Digestive Adaptation with Intestinal Reserve: a neuroendocrine-based operation for morbid obesity

The role of metabolic and bariatric surgery on the obesity pandemic in Latin America: A review of current practices and future directions

Latin America faces a significant public health challenge due to the high prevalence of obesity and its associated diseases. Metabolic and bariatric surgery is effective and safe to treat obesity when other treatments fail; however, its implementation in Latin America remains unsatisfactory. This review explores the current status, challenges, and innovations of metabolic and bariatric surgery in Latin America. We searched peer-reviewed journals in English and Spanish for relevant articles published between 1998 and 2023. We found that more than 20% of the Latin American population is affected by obesity. Unfortunately, only a limited number of patients have access to metabolic and bariatric surgery due to high cost, limited availability, and shortage of specialists. The review found that ongoing clinical trials are being conducted in Brazil, Mexico, Chile, and Venezuela, indicating some regional progress. However, published studies remain low in number compared with other regions. Furthermore, we summarized the clinical outcomes, risks, and perioperative assessments associated with metabolic and bariatric surgery. We discussed potential strategies to enhance the availability and affordability of this intervention. This review emphasizes the significance of metabolic and bariatric surgery in addressing the obesity pandemic, specifically for Latin America, and proposes directions for future research and innovation.

The Alarming Rate of Malnutrition after Single Anastomosis Sleeve Ileal Bypass. A single Centre Experience

BACKGROUND

Single anastomosis sleeve ileal (SASI) bypass is a modification of sleeve gastrectomy with transit bipartition (SG + TB). This study aims to assess the safety and efficacy of SASI as a primary metabolic and bariatric surgery (MBS).

METHODS

This is a retrospective case series of 30 patients who underwent SASI bypass from January to December 2021. All patients completed at least 12 months of follow-up.

RESULTS

Among the 30 patients, 93.3% were women, the mean age was 37.4 years, and the mean body mass index (BMI) was 45.6 kg/m2. The percentage of total body weight loss (TWL%) was 42.7%, the percent excess body weight loss (EWL%) was 92.7%, and the mean BMI at 12 months went from 45.6(35.2-58.4) to 25.8 kg/m2 (19.2-33.4). The obesity-associated complications remission rate was 87.5% for type 2 diabetes (T2D), 71.4% for hypertension (HTN) and 100% for obstructive sleep apnea (OSA). Thirteen patients (43.3%) had diarrhea, 7 (23.3%) had hypoalbuminemia, defined as serum albumin < 3 g/dl, and 6 (20%) underwent reversal of their index SASI. As for other nutritional issues, iron deficiency anemia was present in 21 patients (70%), while 19 patients (63.3%) had vitamin D, and 2(6.6%) had vitamin B12 deficiency.

CONCLUSION

Despite good short-term weight loss and improvement of obesity-associated complications, SASI is accompanied by high alarming malnutrition, even in short-term follow-up. Novel MBS should be judged for their long-term effects and compared to well-tested standard operations before they are used in routine clinical practice.

One Anastomosis Transit Bipartition (OATB): Rational and Mid-term Outcomes

BACKGROUND

The "One-anastomosis transit bipartition" (OATB) is a promising emerging technique in the metabolic syndrome treatment.

OBJECTIVE

To demonstrate the results achieved with OATB in the first 5 years after surgery.

METHOD

Cross-sectional, retrospective study, with individuals undergoing primary OATB. Individuals included in the study were: ≥ 18 years, BMI ≥ 35 kg/m2; and excluded smoking habits, drug dependence, inflammatory bowel diseases. The data analyzed demographic, anthropometric, surgical, clinical, and nutritional.

RESULTS

Sixty eight participants, 75% women, average age 45.5 years and BMI 41 kg/m2. Associated diseases: osteoarthritis (52.9%), hypertension (48.5%) and type 2 diabetes mellitus-T2DM (39.7%). All underwent laparoscopy, without conversions. Average operative time is 122.6 ± 31.7 min, and hospital stay is 2.2 ± 0.8 days. The common channel length 27 and 41 patients with 250 cm and 300 cm respectively. We registered no intraoperative complications, 2 (2.9%) early complications, and 14 (20.6%) late complications. In the first 6 months, 94.7% (250 cm) and 88.9% (300 cm) of the patients no longer used medication for T2DM, with no statistical difference between the two groups. The incidence of nutritional disorders at any time during follow-up: hypovitaminosis D (14.7%), folate hypovitaminosis (14.7%), elevated PTH (7.4%), hypoproteinemia (5.9%) and anemia (5.9%). We found no statistically significant difference between 250 and 300 cm common channel groups.

CONCLUSION

We conclude that OATB is a safe and effective technique, demonstrating good control of T2DM and metabolic syndrome. There is a requirement to treat previous nutritional deficits. We need more long-term evidence and comparison to other surgical techniques.

BRAZILIAN MULTI-SOCIETY POSITION STATEMENT ON EMERGING BARIATRIC AND METABOLIC SURGICAL PROCEDURES

This Brazilian multi-society position statement on emerging bariatric and metabolic surgical procedures was issued by the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM), the Brazilian College of Digestive Surgery (CBCD), and the Brazilian College of Surgeons (CBC). This document is the result of a Brazilian Emerging Surgeries Forum aimed at evaluating the results of surgeries that are not yet listed in the Federal Council of Medicine (CFM), the regulatory agency that oversees and regulates medical practice in Brazil. The Forum integrated more than 400 specialists and academics with extensive knowledge about bariatric and metabolic surgery, representing the three surgical societies: SBCBM, CBC, and CBCD. International speakers participated online and presented their experiences with the techniques under discussion, emphasizing the regulatory policies in their countries. The indications for surgery and the subsequent procedures were carefully reviewed, including one anastomosis gastric bypass (OAGB), single anastomosis duodeno-ileal with sleeve gastrectomy (SADI-S or OADS), sleeve gastrectomy with transit bipartition (SGTB), and sleeve gastrectomy with ileal interposition (SGII). The recommendations of this document are based on an extensive literature review and discussions among bariatric surgery specialists from the three surgical societies. We concluded that patients with a body mass index over 30 kg/m2 may be candidates for metabolic surgery in the presence of comorbidities (arterial hypertension and type 2 diabetes) with no response to clinical treatment of obesity or in the control of other associated diseases. Regarding the surgical procedures, we concluded that OAGB, OADS, and SGTB are associated with low morbidity rates, satisfactory weight loss, and resolution of obesity-related comorbidities such as diabetes and arterial hypertension. SGII was considered a good and viable promising surgical alternative technique. The recommendations of this statement aim to synchronize our societies with the sentiments and understandings of most of our members and also serve as a guide for future decisions regarding bariatric surgical procedures in our country and worldwide.

