Sleeve Gastrectomy Relieves Steatohepatitis in High-Fat-Diet-Induced Obese Rats

Background  Sleeve gastrectomy is thought to decrease the appetite and body weight of morbid obesity patients in the clinic. The purpose is to investigate the effect of sleeve gastrectomy on preventing steatohepatitis in morbid obesity rats. Methods  Thirty rats were randomized into normal chow group (NC), high-fat-diet group (HD), and sleeve group (SG). Rats in the SG group received sleeve gastrectomy operation. After operation, rats in SG and HD group received a high-fat diet, while rats in the NC group received normal chow. Body weight was measured every 10 days. Thirty days later, animals were sacrificed and blood samples were collected to check total cholesterol, HDL, and triglyceride. Fresh liver sections were made and stained with Nile red and observed under a fluorescence microscope. Results  Rats in the SG group received a moderate body weight decrease (191 ± 16.2 g) in the first 10 days, while this did not happen in the other two groups (213 ± 13.7 g and 243 ± 11.9 g). At the sacrifice date, weight of rats in the SG group was still much lower than those in the HD group. Plasma triglycerol (102.3 ± 18.6 mg/dL) and cholesterol (84.3 ± 6.1 mg/dL) of rats in the SG group were much lower than those in the HD group (198.5 ± 18.5 mg/dL, 133.9 ± 22.0 mg/dL). Under the fluorescence microscope, adipose infiltration was very obvious in the liver of the HD animals, while adipose infiltration was not serious in the SG group. Conclusion  High-fat diet can result in obvious body weight increase and hepatic adipose infiltration compared with normal chow. Sleeve gastrectomy can decrease body weight even in high-fat-diet models. Body weight control caused by sleeve gastrectomy can relieve high-fat-diet-induced steatohepatitis in rats. Authors have no commercial interest in the subject of study. This investigation was supported by National Foundation of Liaoning Province (110035).     

Sleeve Gastrectomy Induces Weight Loss in Diet-Induced Obese Rats Even if High-Fat Feeding Is Continued

Background

Sleeve gastrectomy (SG) has been used for the surgical treatment of morbid obesity as a first or definitive procedure with satisfactory results. The objective of this study in rats was to establish the effects of SG on weight loss depending on the post-surgical type of diet followed.

Methods

Thirty male Wistar rats were fed ad libitum during 3 months on a high-fat diet (HFD) to induce obesity. After this first phase, rats were subdivided in three groups of ten rats each and underwent a sham intervention, an SG, or no surgery but were pair-fed to the amount of food eaten by the animals of the SG group. At this time point, half of the animals in each group continued to be fed on the HFD, while the other half was switched to a normal chow diet (ND). Thus, the following subgroups were established: sham-ND, sleeve-ND, pair-fed-ND as well as sham-HFD, sleeve-HFD, and pair-fed-HFD. Body weight and food intake were recorded daily for 4 weeks. The feed efficiency rate (FER) was determined from weekly weight gains and caloric consumption during this period.

Results

Statistically significant (P?<?0.05) differences in body weight were observed between the six experimental groups after 4 weeks of the interventions with rats in the sleeve-ND group experimenting the highest weight loss (?78.2?±?10.3 g) and animals in the pair-fed-HFD group exhibiting the lowest weight reduction (?4.0?±?0.1 g). Interestingly, the FER value of rats that underwent the SG and continued to be fed on a HFD was significantly (P?<?0.05) lower than that of sham operated and pair-fed animals on the same diet.

Conclusion

The positive effects of SG on weight reduction are observed in obese rats submitted to the intervention and subsequently following an ND or even an HFD.     

Indications for Sleeve Gastrectomy as a Primary Procedure for Weight Loss in the Morbidly Obese

Background Single-stage laparoscopic sleeve gastrectomy (LSG) may represent an additional surgical option for morbid obesity. Methods We performed a retrospective review of a prospectively maintained database of LSG performed from November 2004 to April 2007 as a one-stage primary restrictive procedure. Results One hundred forty-eight LSGs were performed as primary procedures for weight loss. The mean patient age was 42 years (range, 13–79), mean body mass index of 43.4 kg/m² (range, 35–75), mean operative time of 60 min (range, 58–190), and mean blood loss of 60 ml (range, 0–300). One hundred forty-seven procedures (99.3%) were completed laparoscopically, with a mean hospital stay of 2.7 days (range, 2–25). A 2.7% major complication rate was observed with four events in three patients and no deaths. Four patients required readmission; mild dehydration in two, choledocholithiasis in one, and a gastric sleeve stricture in one. Conclusion Laparoscopic SG is a safe one-stage restrictive technique as a primary procedure for weight loss in the morbidly obese with an acceptable operative time, intraoperative blood loss, and perioperative complication rate. This work was presented at the SSAT Poster Presentation session on May 21st 2007 at the SSAT Annual Meeting at Digestive Disease Week, Washington. Poster ID M1588.     

