYGB procedures have comparable efficacy in diabetes remission and risk of micronutrient deficiency. These data show that each of the surgery accomplishes diabetes improvements through both overlapping and distinct mechanisms requiring further investigation.
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Affiliation(s)
- Tingfeng Wang
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Yunlong Shen
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Zhengdong Qiao
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Yueqian Wang
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Peng Zhang
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China. .,Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China.
| | - Bo Yu
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China.
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Type 2 Diabetes Remission and Control in Overweight and in Mildly Obese Diabetic Patients at Long-Term Follow-Up After Biliopancreatic Diversion. Obes Surg 2018; 29:239-245. [DOI: 10.1007/s11695-018-3511-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Dong Z, Islam SMS, Yu AM, Qu R, Guan B, Zhang J, Hong Z, Wang C. Laparoscopic metabolic surgery for the treatment of type 2 diabetes in Asia: a scoping review and evidence-based analysis. BMC Surg 2018; 18:73. [PMID: 30223815 PMCID: PMC6142391 DOI: 10.1186/s12893-018-0406-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/06/2018] [Indexed: 12/18/2022] Open
Abstract
Background Laparoscopic metabolic surgery has been previously shown to be an effective treatment for obese patients with type 2 diabetes (T2DM). The objective of this scoping review is to determine the impact of metabolic surgery for the treatment of type 2 diabetes in Asia and perform an evidence-based analysis. Methods We performed a literature search in PubMed for research on laparoscopic metabolic surgery for the treatment of T2DM in Asia region. We classified the included studies based on the Oxford Center for Evidence Based Medicine guidelines. And performed and evidence analysis. Results In total, 205 articles were identified. 62.9% of the studies were from East Asia. The evidence of 26 studies are level I, 59 are level II. Laparoscopic sleeve gastrectomy (LSG) was the most commonly reported surgical procedure (63.1%) in Asia. The number of laparoscopic metabolic surgery for T2DM in Asian countries has increased rapidly over the last 8 years. We identified 16 studies which showed that laparoscopic metabolic surgery is an effective and safe treatment for T2DM in patients with a BMI of > 25 kg/m2 to < 35 kg/m2 in Asia. Conclusions Our results suggest that laparoscopic metabolic surgery might be an effective and safe treatment for T2DM patients with BMI < 35 kg/m2, and that LSG is the most commonly performed surgical procedure for this in Asia.
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Affiliation(s)
- Zhiyong Dong
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | | | - Ashley M Yu
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Rui Qu
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Bingsheng Guan
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Junchang Zhang
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Zhao Hong
- Robert H Lurie Medical Research Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Cunchuang Wang
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China.
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Ambery P, Parker VE, Stumvoll M, Posch MG, Heise T, Plum-Moerschel L, Tsai LF, Robertson D, Jain M, Petrone M, Rondinone C, Hirshberg B, Jermutus L. MEDI0382, a GLP-1 and glucagon receptor dual agonist, in obese or overweight patients with type 2 diabetes: a randomised, controlled, double-blind, ascending dose and phase 2a study. Lancet 2018; 391:2607-2618. [PMID: 29945727 DOI: 10.1016/s0140-6736(18)30726-8] [Citation(s) in RCA: 204] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Weight loss is often key in the management of obese or overweight patients with type 2 diabetes, yet few treatments for diabetes achieve clinically meaningful weight loss. We aimed to assess the efficacy, tolerability, and safety of treatment with MEDI0382, a balanced glucagon-like peptide-1 and glucagon receptor dual agonist developed to provide glycaemic control and weight loss, in patients with type 2 diabetes. METHODS This randomised, placebo-controlled, double-blind, combined multiple-ascending dose (MAD) and phase 2a study was done at 11 study sites (hospitals and contract research organisations) in Germany. We enrolled patients aged 18-65 years with controlled type 2 diabetes (glycated haemoglobin A1c [HbA1c] levels of 6·5-8·5% at screening) and a body-mass index between 27 kg/m2 and 40 kg/m2. An interactive web-response system was used to randomly assign patients to receive MEDI0382 or placebo. Patients were randomly assigned 2:1 in cohorts A-C and 3:1 in cohorts D and E in the MAD portion of the study, and 1:1 in the phase 2a portion. Randomisation was done by a contracted third-party operator who was not