The Protective Effect of Transit Bipartition and Its Modification Against Sleeve Gastrectomy-Related Esophagitis in a Rodent Model

BACKGROUND

The protective effect of transit bipartition against esophagitis has not yet been proven. Thus, we investigate and compare the bariatric outcomes and esophagus' histological changes of sleeve gastrectomy (SG), SG with transit bipartition (SG-TB), and the proximal SG-TB (SG-PTB) in a rodent model.

METHODS

This study included 45 diabetic Sprague-Dawley rats assigned to one of the four groups, SG-PTB (n = 15), SG-TB (n = 12), SG (n = 10), and SHAM (n = 8). Eight surviving rats from each group were included for further investigation. Histological analysis of the gastroesophageal junction was performed. Body weight, food intake, glucose control, and hormonal changes (glucagon-like peptide-1 and insulin) were assessed before and after surgery in all groups.

RESULTS

Preoperatively, no significant differences were observed in food intake, body weight, and fasting blood glucose levels among the groups. Postoperatively, the SG-PTB and SG-TB groups showed significantly superior glucose control compared to the SG group following the gavage of glucose (p < 0.05). Postoperatively, the SG-PTB and SG-TB groups had higher postoperative GLP-1 levels than postoperative SG and SHAM groups. More severe esophageal hyperpapillomatosis (EHP) of the esophageal section was observed in the SG group. The mucosal height of the SG group was significantly higher than that of the SG-PTB, SG-TB, and SHAM groups (p < 0.05).

CONCLUSION

The transit bipartition procedure may protect the distal esophagus from histological changes associated with esophagitis. Clinical studies are needed to confirm the anti-reflux effects of transit bipartition.

Testosterone Changes in Men With Obesity and Type 2 Diabetes 6 Months After Sleeve Gastrectomy With Transit Bipartition

BACKGROUND

Metabolic/bariatric surgery has been shown to increase testosterone in males with obesity. This study investigated the effect of the novel metabolic/bariatric surgery procedure, sleeve gastrectomy with transit bipartition (SG-TB), on serum total testosterone and metabolic variable changes in men with obesity and type 2 diabetes.

METHODS

In a prospective single-center cohort study, laboratory samples were analyzed preoperatively and at 6 months following SG-TB in patients with a body mass index (BMI) ≥30 kg/m2. Changes in metabolic parameters and testosterone were evaluated.

RESULTS

Between July 2018 and March 2019, 166 patients with a mean baseline BMI of 34.9±3.8 kg/m2 (mean age 51.5±9.3 y), glycosylated hemoglobin 9.5±1.3%, and testosterone 3.1±1.3 underwent SG-TB. At 6-month follow-up, mean excess BMI loss was 70.2±24.3%; glycosylated hemoglobin, 6.6±1.1% (P<0.001); and testosterone, 4.5±1.5 (P<0.001).

CONCLUSION

In the early term following SG-TB, more than any other factor assessed, BMI loss was found to be a significant driver of improvement in testosterone levels. Regardless of preoperative obesity classification, patients with initially low testosterone attained significantly increased testosterone levels at 6-month follow-up.

Role of the rs10401670 variant in the resistin gene on the metabolic response after weight loss secondary to a high-fat hypocaloric diet with a Mediterranean pattern

BACKGROUND

The single nucleotide polymorphism (SNP) (rs10401670) of the RETN gene has been associated with metabolic disorder in obese subjects and has scarcely been evaluated after dietary interventions. The present study aimed to analyse the effects of the rs10401670 RETN gene polymorphism on metabolic changes secondary to weight loss and secondary to a high-fat hypocaloric diet with a Mediterranean dietary pattern.

METHODS

A Caucasian population comprising 284 obese patients without diabetes mellitus was analysed. Before and after 3 months of a high-fat hypocaloric diet with a Mediterranean pattern, an anthropometric evaluation, an assessment of nutritional intake and a biochemical analysis were performed. A statistical analysis was conducted for the combined CT and TT as a group and for wild-type CC as a second group.

RESULTS

Decreases in weight, body mass index (BMI), fat mass, systolic blood pressure and waist circumference were similar in both genotypes groups. In T allele carriers, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), triglycerides and C-reactive protein levels were decreased. The decrease in these parameters was statistically significant for triglycerides (-22.3 ± 9.3 mg dl^-1 : p = 0.03), C-reactive protein (-2.8 ± 0.5 mg dl^-1 : p = 0.03), insulin (-7.4 ± 2.9 mUI L^-1 : p = 0.03) and HOMA-IR (-2.4 ± 1.0: p = 0.02). Leptin levels were decreased in both genotypes groups after the hypocaloric diet, as well as the anthropometric parameters BMI, weight, waist circumference and fat mass. Resistin and adiponectin levels remained unchanged in both groups.

CONCLUSIONS

In the present study, we have detected a significant association between the T allele of this SNP and a better response of insulin resistance, triglycerides and C-reactive protein compared to non T allele carriers after weight loss with a high-fat hypocaloric diet and a Mediterranean diet.

Sleeve gastrectomy with transit bipartition in a series of 883 patients with mild obesity: early effectiveness and safety outcomes

BACKGROUND

At least 25 metabolic/bariatric procedures have been proposed globally, 5 formally endorsed. A newer procedure, sleeve gastrectomy with transit bipartition (SG + TB), appears to markedly reduce weight and improve metabolic syndrome while being relatively simple technically and protective of long-term nutritional stability. We aimed to investigate SG + TB effectiveness and safety.

METHODS

In a single-center retrospective analysis of prospectively collected data, SG + TB patients were followed through 12 months. Primary outcomes were changes in weight [body mass index (BMI), total weight loss (TWL)], metabolic parameters [HbA1_C, LDL cholesterol, triglycerides (TG), hypertension], and nutritional status. Repeated-measures analysis of variance (ANOVA) was used to assess changes in weight and metabolic parameters at 1, 3, 6, 9, and 12 months after surgery.

RESULTS

Between 2015 and 2019, 883 patients (mean age 51.8 yrs, BMI 34.1 ± 5.0 kg/m²) underwent SG + TB. Mean operative time was 124 ± 25.4 min; hospitalization, 4.0 ± 2.5 days. ANOVA indicated significant reductions in weight and metabolic parameters (p < 0.005). In 646 patients with complete weight data at 12 months, mean BMI was reduced to 27.2 ± 3.4 kg/m² (p < 0.001), TWL 19.8 ± 6.0%. HbA1_C was normalized in 83.3% of SG + TB patients; hyperlipidemia, hypertension, and hypertriglyceridemia were significantly reduced (p < 0.001). Also, there was a significant reduction in the proportion of patients outside normal nutritional reference ranges. The overall complication rate was 10.2%. There was no mortality.

