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


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.

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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. "
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    • "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]. "
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    • "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"

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