Article

Metabolic and Hormonal Changes After Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: a Randomized, Prospective Trial

Department of Surgery, St Claraspital, 4016 Basel, Switzerland.
Obesity Surgery (Impact Factor: 3.75). 02/2012; 22(5):740-8. DOI: 10.1007/s11695-012-0622-3
Source: PubMed

ABSTRACT

The mechanisms of amelioration of glycemic control early after laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) are not fully understood.
In this prospective, randomized 1-year trial, outcomes of LRYGB and LSG patients were compared, focusing on possibly responsible mechanisms. Twelve patients were randomized to LRYGB and 11 to LSG. These non-diabetic patients were investigated before and 1 week, 3 months, and 12 months after surgery. A standard test meal was given after an overnight fast, and blood samples were collected before, during, and after food intake for hormone profiles (cholecystokinin (CCK), ghrelin, glucagon-like peptide 1 (GLP-1), peptide YY (PYY)).
In both groups, body weight and BMI decreased markedly and comparably leading to an identical improvement of abnormal glycemic control (HOMA index). Post-surgery, patients had markedly increased postprandial plasma GLP-1 and PYY levels (p < 0.05) with ensuing improvement in glucose homeostasis. At 12 months, LRYGB ghrelin levels approached preoperative values. The postprandial, physiologic fluctuation returned, however, while LSG ghrelin levels were still markedly attenuated. One year postoperatively, CCK concentrations after test meals increased less in the LRYGB group than they did in the LSG group, with the latter showing significantly higher maximal CCK concentrations (p < 0.012 vs. LRYGB).
Bypassing the foregut is not the only mechanism responsible for improved glucose homeostasis. The balance between foregut (ghrelin, CCK) and hindgut (GLP-1, PYY) hormones is a key to understanding the underlying mechanisms.

Download full-text

Full-text

Available from: Beatrice Kern, Jan 11, 2014
    • "No significant differences in baseline characteristics between the two groups were observed (Table 1). LSG and LRYGB were performed according to the surgical techniques that have been previously described [20] [21]. All operations were completed successfully without intraoperative complications or adverse effects. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Bariatric patients are at risk of protein deficiency. The aim of this study was to determine possible benefits of postoperative protein supplementation weight reduction, body composition, and protein status. Methods: Twenty obese patients who underwent bariatric surgery were randomized either to the protein (PRO) group, which received a daily protein supplement over 6 months postoperatively, or to the control (CON) group, which received an isocaloric placebo in a double-blind fashion. Data on protein and energy intake, body weight, body composition, blood proteins, and grip force was collected preinterventionally and at 1, 3, and 6 months postoperatively. Results: In both groups body weight was significantly reduced to a similar extent (after 6 months: PRO group 25.4 ± 7.2%, CON group 20.9 ± 3.9%; intergroup comparison P > 0.05). Protein intake was steadily increased in the PRO group, but not in the CON group, and reached maximum at month 6 (25.4 ± 3.7% of energy intake versus 15.8 ± 4.4%; P < 0.001). In the PRO group, body fat mass loss was higher than that in the CON group (79% of absolute weight loss versus 73%; P = 0.02) while lean body mass loss was less pronounced (21% versus 27%, P = 0.05). Blood proteins and grip force did not differ at any time point between the two groups. Conclusions: The present study suggests that protein supplementation after bariatric surgery improves body composition by enhancing loss of body fat mass and reducing loss of lean body mass within the 6 months follow up.
    No preview · Article · Sep 2015 · Nutrition
    • "Other implicated mechanisms involve a change in the composition and levels of bile acids, fibroblast growth factor 19 (FGF-19) and FGF-21 post-RYGB. These have been reported to be elevated post-RYGB and there is increasing evidence to suggest that these molecules act as regulators of glucose and energy metabolism747576. Furthermore, a shift in gut microbiota composition has been observed after RYGB which favors an environment promoting glucose and energy metabolism possibly through short-chain free fatty acids production by colonic bacteria[77,78]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Obesity is on the rise and the pursuit of efficient and safe treatment is ongoing. Available anti-obesity medical therapies have so far proved to be disappointing, whereas bariatric surgery is leading the way and offers long-term health benefits. Part of the success of bariatric surgery is thought to be mediated by gut hormones. A better understanding of the role of gut hormones within the gut-brain signaling pathway in the control of hunger, satiety, and energy homeostasis, has led to their therapeutic exploitation as possible anti-obesity drugs. In this review, we provide a summary of currently available treatment options for obesity from simple lifestyle modifications and bariatric surgery to traditional and novel medical therapies.
    No preview · Article · Jun 2015 · Postgraduate Medicine
  • Source
    • "Sleeve gastrectomy , a surgical technique without duodenal exclusion , produced similar results regarding GLP - 1 secretion in comparison to patients submitted to GB ( Nannipieri et al . , 2013 ; Peterli et al . , 2012 , 2009 ; Romero et al . , 2012 ) . In another study in obese diabetic patients submitted to SG , the first phase of insulin secretion after an intravenous glucose tolerance test improved early after surgery and secretion of GLP - 1 and PYY was increased . However , patients with longstanding T2D ( >10 years ) did not experience the same"

    Full-text · Thesis · Feb 2015
Show more