CONCLUSION

In a series of 833 lower-BMI patients who underwent SG + TB and were followed through 12 months (73.2% follow-up), significant weight loss, comorbidity reduction, and nutritional stability were attained with few major complications and no mortality.

The Mid-Term Effects of Transit Bipartition with Sleeve Gastrectomy on Glycemic Control, Weight Loss, and Nutritional Status in Patients with Type 2 Diabetes Mellitus: a Retrospective Analysis of a 3-Year Follow-up

BACKGROUND

Metabolic surgery is an effective treatment method for glycemic control and weight loss in obese patients with type 2 diabetes mellitus (T2DM). This study aimed to present the mid-term metabolic effects and weight loss results of the patients with T2DM who underwent transit bipartition with sleeve gastrectomy (TB-SG).

METHODS

A total of 32 obese patients with T2DM who underwent TB-SG were included in the study. The T2DM remission status after surgery was evaluated. The postoperative glycemic variables, weight loss, lipid profile, and nutritional profile were also compared with the baseline values.

RESULTS

At 36 months after surgery, T2DM remission occurred in 27 patients (84.3%) and the mean BMI decreased from 44.70 ± 9.34 to 29.75 ± 2.19 kg/m². The percentage of total weight loss (TWL) and excess weight loss (EWL) was 33.84% and 77.19%, respectively. The mean LDL values significantly decreased compared to baseline; however, the mean HDL did not significantly differ. No significant difference was observed regarding the mean albumin, vitamin B12, and folic acid levels.

CONCLUSION

TB-SG procedure seems promising in terms of T2DM remission and weight loss with less malnutrition and vitamin deficiency in treating obese patients with T2DM.

Comparison of 2-Year Results of Roux-en-Y Gastric Bypass and Transit Bipartition with Sleeve Gastrectomy for Superobesity

PURPOSE

Although Roux-en-Y gastric bypass is a powerful procedure, achieving and maintaining significant weight loss remains challenging in superobese populations. Transit bipartition with sleeve gastrectomy is derived from biliopancreatic diversion with duodenal switch and might improve weight loss control.

MATERIALS AND METHODS

Two series of 71 primary laparoscopic Roux-en-Y gastric bypass (RYGB) and transit bipartition (TB) with a body mass index ≥ 50 kg/m² were retrospectively compared after 2 years. Postoperative course, side effects, nutritional status, and weight outcomes were reviewed. Weight was expressed as BMI, percentage of excess BMI lost (%EBMIL), and percentage of total weight lost (%TWL).

RESULTS

The 2 groups were comparable for age and BMI of 51.9 ± 1.8 for RYGB and 51.6 ± 5 for TB. TB was longer to perform (92 vs 74 min, p ≤ 0.001) with a 30-day complication rate of 4.2% and 5.6%, but there was 1 death after RYGB. Weight loss was greater after TB compared with RYGB with %EBMIL of 85.3 ± 15.8% vs 73.9 ± 17.2% (p = 0.0002). One TB patient suffered from protein malnutrition but none after RYGB. After TB, 7% of the patients experienced > 3 stools a day and 1 patient required revision, while 3 patients had diarrhea after RYGB. Late reoperations were required for 7 and 1 patients after RYGB and TB. Comorbidity improvement was similar.

CONCLUSION

In a superobese population, TB appeared relatively safer compared with RYGB. It achieved a better weight loss at 2 years with a trend for more digestive side effects.

Effects of Sleeve Gastrectomy with Transit Bipartition on Glycemic Variables, Lipid Profile, Liver Enzymes, and Nutritional Status in Type 2 Diabetes Mellitus Patients

BACKGROUND

Sleeve gastrectomy with transit bipartition (SG + TB) surgery is an effective treatment modality for the patients with type 2 diabetes mellitus (T2DM). Here, we aimed to present the 1-year follow-up data of our patients with T2DM who underwent SG + TB.

METHODS

We evaluated the follow-up results of 45 patients and evaluated the remission status of T2DM. Additionally, biochemical variables including lipid status, liver function and nutritional status were presented.

RESULTS

A total of 40 T2DM remissions occurred among the 45 patients (88.8%). The complete remission was present in 35 of the patients at the end of the postoperative first year. The lipid profile markers improved following the first postoperative month. The levels of the liver enzyme alanine aminotransferase (ALT) decreased after the first postoperative month, while aspartate aminotransferase (AST) levels did not alter significantly during the follow-up period. We did not observe a change regarding albumin and vitamin B12 levels following the surgery.

CONCLUSION

SG + TB is a convenient and therapeutic method for the treatment of T2DM, along with the improvement in lipid profile and liver enzyme levels.

The Short-Term Effects of Transit Bipartition with Sleeve Gastrectomy and Distal-Roux-en-Y Gastric Bypass on Glycemic Control, Weight Loss, and Nutritional Status in Morbidly Obese and Type 2 Diabetes Mellitus Patients

PURPOSE

The aim of this study was to compare the postoperative metabolic and nutritional outcomes after transit bipartition with sleeve gastrectomy (TB-SG) and distal-Roux-en-Y gastric bypass (D-RYGB).

MATERIALS AND METHODS

A retrospective evaluation was made of 109 morbidly obese patients who underwent TB-SG or D-RYGB. Primary outcomes included metabolic variables such as glycemic control and serum lipid levels, and secondary outcomes consisted of nutritional deficiencies and weight loss after surgical procedures.

RESULTS

During the study period, 83 and 26 patients underwent D-RYGB and TB-SG, respectively. The preoperative characteristics and nutritional status of the groups were similar. D-RYGB resulted in significantly higher weight loss rates in the first 3 months, but the percentage of excess weight loss (EWL %) was not different in the 12-month follow-up period. Although D-RYGB provided faster glycemic control due to early weight loss, there was no difference between the two groups. At the end of the follow-up period, the TB-SG was associated with significantly less deficiency of vitamin D, vitamin B12, iron, and folic acid. Anastomosis leakage was more common in the D-RYGB technique. The overall complication rates of the groups were similar.

CONCLUSION

TB-SG is a safe and effective alternative to D-RYGB for the treatment of obesity-related metabolic disorders with fewer nutritional deficiencies.