involved in the clinical operations of the study. The pharmacists, participants, and study site personnel involved in treating and assessing participants were masked to treatment allocation. Patients received once-daily subcutaneous injections of the study drug at doses of no more than 300 μg for 22 days or less in the MAD portion of the study, and a dose of no more than 200 μg for 41 days or less in the phase 2a portion. The two primary endpoints of the phase 2a portion were the change from baseline to day 41 in glucose area under the curve at 0-4 h (AUC0-4 h) after a mixed-meal tolerance test (MMTT), assessed in all participants who received at least one dose of study drug and whose measurements were taken at baseline and day 41, and change from baseline in bodyweight, assessed in the intention-to-treat (ITT) population. Safety analyses were done in all participants who received any study drug analysed according to the treatment they received. This study is registered with ClinicalTrials.gov, number NCT02548585. FINDINGS Patients were recruited between Dec 9, 2015, and Feb 24, 2017. 61 patients were randomly assigned to the MAD part of the study (42 to MEDI0382 and 19 to placebo). 51 patients were randomly assigned to the phase 2a part, of whom 25 were randomly assigned to MEDI0382 and 26 to placebo. In the phase 2a study, three patients in the MEDI0382 group and one in the placebo group discontinued, all as a result of adverse events. 22 (88%) patients in the MEDI0382 group and 25 (96%) in the placebo group received at least one dose and had measurements taken at baseline and day 41. Glucose AUC0-4 h post MMTT decreased significantly with MEDI0382 versus placebo (least squares [LS] mean -32·78% [90% CI -36·98 to -28·57] vs -10·16% [-14·10 to -6·21], and the mean difference was -22·62% [-28·40 to -16·85]; p<0·0001). In the ITT population, reduction in bodyweight was significantly greater with MEDI0382 than with placebo (LS mean -3·84 kg [90% CI -4·55 to -3·12] vs -1·70 kg [-2·40 to -1·01] and mean difference of 2·14 kg [-3·13 to -1·31]; p=0·0008). The proportion of patients who had a treatment-emergent adverse event (TEAE) was similar between treatment groups (22 [88%] of 25 in the MEDI0382 group vs 23 [88%] of 26 in the placebo group); gastrointestinal disorders (18 [72%] vs 13 [40%]) and decreased appetite (five [20%] vs none) occurred more frequently with MEDI0382 than placebo. No participants in the MEDI0382 group had a grade 3 or worse TEAE (vs two [8%] in the placebo group). INTERPRETATION MEDI0382 has the potential to deliver clinically meaningful reductions in blood glucose and bodyweight in obese or overweight individuals with type 2 diabetes. FUNDING MedImmune.
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Affiliation(s)
- Philip Ambery
- Cardiovascular, Renal, and Metabolism, MedImmune, Cambridge, UK.
| | | | | | | | | | | | | | | | - Meena Jain
- Cardiovascular, Renal, and Metabolism, MedImmune, Cambridge, UK
| | | | | | | | - Lutz Jermutus
- Cardiovascular, Renal, and Metabolism, MedImmune, Cambridge, UK
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Neves JS, Castro Oliveira S, Souteiro P, Pedro J, Magalhães D, Guerreiro V, Bettencourt-Silva R, Costa MM, Cristina Santos A, Queirós J, Varela A, Freitas P, Carvalho D. Effect of Weight Loss after Bariatric Surgery on Thyroid-Stimulating Hormone Levels in Patients with Morbid Obesity and Normal Thyroid Function. Obes Surg 2018; 28:97-103. [PMID: 28725979 DOI: 10.1007/s11695-017-2792-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Several studies have reported that morbid obesity is associated with increased thyroid-stimulating hormone (TSH) levels. However, it is not clear what is the impact of bariatric surgery on postoperative thyroid function. The aim of this study was to evaluate the effect of weight loss after bariatric surgery on TSH levels in euthyroid patients with morbid obesity. METHODS We performed a retrospective observational study of 949 euthyroid patients (86.1% female; age 42.0 ± 10.3 years, BMI 44.3 ± 5.7 kg/m2) with morbid obesity submitted to bariatric surgery (laparoscopic adjustable gastric band, Roux-en-Y gastric bypass, or sleeve gastrectomy). Patients were subdivided in two groups: normal TSH group (TSH <2.5 mU/L) and high-normal TSH group (TSH ≥2.5 mU/L). The impact of anthropometric parameters, comorbidities, TSH, free thyroxine (FT4), free triiodothyronine (FT3), type of surgery, and excessive body weight loss (EBWL) on TSH variation 12 months after surgery was evaluated. RESULTS The high-normal TSH group (24.3% of patients) included more women, presented a higher BMI, higher systolic blood pressure, and higher FT3 levels. There was a significant decrease of TSH 12 months after surgery that was more marked in the high-normal TSH group (normal TSH group: 1.57 ± 0.49 to 1.53 ± 0.69 mIU/L, p = 0.063; high-normal TSH group: 3.23 ± 0.59 to 2.38 ± 0.86 mIU/L, p < 0.001). In a multivariate analysis, after adjusting for relevant covariates, EBWL, baseline BMI, and baseline FT3 were significantly associated with TSH decrease 12 months after bariatric surgery. CONCLUSION Bariatric surgery promotes a decrease of TSH that is significantly greater in patients with high-normal TSH and is independently associated with EBWL after surgery.