改良胃袖状切除对肥胖大鼠ghrelin及胰高血糖素样肽-1水平的影响

目的根据胃肠道不同部位激素分泌的特点,探讨一种新的长期减重效果明显的手术方式。方法高脂饮食诱导Wistar肥胖大鼠35只,然后将诱导成功的肥胖大鼠按完全随机方法分为改良胃袖状切除术组(n=12)、胃袖状切除术组(n=12)及假手术组(n=11)3组,分别比较3组大鼠术前、术后连续8周的体重和摄食量,以及术前及术后第8周时外周血清中生长激素释放肽ghrelin和胰高血糖素样肽-1(GLP-1)水平的变化。结果①大鼠体重和摄食量:3组间术前大鼠的体重和摄食量差异均无统计学意义(P>0.05)。改良胃袖状切除术组和胃袖状切除术组术后1～8周,大鼠的体重均较假手术组明显下降(P<0.05),改良胃袖状切除术组较胃袖状切除术组大鼠的体重也明显下降(P<0.05)。改良胃袖状切除术组术后1～8周大鼠的摄食量较假手术组明显减少(P<0.05),改良胃袖状切除术组于术后3、6、7及8周大鼠的摄食量较胃袖状切除术组大鼠明显减少(P<0.05)。②外周血清中ghrelin和GLP-1水平:3组间术前大鼠ghrelin和GLP-1水平变化差异均无统计学意义(P>0.05);术后第8周,血清ghrelin水平改良胃袖状切除术组和胃袖状切除术组均较假手术组明显下降(P<0.05),改良胃袖状切除术组又较胃袖状切除术组明显下降(P<0.05);GLP-1水平改良胃袖状切除术组较假手术组和胃袖状切除术组明显升高(P<0.05)。同时,术后第8周时改良胃袖状切除术组和胃袖状切除术组ghrelin水平较术前明显下降(P<0.05),GLP-1水平在改良胃袖状切除术组较术前明显升高(P<0.05)。结论改良胃袖状切除术在肥胖大鼠模型中成功实施为进一步探索其临床应用提供了可能。     

Laparoscopic Sleeve Gastrectomy Leads to Reduction in Thyroxine Requirement in Morbidly Obese Patients With Hypothyroidism

Background

The impact of laparoscopic sleeve gastrectomy (LSG) on various co-morbidities including type II diabetes mellitus, hypertension, and sleep apnea is well established. However, its effect on hypothyroidism has not been given due attention evidenced by the scant literature on the subject. The purpose of this report is to assess the change in thyroxine (T₄) requirement in morbidly obese patients with clinical hypothyroidism after LSG.

Methods

We conducted a retrospective review of morbidly obese patients on T₄ replacement therapy for clinical hypothyroidism who underwent LSG from August 2009 to July 2012 at our institution.

Results

Of the 200 patients who underwent LSG during this period, 21 (10.5 %) were on T₄ replacement therapy preoperatively for clinical hypothyroidism. Two patients were lost to follow-up. The remaining 19 patients were categorized into two groups. Group 1 comprised 13 patients with decreased T₄ requirements after LSG. Group 2 comprised six patients in whom the T₄ dose remained unaltered. The mean change in T₄ requirement in group 1 was 42.07 % (12–100 %). Group 1 patients had a significantly higher mean preoperative body mass index (48.7 vs. 43.0 kg/m²; p = 0.03) than the group 2 patients. There was a significant correlation between the percentage excess weight loss and the percentage change in T₄ requirement in group 1 (r = 0.607, p = 0.028).

Conclusions

Sleeve gastrectomy has a favorable impact on hypothyroid status as seen by a reduction in T₄ requirement in the majority of morbidly obese patients with overt hypothyroidism.     

Vertical Gastric Resection (Sleeve Gastrectomy) in a Morbidly Obese Patient with Past Jejunoileal Bypass

Jejunoileal bypass (JIB) is a purely malabsorptiveoperation, which has been abandoned in the USA andWestern Europe due to occasional serious complications.We are still seeing past JIB patients who havebecome obese again over the years, but are not sufferingside-effects of the previous JIB, and are complainingof typical co-morbidities of the obesity. Wepresent a prior JIB patient who underwent a sleevegastrectomy in 2003 for recurrence of morbid obesity.The patient has been followed for another 4 years withregular laboratory tests, monitoring of weight loss,bone densitometry and possible complications.Selected morbidly obese patients who have undergonepast JIB, can be safely treated by a restrictiveprocedure, sleeve gastrectomy, to accomplish successfulweight loss without increasing the risk of possibleserious complications.     