Single Anastomosis Sleeve Ileal Bypass (SASI Bypass): Short-Term Outcomes and Concerns

BACKGROUND

Single anastomosis sleeve ileal (SASI) Bypass has recently emerged as a novel surgical technique. The purpose of this study is evaluating the efficacy and feasibility of our SASI technique.

METHODS

Between April 2018 and February 2020, 83 patients underwent SASI bypass at our center. A retrospective analysis was performed. Forty-three patients (51.8%) completed follow-up at 12 months.

RESULTS

Average BMI at 12 months, change in BMI, and %EWL were 28.2 ± 4.5 kg/m², 13.5 ± 5.7 kg/m², and 85.6% respectively. From the 25 patients evaluated, diabetes remission occurred in 95.8% of them. There were 4 (4.8%) Clavien-Dindo (CD) I, 5 (6.0%) CD II, and 2 (2.4%) CD IIIb complications.

CONCLUSIONS

SASI bypass offers excellent weight loss and comorbidities resolution. As expected, higher-quality studies are needed.

Oxidized Hyaluronic Acid Hydrogels as a Carrier for Constant-Release Clenbuterol Against High-Fat Diet-Induced Obesity in Mice

The global obesity population is increasing year-by-year, and the related cost is sharply increasing annually. There are several methods available to combat obesity; however, there is a lack of a single tool that is both safe and efficacious. The use of Clenbuterol in bodybuilding and by professional athletes is controversial owing to its side effects, including hepatotoxicity. This study administered Clenbuterol at a much lower dose than the established safety level, and rather than through oral administration, the treatments were delivered through controlled-release intra-adipose injection. The different dosing and mode of administration will lower the risk of side effects, increase the safety profile, and could facilitate use in the anti-obesity market. A thermo-sensitive hydrogel was used as the carrier uploaded with Clenbuterol to achieve controlled-release. In the in vitro study, the developed new formulae were not cytotoxic to 3T3-L1 cells and could inhibit lipogenesis effectively. In the animal study, the mice were fed a high-fat diet and treated with Clenbuterol by oral administration, or injected with Clenbuterol-modified hyaluronate hydrogel (HAC) regularly. Both groups showed reduction in whole-body, visceral, and gonadal fat contents and body weight. The abdominal fat was analyzed using MRI imaging in adipose mode and water mode. The abdominal fat ratio in the mice treated with normal diet and those given intra-adipose injections with HAC had the lowest value among the test groups. The mice treated with high-fat diet (HFD) showed the highest value of 53.78%. The chronic toxicity in-vivo test proved that controlled-release injections of 2-10 µg Clenbuterol daily were safe, as demonstrated in the blood elements and serological analyses. This study developed a new and promising method for anti-obesity treatment, using a monthly intra-adipose controlled-release injection of HAC. The developed new formulae of Clenbuterol not only effectively decreased body weight and body fat content but also inhibited lipogenesis on the harvested visceral tissue and reduced adipose tissue around the gonadal fat area. The side effects induced by traditional oral administration of Clenbuterol were not observed in this research; this has excellent potential to be a useful tool for future obesity treatment without safety concerns.

Single-Anastomosis Sleeve Ileal (SASI) Bypass: Hopes and Concerns after a Two-Year Follow-up

BACKGROUND

Single-anastomosis sleeve ileal (SASI) bypass is a simplification of sleeve gastrectomy with transit bipartition. Both share a metabolic foundation through early postprandial ileal brake, and SASI bypass has the advantages of shorter operative time and less incidence of internal herniation. This study evaluates the safety and outcome of SASI bypass with 2-year follow-up.

METHODS

A retrospective cohort study of all patients who underwent SASI bypass in the period between June 2016 and January 2019. The primary outcome was weight loss and diabetic remission.

RESULTS

Three hundred twenty-two patients underwent SASI bypass with a mean age of 37.4 ± 15 years and a mean body mass index of 50.1 ± 7.7 kg/m². Thirteen patients (4%) had early major postoperative complications. The 1-year percentage of excess weight loss (%EWL) was 86.9 ± 9.2, and diabetic remission rate was 98.2%. The 2-year %EWL was 96.7 ± 5, and diabetic remission rate was 97.9%. Twenty-six patients had gastroesophageal reflux that improved in 21 (80.7%) patients, remained stationary in 4 (15.4%) patients, and worsened in one patient who required reversal. One patient (0.3%) had severe protein-energy malnutrition and is prepared for reversal. Technical variations had no significant impact on %EWL or diabetic remission.

CONCLUSION

SASI bypass had a promising outcome in terms of 2-year %EWL, diabetic remission, and improvement of preoperative GERD. However, stationary or progressive course of GERD is a substantial possibility. Although the double-outlet for the gastric content allows duodenal access, it may be an obstacle to the standardization of postoperative care. The double-outlet is not a guarantee for absence of malnutrition.

Isolated intestinal transit bipartition: a new strategy for staged surgery in superobesity

OBJECTIVE

biliopancreatic diversion with duodenal switch is a complex, malabsorptive procedure, associated with improved weight loss and metabolic control. Staged surgery with sleeve gastrectomy as the first stage is an option for reducing complications in superobese patients. However, some problems persist: large livers can hamper the surgical approach and complications such as leaks can be severe. Intestinal transit bipartition is a modified and simplified model of biliopancreatic diversion that complements sleeve gastrectomy. It is similar to the duodenal switch, but with less complexity and fewer nutritional consequences. This study assessed the feasibility and safety of isolated transit bipartition as the initial procedure in a two-step surgery to treat superobesity.

METHODS

this prospective study included 41 superobese patients, with mean BMI 54.5±3.5kg/m2. We performed a laparoscopic isolated transit bipartition as the first procedure in a new staged approach. We analyzed weight loss and complications during one year of follow-up.

RESULTS

we completed all the procedures by laparoscopy. After six months, the mean percent excess weight loss was 28%, remaining stable until the end of the study. There were no intraoperative difficulties. Half of the patients experienced early diarrhea, and three had marginal ulcers. There were no major surgical complications or deaths.

CONCLUSION

isolated laparoscopic transit bipartition is a new option for a staged approach in superobesity, which can provide a safer second procedure after effective weight loss over six months. It may be useful particularly in the management of patients with severe obesity.

Cardiac remodeling in obesity and after bariatric and metabolic surgery; is there a role for gastro-intestinal hormones?