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Affiliation(s)
- João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.
- Department of Surgery and Physiology, Cardiovascular Research Center, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Sofia Castro Oliveira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Pedro Souteiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
| | - Daniela Magalhães
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
| | - Rita Bettencourt-Silva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Maria Manuel Costa
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ana Cristina Santos
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal
| | - Joana Queirós
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar São João, Porto, Portugal
| | - Ana Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
- Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar São João, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
- Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar São João, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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Huang ZP, Guo Y, Liu CQ, Qi L, Zou DJ, Zhou WP. The effect of metabolic surgery on nonobese patients (BMI<30 kg/m 2) with type 2 diabetes: a systematic review. Surg Obes Relat Dis 2018; 14:810-820. [PMID: 29571634 DOI: 10.1016/j.soard.2018.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/17/2018] [Accepted: 02/11/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The influence of metabolic surgery on the glucose and lipid profiles of nonobese body mass index<30 kg/m2 patients with type 2 diabetes, particularly the effect ≥1 year, remains unknown. METHODS PubMed and Ovid Embase were used. SETTING University hospitals. RESULTS In total, 21 studies including 921 patients were examined in this systematic review, the results of which revealed decrease in body mass index, waist circumference, fasting plasma glucose, glycosylated hemoglobin A1C, fasting C-peptide, fasting insulin, homeostasis model of assessment for insulin resistance index, triglycerides, total cholesterol, and low-density lipoprotein cholesterol. An increase in high-density lipoprotein cholesterol was also observed. The diabetes remission rates ranged from 13.3% to 90.2% according to 20 studies. The incidence of gastrointestinal bleeding ranged from 1% to 10% according to 9 studies. Four studies reported anemia after Roux-en-Y gastric bypass or one-anastomosis gastric bypass, with the incidence ranging from 8% to 33%. CONCLUSIONS Nonobese patients can achieve improvements in weight-related indices and glucose and lipid profiles in the short and medium term after metabolic surgery; however, the complications of metabolic surgery warrant further attention.
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Affiliation(s)
- Zhi-Ping Huang
- Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Yan Guo
- Department of Endocrinology, Changhai Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Chao-Qian Liu
- Department of General Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Lin Qi
- Department of Orthopaedics, the Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Da-Jin Zou
- Department of Endocrinology, Changhai Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
| | - Wei-Ping Zhou
- Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
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25
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Ke Z, Tong W. Response to the Comment on: Effects of Laparoscopic Roux-en-Y Gastric Bypass for Type 2 Diabetes Mellitus: Comparison of BMI > 30 and < 30 kg/m 2. Obes Surg 2017; 28:848-849. [PMID: 29282630 DOI: 10.1007/s11695-017-3073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Zhigang Ke
- Department of General Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Weidong Tong
- Department of General Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
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26
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Chen J, Yu H, Chen L, Wu L, Hu B, Bao Y, Jiang L. Effect of Roux-en-Y gastric bypass on carotid intima-media thickness in Chinese obese patients with type 2 diabetes. Surg Obes Relat Dis 2017; 13:1530-1535. [DOI: 10.1016/j.soard.2017.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/29/2016] [Accepted: 01/27/2017] [Indexed: 12/27/2022]
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27
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Adami GF, Cordera R. Assessing the Actual Clinical Effectiveness of Metabolic/Bariatric Surgery for the Type 2 Diabetes Therapy. Obes Surg 2017; 27:1886-1888. [PMID: 28502027 DOI: 10.1007/s11695-017-2735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gian Franco Adami
- Department of Internal Medicine, University of Genova, Genoa, Italy.