Short- and Long-Term Changes in Gastric Morphology and Histopathology Following Sleeve Gastrectomy in Diet-Induced Obese Rats

Background

Sleeve gastrectomy (SG) has been used as a multipurpose surgical procedure for the treatment of morbid obesity. The aim of the study was to analyze gastric morphology and histology at two different time points after SG in rats.

Methods

Thirty-five male Wistar rats were fed ad libitum during 3?months on a high-fat diet to induce obesity. Subsequently, 25 diet-induced obese rats underwent either SG (n?=?12) or a sham operation (n?=?13). The remaining ten obese animals encompassed the nonoperated control group (Co). Four weeks postoperatively, 15 rats (n?=?5 rats/experimental group) were sacrificed, while the remaining 20 rats were sacrificed after 16?weeks (animals/group; Co?=?5, sham?=?8, SG?=?7) to compare the gastric morphological and histopathological changes over time. Body weight and food intake were regularly recorded.

Results

For both time periods, the Co groups exhibited the highest body weight, while the rats undergoing the SG showed the lowest weight gain (P?P?Conclusion After SG gastric macro- and microscopic changes with functional implications in both the short and long term take place.     

Goal-Directed Fluid Therapy on Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients

Background

In bariatric surgery, there are no guidelines available for intraoperative fluid administration. Goal-directed fluid therapy (GDFT) is a new concept of perioperative fluid management that has been shown to improve the prognosis of patients undergoing abdominal surgery. The aim of our study is to assess the impact of the implementation of a GDFT protocol in morbidly obese patients who underwent laparoscopic sleeve gastrectomy (LSG).

Methods

A before-after intervention study, in morbidly obese patients who underwent LSG, was conducted at the Obesity Unit of the General University Hospital Elche. Data from the GDFT implementation group (January 2014 to December 2015) were prospectively collected and compared with a preimplementation group (January 2012 to December 2013).

Results

Baseline demographic and comorbidity data between the two groups of patients were similar. The length of stay in the hospital was significantly shortened in GDFT group from 4.5 to 3.44 days (p?<?0.001). Intraoperative fluid administration was significantly lower in the GDFT group (1002.4 vs 1687.2 ml in preimplementation group, p?<?0.001). In the postoperative period, there was a statistically significant reduction in postoperative nausea and vomiting (PONV) after GDFT implementation (48 to 14.3 %, p?<?0.001).

Conclusions

Implementation of GDFT protocols can prevent intraoperative fluid overload in patients undergoing bariatric surgery. It could improve outcomes, for example decreasing PONV or even hospital stay.

     

Technical Aspects of Laparoscopic Sleeve Gastrectomy in 25 Morbidly Obese Patients

Background Laparoscopic sleeve gastrectomy (LSG) has recently come to be performed as a sole bariatric operation. The postoperative morbidity and mortality are cause for concern, and possibly are related to non-standardized surgical technique. Methods The following is the surgical LSG technique used in 25 morbidly obese patients. Five trocars are used. Division of the vascular supply of the greater gastric curvature is begun at 6–7 cm proximal to the pylorus, proceeding to the angle of His. A 50-Fr calibrating bougie is positioned against the lesser curvature. The LSG is created using a linear staplercutter device with one 4.1-mm green load for the antrum, followed by five to seven sequential 3.5-mm blue loads for the remaining gastric corpus and fundus. The staple-line is inverted by placing a seroserosal continuous absorbable suture over the bougie from the angle of His .The resected stomach is removed through the 12-mm trocar, and a Jackson-Pratt drain is left along the suture-line. Results The mean operative time was 120 minutes, and length of hospital stay was 4 ± 2 days.There were no conversions to open procedures. There were no postoperative complications (no hemorrhage from the staple-line, no anastomotic leakage, no stricture) and no mortality. In 1 patient, cholecystectomy was also done, and in 4, a gastric band was removed. During a median follow-up of 4 months, BMI decreased from 43 ± 5 kg/m² to 34 ± 6 kg/m², and the % excess BMI loss was 49 ± 25%. Conclusions The proposed surgical technique appears to be a safe and effective procedure for morbid obesity.     