Introduction: Obesity is associated with various diseases such as type 2 diabetes, hypertension, obstructive sleep apnea syndrome (OSAS), metabolic syndrome, and cardiovascular diseases. It affects several organ systems, including the pulmonary and cardiac systems. Furthermore, it induces pulmonary and cardiac changes that can result in right and/or left heart failure.Areas covered: In this review, authors provide an overview of obesity and cardiovascular remodeling, the individual actions of the gut hormones (like GLP-1 and PYY), the effects after bariatric/metabolic surgery and its influence on cardiac remodeling. In this review, we focussed and searched for literature in Pubmed and The Cochrane library (from the earliest date until April 2019), regarding cardiac function changes before and after bariatric surgery and literature regarding changes in gastrointestinal hormones.Expert opinion: Regarding the surgical treatment of obesity and metabolic diseases there is recognition of the importance of both weight loss (bariatric surgery) and improvement in metabolic milieu (metabolic surgery). A growing body of evidence further suggests that bariatric surgical procedures [like the Sleeve Gastrectomy (SG), Roux-en Y Gastric Bypass (RYGB), or One Anastomosis Gastric Bypass (OAGB)] have can improve outcomes of patients suffering from a number of cardiovascular diseases, including heart failure.

Pilot Study of a New Model of Bariatric Surgery: Laparoscopic Intestinal Bipartition-Safety and Efficacy Against Metabolic Disorders

BACKGROUND

Despite the availability of many gastric surgery techniques to reduce obesity and its associated comorbidities, most of these procedures can result in life-threatening conditions including lifetime chronic illnesses and death. Vertical sleeve gastrectomy and Roux-en-Y gastric bypass have been reported to improve obesity-related comorbidities such as T2DM, but the long-term efficacy of these two procedures is unknown, and their significant impact on long-term weight loss was diminished by complications as reported in previous studies. Recently, laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) was developed to achieve sustained weight loss (Buchwald et al. Am J Med. 122:248-56, 2009; Sjöström et al. N Engl J Med. 351:2683-93, 2004) as well as an improvement in comorbid conditions, such as T2DM and hypertension (Buchwald et al. in Am J Med. 122:248-56, 2009; Dorman et al. Surgery. 152:758-65, 2012). The malabsorptive strategy of bypassing portions of the small intestine and delivering nutrients directly to the ileum may promote weight loss by enhanced activation of a negative feedback mechanism known as the "ileal brake" (Näslund et al. J Gastrointest Surg. 5:556-67, 2001). The purpose of this pilot study was to evaluate the safety, reproducibility, and efficiency of a new surgical bariatric model of laparoscopic intestinal bipartition (LIB) in patients with a BMI between 35 and 40 kg/m². The setting was in university hospitals.

METHODS

Between January 2011 and September 2012, seven patients were enrolled in the study and underwent the LIB procedure. One patient was operated by LIB for morbid obesity with comorbidities, especially T2DM, without any previous bariatric or gastric surgery. Six patients underwent the surgery after a sleeve gastrectomy for ≥ 4 years with a recurrence of obesity and diabetes.

RESULTS

The comorbidity factors decreased to the normal values in all patients at 6 months, 1 year, and 5 years postoperatively. The percentage of total weight loss was 21.1% at 6 months, 22.6% at 1 year, and 15.6% at 5 years. Weight excess was significantly lower at 6-month, 1-year, and 5-year postoperatively compared with baseline (p < 0.001). Comparison of comorbidity values at 6 months, 1 year, and 5 years did not show any significant differences.

CONCLUSION

Laparoscopic intestinal bipartition produced a total recovery from obesity-related comorbidities, especially T2DM and EWL without any signs of nutritional deficiency, although the 5-year follow-up is ongoing in order to demonstrate the efficacy and long-term durability of this procedure.

The rs10401670 variant in resistin gene improved insulin resistance response and metabolic parameters secondaries to weight loss after a hypocaloric diet

BACKGROUND

The SNP 3'UTR C/T (rs10401670), it is a polymorphism that has been associated with diabetes mellitus and it has been scarcely studied before. As far as we know, no studies on interaction among diet intervention, rs10401670 variant of RETN and metabolic response has been realized.

OBJECTIVE

Our aim was to analyze the effects of the rs10401670 RETN gene polymorphism on insulin resistance response and metabolic changes secondary to weight loss after 3 months of a hypocaloric diet in adults obese patients without diabetes mellitus.

DESIGN

A Caucasian population of 135 obese patients without diabetes mellitus was analyzed. Before and after 3 months on a low fat hypocaloric diet, an anthropometric evaluation, an assessment of nutritional intake and a biochemical analysis were performed. The statistical analysis was performed for the combined CT and TT as a group (minor allele group) and wild type CC as second group (major allele group) (dominant model).

RESULTS

Forty nine patients (36.3%) had the genotype CC (major allele group) and 86 (63.7%) patients had the next genotypes; CT (67 patients, 49.6%) or TT (19 patients, 14.1%) (minor allele group). After dietary treatment and in major allele group, weight, BMI, fat mass, systolic blood pressure and waist circumference decreases were similar than minor allele group. In T allele carriers, fasting plasma glucose, insulin, HOMA-IR, total cholesterol and LDL cholesterol levels decreased significantly. In non T allele carriers and after dietary treatment, only LDL cholesterol and total cholesterol decreased. In non T Allele carriers, the decrease in total cholesterol was -15.1 ± 18.3 mg/dl (decrease in T Allele carriers -18.3 ± 15.7 mg/dl: p > 0.05), LDL-cholesterol was -14.3 ± 18.5 mg/dl (decrease in T Allele carriers -17.3 ± 10.1 mg/dl:p > 0.05), fasting glucose plasma -2.2 ± 1.5 mg/dL (decrease in T Allele carriers -4.8 ± 1.2 mg/dL: p = 0.02), insulin -1.1 ± 2.0 mUI/L (decrease in T Allele carriers -6.3 ± 1.9 mUI/L: p = 0.001) and HOMA-IR -0.2 ± 1.0 (decrease in T Allele carriers -1.8 ± 1.4: p = 0.005). Leptin levels decrease in both genotypes after dietary treatment (-21.1 ± 8.5 ng/dL in nonT Allele carriers vs -16.2 ± 10.2 ng/dL in T Allele carriers:p > 0.05). Resistin remained unchanged in both groups.

CONCLUSION

In our study in non-diabetic obese subjects, we describe an association of rs10401670T allele with a better metabolic response (glucose, insulin and HOMA-IR) secondary to weight loss with a hypocaloric diet.

The rs1862513 Variant in Resistin Gene-Modified Insulin Resistance and Insulin Levels after Weight Loss Secondary to Hypocaloric Diet

BACKGROUND/AIMS

Polymorphisms of a single nucleotide in RETN have been associated with indexes of insulin resistance. Our aim was to analyze the effects of the rs1862513 RETN gene polymorphism on insulin resistance, insulin levels, and resistin levels changes after 3 months of a low-fat hypocaloric diet.

