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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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Functional Laparoscopic Roux-en-Y Gastric Bypass with Fundectomy and Gastric Remnant Exploration (LRYGBfse)-a Video Vignette. Obes Surg 2021; 31:2350-2352. [PMID: 33616850 PMCID: PMC8041701 DOI: 10.1007/s11695-021-05298-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The laparoscopic Roux en-Y gastric bypass (LRYGB) is performed worldwide and is considered by many the gold standard treatment for morbid obesity. However, the difficult access to the gastric remnant and duodenum represents intrinsic limitations. The functional laparoscopic gastric bypass with fundectomy and gastric remnant exploration (LRYGBfse) is a new technique described in attempt to overcome the limitations of the LRYGB. The purpose of this video was to demonstrate the LRYGBfse in a 48-year-old man with type II diabetes and hypertension. METHODS An intraoperative video has been anonymized and edited to demonstrate the feasibility of LRYGBfse. RESULTS The operation started with the opening of the gastrocolic ligament. Staying close to the gastric wall, the stomach is prepared up to the angle of His. After the placement of a 36-Fr orogastric probe, gastric fundectomy is completed in order to create a 30cc gastric pouch. A polytetrafluoroethylene banding (ePTFE) is placed at the gastro-gastric communication, 7cm below the cardia, and gently closed after bougie retraction. The bypass is completed by the creation of an antecolic Roux-en-Y 150cm alimentary and 150cm biliopancreatic limb. CONCLUSION The LRYGBfse is a feasible and safe technique. The possibility to endoscopically explore the excluded stomach with an easy access to the Vater's papilla is a major advantage. Further studies are warranted to deeply explore and compare outcomes with the standard LRYGB.
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Facchiano E. Comment on: Revision of vertical banded gastroplasty to Roux-en-Y gastric bypass with fundectomy. Surg Obes Relat Dis 2021; 17:877-878. [PMID: 33750667 DOI: 10.1016/j.soard.2021.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Enrico Facchiano
- Department of Surgery, General and Bariatric Surgery Unit, Santa Maria Nuova Hospital, Florence, Italy
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Denneval A, Chalumeau C, Iceta S, Pelascini E, Disse E, Robert M. Revision of Mason's procedure (vertical banded gastroplasty) to Roux-en-Y gastric bypass: role of an associated fundectomy in weight loss outcomes. Surg Obes Relat Dis 2021; 17:870-877. [PMID: 33549506 DOI: 10.1016/j.soard.2020.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vertical banded gastroplasty (VBG) presents a significant rate of long-term complications, and revisions are often necessary. Conversion to Roux-en-Y gastric bypass (RYGB) seems to be preferred, but literature data remain limited. OBJECTIVES To analyze the indications, safety, results of conversions from VBG to RYGB, and to identify predictive factors of success or failure. SETTING Two specialized centers of bariatric surgery. METHODS This bicentric retrospective study included all the patients who benefited from a conversion from VBG to RYGB between 2008 and January 2020. Demographic characteristics, indications, preoperative workups, intraoperative data, complications, and weight loss results were analyzed. RESULTS During the study period, 85 patients underwent a conversion to RYGB. The mean body mass index (BMI_ before conversion was 40.6 kg/m2. 82.3% of the patients were converted because of weight loss failure and 17.6% because of a complication of their VBG. The global rate of complications was 25%. After an average follow-up of 35 months and a rate of loss to follow-up of 33%, the mean BMI was 33.5 kg/m. The weight loss success rate according to Reinhold's criteria was 64.7%, and resolution of complications was obtained in 89.1%. The association of a fundectomy was a predictive factor of weight loss (odds ratio, .27; P = .04), whereas primary failure of the VBG was a predictive factor of failure. CONCLUSION Conversion from VBG to RYGB remains the procedure of choice to achieve satisfying weight loss and resolution of functional complications. The addition of a fundectomy appeared to have a significant positive impact on weight loss outcomes.