A Prospective Study on Inflammatory Parameters in Obese Patients After Sleeve Gastrectomy

Different hormones and peptides involved in inflammation have been studied in and related to obesity. The aim of our work is to assess the variations of different molecules related to inflammation in obese patients during the first year following sleeve gastrectomy. This was a prospective study on patients who underwent sleeve gastrectomy. The variations in different clinical, anthropometric, and analytical parameters related to inflammation were determined and analysed in all patients at the preoperative visit and at the first and fifth days, first and sixth months, and 1 year following surgery. We enrolled 20 patients to the study. The median body mass index (BMI) before intervention was 48.5 kg/m². With respect to comorbidities, 70 % of the patients had obstructive sleep apnoea syndrome (OSA), 65 % high blood pressure, 45 % dyslipidaemia, and 40 % diabetes mellitus (DM). The median percentage of BMI lost (%BMIL) 1 year after the intervention was 71 %. The dyslipidaemia healing or improvement rate was 100 %, whereas it was 87.5 % for diabetes, 84.6 % for hypertension, and 57.1 % for OSA. During the 1-year postintervention period, the average levels of adiponectin increased, although not significantly, whereas those of leptin significantly decreased. In addition, the blood levels of MCP-1, IL-6, CRP, ferritin, and PAI-1 significantly decreased in that period. Sleeve gastrectomy is a surgical technique that is associated with improvements in body weight and comorbid conditions from the first postoperative months, which lead to significant variations in the levels of different inflammation-related parameters and a decrease in the levels of leptin, IL-6, CRP, MCP-1, ferritin, and serpin (PAI-1).     

Effects of Sleeve Gastrectomy on Lipid Metabolism in an Obese Diabetic Rat Model

Background

Laparoscopic sleeve gastrectomy (SG) is a popular bariatric procedure for treating morbid obesity. This study aimed to investigate the relation between SG and lipid metabolism in an obese diabetic rat model.

Methods

Forty-five male Zucker diabetic fatty (ZDF) rats were divided into three groups: sham-operated (SO) control, gastric banding (GB), and SG. Six weeks after surgery, metabolic parameters, including plasma adiponectin level, small bowel transit, mRNA expression of peroxisome proliferator-activated receptor (PPAR)-α and PPARγ in the liver, skeletal muscle and white adipose tissue, and that of adiponectin in white adipose tissue, and triglyceride (TG) contents in the liver and skeletal muscle were measured.

Results

Metabolic parameters in the GB and SG groups were significantly improved compared with those in the SO group. However, plasma total cholesterol (TC) and free fatty acid (FFA) concentrations were significantly lower while the plasma adiponectin level was significantly higher in the SG group than in the GB and SO groups. In addition, small bowel transit time was significantly shorter in the SG group than in the other two groups. Furthermore, in the SG group, mRNA expression of PPARα in the liver and skeletal muscle and that of adiponection and PPARγ in white adipose tissue were significantly higher, while TG in the liver and skeletal muscle were significantly lower, compared with those in the other two groups.

Conclusions

These results suggest that SG improves lipid metabolism compared with GB, although there were no significant differences in the effect on weight loss between the two procedures.     

Effect of Sleeve Gastrectomy on Gastroesophageal Reflux

Laparoscopic sleeve gastrectomy (LSG) is effective as a stand-alone bariatric procedure. Despite its positive effect with regard to weight loss and improvement of obesity-related co-morbidities, some patients develop gastroesophageal reflux symptoms postoperatively. The pathogenesis of these symptoms is not completely understood. Hence, this study aimed to assess the effect of sleeve gastrectomy on acid and non-acid gastroesophageal reflux, reflux symptoms and esophageal function. In a prospective study, patients underwent esophageal function tests (high-resolution manometry (HRM) and 24-h pH/impedance metry) before and 3 months after LSG. Preoperative and postoperative symptoms were assessed using the Reflux Disease Questionnaire (RDQ). In total, 20 patients (4 male/16 female, mean age 43?±?12 years, mean weight 137.3?±?25 kg, and mean BMI 47.6?±?6.1 kg/m²) participated in this study. GERD symptoms did not significantly change after sleeve gastrectomy, but other upper gastrointestinal symptoms, particularly belching, epigastric pain and vomiting increased. Esophageal acid exposure significantly increased after sleeve gastrectomy: upright from 5.1?±?4.4 to 12.6?±?9.8 % (p?=?0.003), supine from 1.4?±?2.4 to 11?±?15 % (p?=?0.003) and total acid exposure from 4.1?±?3.5 to 12?±?10.4 % (p?=?0.004). The percentage of normal peristaltic contractions remained unchanged, but the distal contractile integral decreased after LSG from 2,006.0?±?1,806.3 to 1,537.4?±?1,671.8 mmHg?·?cm?·?s (p?=?0.01). The lower esophageal sphincter (LES) pressure decreased from 18.3?±?9.2 to 11.0?±?7.0 mmHg (p?=?0.02). After LSG, patients have significantly higher esophageal acid exposure, which may well be due to a decrease in LES resting pressure following the procedure.