DESIGN

A Caucasian population of 133 obese patients was analyzed before and after 3 months on a low-fat hypocaloric diet.

RESULTS

Fifty-six patients (42.1%) had the genotype GG (wild group) and 77 (57.9%) patients had the other genotypes; GC (59 patients, 44.4%) or CC (18 patients, 13.5%; mutant group). In wild and mutant genotype groups, weight, body mass index, fat mass, waist circumference, and systolic blood pressure decreased. In the wild genotype group, the decrease in total cholesterol was -13.1 ± 25.3 mg/dL (vs. -4.4 ± 13.7 mg/dL in mutant group: p = 0.004 for group deltas), low density lipoprotein (LDL)-cholesterol was -13.0 ± 21.5 mg/dL (-4.3 ± 10.5 mg/dL: p = 0.007), glucose -7.2 ± 3.5 mg/dL (-0.8 ± 0.2 mg/dL: p = 0.01), insulin -5.6 ± 2.5 mUI/L (-2.9 ± 1.2 mUI/L: p = 0.03) and homeostasis model assessment-insulin resistance (HOMA-IR) -2.5 ± 1.1 (-0.6 ± 1.4: p = 0.02). Leptin levels decreased in both genotypes (-10.1 ± 9.5 ng/dL in wild type group vs. -13.1 ± 0.2 ng/dL in mutant type group: p > 0.05).

CONCLUSION

The present study suggests that the G/G genotype of RETN rs1862513 could be a predictor of the reduction of HOMA-IR, insulin, fasting glucose and LDL cholesterol secondary to a hypocaloric diet in obese subjects.

Effect of Sleeve Gastrectomy Plus Side-to-Side Jejunoileal Anastomosis for Type 2 Diabetes Control in an Obese Rat Model

BACKGROUND

Sleeve gastrectomy plus side-to-side jejunoileal anastomosis (JI-SG), a relatively new approach to bariatric surgeries, has shown promising results for treating obesity and metabolic comorbidities. This study investigated the feasibility and safety of JI-SG in weight loss and diabetes remission compared with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).

METHODS

Forty 10-week-old male Zucker diabetic fatty rats were randomly assigned to four groups: control, SG, JI-SG, and RYGB. Their body weights, food intake, and levels of gut hormones (ghrelin, insulin, and glucagon-like peptide-1 (GLP-1)) and lipids were measured.

RESULTS

Rats in the SG, JI-SG, and RYGB groups demonstrated lower food intake and more weight loss 2 weeks postoperatively compared with control rats. Furthermore, rats in the JI-SG group achieved more weight loss (mean 242.7 ± 11.2 g) compared with those in the SG and RYGB groups (SG, 401.4 ± 15.1 g and RYGB, 298 ± 12 g, both P < 0.01). All surgery groups demonstrated a decreased fasting insulin, serum glucose, lipid levels, and increased GLP-1 postoperatively. The JI-SG group had lower fasting ghrelin levels than the RYGB group (168 ± 19.8 ng/L vs. 182 ± 16.7 ng/L, P < 0.01) and higher fasting GLP-1 levels than the SG group (1.99 ± 0.11 pmol/L vs. 1.71 ± 0.12 pmol/L, P < 0.01) at 12 weeks postoperatively. Over the experimental period, the ghrelin levels slowly increased in all surgical groups but remained lower than the preoperative and control levels.

CONCLUSIONS

JI-SG induced higher ghrelin and GLP-1 levels and improved glycemic control in Zucker diabetic fatty rats. Compared with SG and RYGB, JI-SG appeared to be a simple, relatively safe, and more effective procedure for treating type 2 diabetes and obesity in this animal model.

Effect of two polymorphisms of the resistin gene (rs10401670 and rs1862513) on resistin levels and biochemical parameters in morbidly obese patients 1 year after a biliopancreatic diversion surgery

BACKGROUND & AIMS

Two single nucleotide polymorphisms (SNPs) of the resistin gene RETN have been described: rs10401670 and rs1862513. The objective of this study was to investigate the effect of these SNPs on changes in serum resistin levels, biochemical parameters and weight after biliopancreatic diversion surgery in morbidly obese patients without diabetes mellitus.

METHODS

A sample of 155 patients with morbid obesity without diabetes mellitus was enrolled. Anthropometric and biochemical evaluations were realized at the basal visit and at 12 months. The percentage of subjects with hypertension and hyperlipidemia was also reported.

RESULTS

Initial percentage excess weight loss, body mass index, weight, waist circumference, fat mass, blood pressure, low-density lipoprotein cholesterol, total cholesterol, triglycerides levels, insulin and the homeostasis model assessment for insulin sensitivity (HOMA-IR) improve after 12 months. No differences in these improvements were detected between the two genotypes (wild vs mutant group) in each SNP analysis. Resistin levels only changed after surgery in wild genotypes of both SNPs (rs1862513 and rs10401670). The improvement in insulin levels was lower in the mutant group of rs1862513 (-3.4 ± 0.4 UI/dl vs -2.3 ± 0.2 UI/dl; P < 0.05) and rs1040167 (-3.3 ± 0.2 UI/dl vs -1.9 ± 0.3 UI/dl; P < 0.05). The decrease of HOMA-IR was lower in mutant group of rs1862513 (-1.4 ± 0.1 units vs -0.9 ± 0.3 units; P < 0.05) and rs10401670 (-1.2 ± 0.2 units vs -0.9 ± 0.3 units; P < 0.05).

CONCLUSIONS

The main result of this study was that the mutant genotype of two SNPs of the RETN gene (rs1862513 and rs10401670) was associated with a lack of change in resistin secondary to biliopancreatic diversion. The improvement in insulin levels and HOMA-IR was also lower in these patients.

Ileal food diversion: a simple, powerful and easily revisable and reversible single-anastomosis gastric bypass

BACKGROUND

Malabsorptive interventions are recognized as procedure of choice in metabolic surgery and the best strategy for re-do surgery when restriction failed. We describe a novel procedure, the ileal food diversion, an easy and effective non-restrictive one-anastomosis gastric bypass.

METHODS

We report the preliminary results of a series of 68 consecutive patients performed by two surgeons in two different hospitals since 2009 (49 females, 13 re-do surgeries).

RESULTS

Mean operating time was 65 min. All operations were performed by laparoscopy (three-trocar technique in 44 cases and 24 single-incision laparoscopies). Median follow-up is 9.6 months (range 2-48). Diabetes resolution was accomplished in 80% of patients. Average BMI decreases from 44 to 27 after 24 months.