- IRCCS, Azienda Ospedale-Universitaria San Martino, Genoa, Italy.
- Department of Surgery, University of Genova, Largo Benzi 8, 16132, Genoa, Italy.
| | - Renzo Cordera
- Department of Internal Medicine, University of Genova, Genoa, Italy
- IRCCS, Azienda Ospedale-Universitaria San Martino, Genoa, Italy
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28
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Ma JJ, Zang L, Yang A, Hu WG, Feng B, Dong F, Wang ML, Lu AG, Li JW, Zheng MH. A modified uncut Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy: preliminary results and initial experience. Surg Endosc 2017; 31:4749-4755. [PMID: 28411343 DOI: 10.1007/s00464-017-5551-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/28/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the safety and feasibility of totally laparoscopic uncut Roux-en-Y anastomosis in the distal gastrectomy with D2 dissection for gastric cancer. We also summarized the preliminary experience of totally laparoscopic uncut Roux-en-Y anastomosis. METHODS A retrospective analysis was done in 51 cases of total laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D2 dissection for gastric cancer in our hospital from September 2014 to December 2015. RESULTS All of 51 cases underwent total laparoscopic uncut Roux-en-Y anastomosis. All the procedures were performed successfully. There were neither conversions to open surgery nor intraoperative complications in all 51 cases. In this study, the median operative time was 170 (135-210) min and the median time of anastomosis was 27 (24-41) min. The blood loss was 60 (30-110) ml. The time to flatus and length of postoperative hospital stay were 2 (1-3) days, and 8 (7-12) days, respectively. The mean lymph node harvest was 34 (18-49). One anastomotic bleeding occurred postoperatively which was cured by conservative treatment. No major postoperative complication occurred, such as anastomotic leak, anastomotic stenosis, and Roux stasis syndrome. After a short-term follow-up, no recanalization or reflux gastritis was encountered by endoscopy. CONCLUSION The totally laparoscopic uncut Roux-en-Y anastomosis in distal gastrectomy with lymph node dissection for gastric cancer is safe and feasible, with a very low rate of recanalization and reflux gastritis.
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Affiliation(s)
- Jun-Jun Ma
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Lu Zang
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China. .,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Annie Yang
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Wei-Guo Hu
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Bo Feng
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Feng Dong
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Ming-Liang Wang
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Ai-Guo Lu
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jian-Wen Li
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Min-Hua Zheng
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
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29
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Yan W, Bai R, Yan M, Song M. Preoperative Fasting Plasma C-Peptide Levels as Predictors of Remission of Type 2 Diabetes Mellitus after Bariatric Surgery: A Systematic Review and Meta-Analysis. J INVEST SURG 2017; 30:383-393. [PMID: 28045566 DOI: 10.1080/08941939.2016.1259375] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Wenmao Yan
- Department of General Surgery, Beijing Tian Tan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Rixing Bai
- Department of General Surgery, Beijing Tian Tan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Ming Yan
- Department of General Surgery, Beijing Tian Tan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Maomin Song
- Department of General Surgery, Beijing Tian Tan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing, China
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Finelli C. WITHDRAWN: Dealing with visceral fat reduction to slow the progression of NAFLD. Surg Obes Relat Dis 2016:S1550-7289(16)30885-1. [PMID: 28254261 DOI: 10.1016/j.soard.2016.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Carmine Finelli
- Department of Emergency and Internal Medicine, Ospedale S. Maria della Pietà-ASL Napoli 3 Sud, Nola (Napoli), Italy
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