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Affiliation(s)
- Axel Denneval
- Department of Digestive Surgery, Center of Bariatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Department of Endocrinology Diabetology and Nutrition, Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
| | - Claire Chalumeau
- Fédération de Chirurgie Viscérale, Centre Hospitalier William Morey, Chalon-sur-Saône, France
| | - Sylvain Iceta
- Department of Endocrinology Diabetology and Nutrition, Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France; Quebec Heart and Lung Institute (IUCPQ), Québec, Canada; School of Nutrition, Laval University, Québec, Canada
| | - Elise Pelascini
- Department of Digestive Surgery, Center of Bariatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Department of Endocrinology Diabetology and Nutrition, Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Emmanuel Disse
- Department of Endocrinology Diabetology and Nutrition, Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France; Carmen Lab, INSERM Unit 1060, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Maud Robert
- Department of Digestive Surgery, Center of Bariatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Department of Endocrinology Diabetology and Nutrition, Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France; Carmen Lab, INSERM Unit 1060, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
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Tornese S, Aiolfi A, Bonitta G, Rausa E, Guerrazzi G, Bruni PG, Micheletto G, Bona D. Remnant Gastric Cancer After Roux-en-Y Gastric Bypass: Narrative Review of the Literature. Obes Surg 2020; 29:2609-2613. [PMID: 31001760 DOI: 10.1007/s11695-019-03892-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures for surgical weight loss. It has been shown that overweight may be associated with an increased risk of gastric cancer. However, the risk of remnant gastric cancer after RYGB has not been defined yet and the development of neoplasm in the excluded stomach remains a matter of concern. METHODS PubMed, EMBASE, and Web of Science databases were consulted. Articles that described the diagnosis and management of remnant gastric cancer after RYGB were considered. RESULTS Seventeen patients were included. The age of the patient population ranged from 38 to 71 years. The most commonly reported symptoms were abdominal pain, nausea/vomiting, and anemia. Abdominal computed tomography was used for diagnosis in the majority of patients. The neoplasm was located in the antrum/pre-pyloric region in 70% of cases and adenocarcinoma was the most common tumor histology (80%). An advanced tumor stage (III-IV) was diagnosed in almost 70% of patients and 40% were considered unresectable. Gastrectomy with lymphadenectomy was performed in 9 cases (53%). Post-operative morbidity was 12%. The follow-up ranged from 3 to 26 months and the overall disease-related mortality rate was 33.3%. CONCLUSION The development of remnant gastric cancer after RYGB is rare. Surgeons should be aware of this potential event and the new onset of epigastric pain, nausea, and anemia should raise clinical suspicion. Further epidemiologic studies are warranted to deeply investigate the post-RYGB-related risk of remnant gastric cancer development in high-risk populations.
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Affiliation(s)
- Stefania Tornese
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy.
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Emanuele Rausa
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Guglielmo Guerrazzi
- Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Piero Giovanni Bruni
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Giancarlo Micheletto
- Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
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Lesti G, Bona D, Sozzi A, Lesti F, Bonitta G, Zappa MA, Aiolfi A. Impact of Functional Laparoscopic Gastric Bypass with Fundectomy and Gastric Remnant Exploration (LRYGBfse) on Patients’ Quality of Life: Trajectory and 5-Year Follow-up Result. Obes Surg 2020; 30:3046-3053. [DOI: 10.1007/s11695-020-04650-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Rodríguez-Rivera C, Pérez-García C, Muñoz-Rodríguez JR, Vicente-Rodríguez M, Polo F, Ford RM, Segura E, León A, Salas E, Sáenz-Mateos L, González-Martín C, Herradón G, Beato-Fernández L, Martín-Fernández J, Alguacil LF. Proteomic Identification of Biomarkers Associated with Eating Control and Bariatric Surgery Outcomes in Patients with Morbid Obesity. World J Surg 2019; 43:744-750. [PMID: 30426189 DOI: 10.1007/s00268-018-4851-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The current therapeutics of morbid obesity could be significantly improved after the identification of novel biomarkers associated with the food addiction endophenotype of obesity and with bariatric surgery outcomes. METHODS We applied differential expression proteomics and enzyme-linked immunosorbent confirmatory assays to identify (a) proteins that varied according to loss of control over eating in morbidly obese patients and (b) proteins that varied between normoweight controls and patients before and 1 year after bariatric surgery. RESULTS Clusterin was the only protein that consistently varied according to eating control in patients. Patients showed increased levels of serum amyloid P protein, apolipoprotein A4, serotransferrin, complement factors B and C3 and haptoglobin with respect to controls; the levels of all these proteins tended to return to control values 1 year after surgery. In contrast, apolipoprotein A1 and transthyretin were initially downregulated in patients and were scarcely changed by surgery. Leucine-rich alpha-2-glycoprotein was markedly increased in patients only after surgery. CONCLUSIONS Clusterin could be of interest as a putative biomarker for food addiction diagnosis in people with morbid obesity. In addition, postsurgical normalization of the proteins initially dysregulated in obese subjects might help monitor clinical improvements after surgery, while lasting or newly detected alterations (i.e., those affecting transthyretin and leucine-rich alpha-2-glycoprotein) could reflect partial refractoriness and/or contribute to the early prediction of clinical problems.