CONCLUSIONS

Ileal food diversion is an interesting option in super-obese patients, re-do surgery and patients with metabolic syndrome. Technical considerations, physiological assumptions and rationale were discussed.

Mid to distal small bowel resection with the preservation of the terminal ileum improves glucose homeostasis in diabetic rats by activating the hindgut-dependent mechanism

BACKGROUND

The aim of this study was to develop a novel surgical model to test the "hindgut hypothesis" and thereby study the role of the gut in glucose homeostasis and the mechanism of action of bariatric surgery.

METHOD

Sprague-Dawley rats were given a high-fat and high-sugar diet and treated with 25 mg/kg streptozotocin (STZ). The fat-sugar-fed/STZ-treated rats were randomized into mid to distal small bowel resection with the preservation of the terminal ileum (DBRPI) and sham operation (which had a formal celiotomy with bowel manipulation only) groups. Rats were observed for 12 weeks after the operation. The main outcome measures were weight, food intake, non-fasting glucose, an oral glucose tolerance test (OGTT), an insulin tolerance test (ITT), the levels of fasting and glucose-induced insulin, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), serum bile acids, and lipid profile.

RESULT

The DBRPI and sham groups exhibited no difference in weight and food intake after surgery. When compared to the sham controls, the DBRPI group displayed an improvement in non-fasting glucose, oral glucose tolerance, and insulin tolerance at 4 and 12 weeks postresection. DBRPI elicited an increased serum insulin, PYY and GLP-1 levels at 12 weeks postoperation; furthermore, DBRPI resulted in higher serum levels of triglyceride, total bile acids, total bilirubin, and direct bilirubin levels and lower free fatty acid level at 12 weeks.

CONCLUSIONS

This study provides strong evidences for the key role of hindgut in the amelioration of diabetes after bariatric surgery. Moreover, these findings confirm that DBRPI is a simple and effective surgical model for testing the "hindgut hypothesis" and focused study of biliary enterohepatic recycling in the context of bariatric operations.

Laparoscopic sleeve gastrectomy with loop bipartition: A novel metabolic operation in treating obese type II diabetes mellitus

INTRODUCTION

We report the first case of laparoscopic sleeve gastrectomy with loop bipartition (a modified form of Santoro's operation) in the treatment of type II diabetes mellitus associated with obesity.

PRESENTATION OF CASE

A 46-year-old gentleman (baseline BMI 32.9; BW 98.5kg) with 7-year history of type II diabetes mellitus (DM) underwent the procedure in Hong Kong. The control of DM was poor even with intensive medical therapy before the operation. Standard laparoscopic sleeve gastrectomy (SG) was performed and a loop gastroileostomy was fashioned at the antrum 250cm from the ilececal valve without division of the 1st part of duodenum after SG. The resultant gastric tube has two outlets, one to the first part of duodenum and the other to the ileum with preferential passage of food through the gastroileostomy as shown on subsequent contrast study. The patient's recovery was uneventful. The excess BMI loss was 97% with complete normalization of all metabolic parameters at 1-year follow-up.

DISCUSSION

This new surgical procedure (sleeve gastrectomy with loop bipartition: SG+LB) was evolved and derived from the combined concepts of sleeve gastrectomy with transit bipartition (SG+TB), single anastomosis duodenal-ileostomy (SADI), mini-gastric bypass (MGB) and duodenal-jejunal bypass (DJB) with less nutritional and surgical complications.

CONCLUSION

Sleeve gastrectomy with loop bipartition may be a very effective and simple operation to treat uncontrolled DM associated with obesity with a lot of apparent advantages over most current metabolic procedures available at the moment.

Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity

OBJECTIVE

To present 5-year results of sleeve gastrectomy (SG) with transit bipartition (TB) as a metabolic intervention for obesity.

BACKGROUND

Recent data suggest that high glycemic index foods may lead to a hormonally hyperactive proximal gut and a hypoactivate distal gut, which are linked to metabolic syndrome. TB was designed to counterbalance these effects.

METHODS

A total of 1020 obese patients with body mass index (BMI) ranging from 33 to 72 Kg/m underwent SG and TB (SG + TB). TB creates a gastroileal anastomosis in the antrum after the SG; nutrient transit is maintained in the duodenum, avoiding blind loops and minimizing malabsorption. The stomach retains 2 outflow pathways. A lateral enteroanastomosis connects both segments at 80 cm proximal to the cecum.

RESULTS

Adequate follow-up data were collected in 59.1% of patients from 4 months to 5 years. The average percent of excess BMI loss was 91%, 94%, 85%, 78%, and 74% in the first, second, third, fourth, and fifth year, respectively. Patients experienced early satiety and major improvement in presurgical comorbidities, including diabetes (86% in remission), following surgery. Two deaths occurred (0.2%). Other surgical complications occurred in 6% of patients. Signs of malabsorption were rare.

CONCLUSIONS

SG + TB is a simple procedure that results in rapid weight loss and remission or major improvement of comorbidities. Strictly aiming at physiological correction, TB avoids prostheses, narrow anastomoses, excluded segments, and malabsorption. Weight and comorbidities are much improved. Diabetes is improved without duodenal exclusion. TB is an excellent complement to an SG.

Future directions in bariatric surgery

Bariatric surgery is a field in rapid evolution, and the speed of this evolution has been accelerating over the last several decades. A thorough understanding of past developments is crucial to anticipating the future intelligently. The trends that have driven evolution historically often persist, and continue to be influential in the future. With this in mind, this article briefly outlines the historical and current trends in bariatric surgery, and follows the trajectory of these trends into the future to anticipate the technologies and techniques that will be most important to the field in the coming years.

Resolution of type 2 diabetes following bariatric surgery: implications for adults and adolescents

Bariatric surgery is now widely reported to ameliorate or resolve type 2 diabetes mellitus in adults. Some clinical investigators even suggest its use as an early therapeutic intervention for type 2 diabetes in patients not meeting standard criteria for bariatric surgery. However, little is known about the exact mechanisms explaining the metabolic consequences, and much active investigation is underway to identify hormonal changes leading to diabetes resolution. This review includes a detailed description of various bariatric surgical procedures, including the latest less-invasive techniques, and a summary of current data providing insight into the short- and long-term metabolic effects. We outline current hypotheses regarding the mechanisms by which these surgical procedures affect diabetes and report on morbidity and mortality. Finally, we discuss the available data on bariatric surgery in adolescent patients, including special considerations in this potentially vulnerable population.

Medical and surgical treatments for obesity have opposite effects on peptide YY and appetite: a prospective study controlled for weight loss

CONTEXT

The effects of medical and surgical treatments for obesity on peptide YY (PYY) levels, in patients with similar weight loss, remain unclear.

OBJECTIVE

The objective of the study was to assess PYY and appetite before and after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and medical treatment (MED).

DESIGN

This was a prospective, controlled, nonrandomized study.

SETTING

The study was conducted at the Departments of Nutrition and Digestive Surgery at a university hospital.

PARTICIPANTS

PARTICIPANTS included three groups of eight patients with similar body mass indexes (RYGB 37.8 +/- 0.8, SG 35.3 +/- 0.7, and MED 39.1 +/- 1.7 kg/m(2), P = NS) and eight lean controls (body mass index 21.7 +/- 0.7 kg/m(2)).

MAIN OUTCOME MEASURES

Total plasma PYY, hunger, and satiety visual analog scales in fasting and after ingestion of a standard test meal were measured.

RESULTS

At baseline there were no differences in the area under the curve (AUC) of PYY, hunger, or satiety in obese groups. Two months after the interventions, RYGB, SG, and MED groups achieved similar weight loss (17.7 +/- 3, 14.9 +/- 2.4, 16.6 +/- 4%, respectively, P = NS). PYY AUC increased in RYGB (P < 0.001) and SG (P < 0.05) and did not change in MED. PYY levels decreased at fasting, 30 min, and 180 min after a standard test meal in MED (P < 0.05). Hunger AUC decreased in RYGB (P < 0.05). Satiety AUC increased in RYGB (P < 0.05) and SG (P < 0.05). Appetite did not change in MED. PYY AUC correlated with satiety AUC (r = 0.35, P < 0.05).

CONCLUSION

RYGB and SG increased PYY and reduced appetite. MED failed to produce changes. Different effects occur despite similar weight loss. This suggests that the weight-loss effects of these procedures are enhanced by an increase in PYY and satiety.

Metabolic surgery and gut hormones - a review of bariatric entero-humoral modulation

The global pandemic of obesity is increasing. Inappropriate food intake relative to energy expenditure results in increased adiposity. These factors are partly regulated by signals through the gut-brain and adipose-brain axes. Metabolic operations (otherwise known as Bariatric surgery) offer the most effective results for sustained metabolic improvement and weight loss. They modulate a number of gut hormones that constitute the gut-brain axis. This review summarizes the literature to-date reporting the gut hormone changes associated with these operations and their subsequent effects on appetite. Understanding the anatomical differences between each operation and how these can differentially regulate gut hormonal release can provide new treatments and targets for obesity, appetite and metabolic disorders.

Bariatric surgery for metabolic disorders

Help for diabetics

Bariatric surgery, safety and type 2 diabetes

Obesity and type 2 diabetes (T2D) represent major health concerns in the USA. Weight loss is the most important aspect in T2D management, as it reduces both morbidity and mortality. Available lifestyle, behavioral, and pharmacological strategies provide just mild to moderate weight loss. The greatest degree of T2D prevention or T2D amelioration in obese subjects has been reported in subjects who underwent bariatric surgery. In the current review, we will describe various types of bariatric surgery, related safety profiles, and their effect on T2D, as well as the potential mechanisms involved in the remission of T2D. Finally, we hereby examine whether bariatric surgery may be considered a treatment for T2D in pregnant women, children, adolescents and subjects at least 65 years old.

The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25-27, 2007

Sleeve gastrectomy is a rapid and less traumatic operation, which thus far is showing good resolution of comorbidities and good weight loss if a narrower channel is constructed than for the duodenal switch. There are potential intraoperative complications, which must be recognized and treated promptly. Like other bariatric operations, there are variations in the technique used. The laparoscopic sleeve gastrectomy (LSG) is being performed for super-obese and high-risk patients, but its indications have been increasing. A second-stage bariatric operation may be performed if necessary, with increased safety. Long-term results of LSG and further networking are anxiously awaited.

A prospective randomized study comparing patients with morbid obesity submitted to laparotomic gastric bypass with or without omentectomy

BACKGROUND

Visceral fat, especially the greater omentum, seems to be an important factor in the development of some metabolic disturbances such as insulin resistance, hyperglycemia, and dyslipidemia. Therefore, we wanted to evaluate the influence of resecting or leaving in situ the greater omentum in a group of patients with morbid obesity.

METHODS

Seventy patients with morbid obesity were submitted to laparotomic resectional gastric bypass and an omentectomy was randomly performed in some patients. Body mass index (BMI), serum levels of sugar, insulin, total cholesterol, and triglycerides were determined prior to surgery and followed up on for 2 years afterwards.

RESULTS

Two years after surgery, no differences were seen in BMI levels in either group. Blood sugar levels, serum insulin, total cholesterol levels, and serum triglycerides had similar values in both groups. Arterial hypertension had similar behavior.

CONCLUSIONS

Based on these results, omentectomy is not justified as part of bariatric surgery. Its theoretical advantages are not reflected in this prospective random trial.

Additional effect of visceral fat resection in an obese rat model of gastric banding

BACKGROUND

There is accumulating agreement that bariatric surgery is currently the most efficacious and enduring treatment for clinically severe obesity, and as a result, the number of bariatric surgeries performed worldwide has increased in recent years. Although the function of visceral fat has gradually become clear, the effect of visceral fat resection is still unknown. The aim of this study was to clarify the additional effect of visceral fat resection in an obese rat model of gastric banding.

METHODS

Forty male Zucker fatty rats were divided into four groups: the control group, visceral fat resection group, gastric banding group, and gastric banding with visceral fat resection group. They were followed for 8 weeks after surgery, and their body weight change, cumulative food intake, metabolic parameters, and adipocytokines were measured.

RESULTS

The gastric banding rats either with or without visceral fat resection showed significant decreases in weight gain, cumulative food intake, and levels of metabolic parameters compared to the control rats. There were no significant differences in weight gain and cumulative food intake between gastric banding with and without visceral fat resection. However, gastric banding with visceral fat resection resulted in lower plasma levels of free fatty acid and TNF-alpha compared to gastric banding alone, and expression of adiponectin mRNA in the adipose tissue was significantly decreased with the addition of visceral fat resection compared with banding alone. There were no significant differences in any parameters between controls and rats receiving visceral fat resection alone.

CONCLUSION

Visceral fat resection may improve adipocytokines and free fatty acid in an obese rat model of gastric banding. However, further studies are necessary before the procedure can be considered an option on bariatric surgery.