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Affiliation(s)
- Carmen Rodríguez-Rivera
- Facultad de Farmacia, Universidad CEU San Pablo, Campus de Montepríncipe, 28925, Alcorcón, Madrid, Spain
| | - Carmen Pérez-García
- Facultad de Farmacia, Universidad CEU San Pablo, Campus de Montepríncipe, 28925, Alcorcón, Madrid, Spain
| | | | - Marta Vicente-Rodríguez
- Facultad de Farmacia, Universidad CEU San Pablo, Campus de Montepríncipe, 28925, Alcorcón, Madrid, Spain
| | - Filomena Polo
- Hospital General Universitario de Ciudad Real, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
| | - Rhian-Marie Ford
- Facultad de Farmacia, Universidad CEU San Pablo, Campus de Montepríncipe, 28925, Alcorcón, Madrid, Spain
| | - Esperanza Segura
- Hospital General Universitario de Ciudad Real, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
| | - Alberto León
- Hospital General Universitario de Ciudad Real, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
| | - Elisabet Salas
- Hospital General Universitario de Ciudad Real, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
| | - Luis Sáenz-Mateos
- Hospital General Universitario de Ciudad Real, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
| | - Carmen González-Martín
- Facultad de Farmacia, Universidad CEU San Pablo, Campus de Montepríncipe, 28925, Alcorcón, Madrid, Spain
- Hospital General Universitario de Ciudad Real, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
| | - Gonzalo Herradón
- Facultad de Farmacia, Universidad CEU San Pablo, Campus de Montepríncipe, 28925, Alcorcón, Madrid, Spain
| | - Luis Beato-Fernández
- Hospital General Universitario de Ciudad Real, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
| | - Jesús Martín-Fernández
- Hospital General Universitario de Ciudad Real, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
| | - Luis F Alguacil
- Facultad de Farmacia, Universidad CEU San Pablo, Campus de Montepríncipe, 28925, Alcorcón, Madrid, Spain.
- Hospital General Universitario de Ciudad Real, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain.
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Zappa MA, Giusti MP, Galfrascoli E. Gastric cancer after gastric bypass with fundectomy: The possibility for early diagnosis. Int J Surg Case Rep 2019; 55:156-159. [PMID: 30739871 PMCID: PMC6369259 DOI: 10.1016/j.ijscr.2019.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/19/2019] [Accepted: 01/27/2019] [Indexed: 11/12/2022] Open
Abstract
RYGB is the most important bariatric procedure worldwide. The RYGB mayor limitation is the difficult exploration of the excluded stomach and duodenum. The gastric bypass with fundectomy allowed for an easly endoscopic evaluation. The possibility to easly perform OGD guaranteed the detection of gastric carcinoma at an early stage.
Introduction: Roux-an-Y gastric bypass (RYGP) is one of the most important bariatric procedures and its results are well known in terms of weight loss and comorbid improvement. The major limitation of this technique is the difficult exploration of the excluded stomach and duodenum. Some Authors are performing the gastric bypass with fundectomy and, according to Literature, it is feasible and effective, with major advantage of explorable gastric pouch. Presentation of case: We report the case of a 54-year-old woman affected by obesity (BMI 49 kg/m2). After a pre-operative multidisciplinary evaluation and gastroscopy, she underwent a laparoscopic RYGB with fundectomy in October 2016. One year after surgery she contacted the department for vomiting, pyrosis and weakness. Thanks to the characteristics of the surgical technique it was possible to easily perform an OGD that detected an antral ulcer. The byopsy revealed a gastric adenocarcinoma. A degastroresection was performed and the istological finding was a gastric adenocarcinoma pT1b N0 G3. Discussion: Early diagnosis is essential in gastric tumors to ensure a good prognosis and the gold standard is performing gastroscopy with biopsies. With the standard technique is very challenging to perform an OGD and the cancer stage is likely to be advanced at diagnosis, with a bad prognosis for the patient. Conclusion: From the clinical case described and the analysis of the Literature, the advantages of this technique are clear, allowing for an easy endoscopic evaluation of gastric walls with the possibility of diagnosing early stage tumors with a better outcome for patients.
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Affiliation(s)
- Marco Antonio Zappa
- Department of General Surgery, Fatebenfratelli Hospital, Piazzale Principessa Clotilde, 3, 20121, Milano, MI, Italy.
| | - Maria Paola Giusti
- Department of General Surgery, Fatebenefratelli Hospital, Via fatebenefraatelli 20, 22036, Erba, CO, Italy.
| | - Elisa Galfrascoli
- Department of General Surgery, Fatebenfratelli Hospital, Piazzale Principessa Clotilde, 3, 20121, Milano, MI, Italy.
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Muñoz-Rodríguez JR, Agarrado A, Martín-Fernández J, Salas E, González-Martín C, Alguacil LF. Cocaine and amphetamine regulated transcript and brain-derived neurotrophic factor in morbid obesity. One-year follow-up after gastric bypass. Surg Obes Relat Dis 2018; 14:1732-1739. [PMID: 30274741 DOI: 10.1016/j.soard.2018.07.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 01/09/2023]
Affiliation(s)
| | - Andrea Agarrado
- University General Hospital of Ciudad Real, SESCAM, Ciudad Real, Spain; University Hospital of Jerez, SAS, Jerez de la Frontera, Cádiz, Spain
| | | | - Elisabet Salas
- University General Hospital of Ciudad Real, SESCAM, Ciudad Real, Spain
| | - Carmen González-Martín
- University General Hospital of Ciudad Real, SESCAM, Ciudad Real, Spain; School of Pharmacy, San Pablo CEU University, Boadilla, Madrid, Spain
| | - Luis F Alguacil
- University General Hospital of Ciudad Real, SESCAM, Ciudad Real, Spain; School of Pharmacy, San Pablo CEU University, Boadilla, Madrid, Spain
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