Is splenectomy a dyslipidemic intervention? Experimental response of serum lipids to different diets and operations

Spleen removal may be recommended during organ transplantation in ABO‐incompatible recipients as well as for hypoperfusion of the grafted liver, besides conventional surgical indications, but elevation of serum lipids has been observed in certain contexts. Aiming to analyze the influence of two dietary regimens on lipid profile, an experimental study was conducted. Methods: Male Wistar rats (n = 86, 333.0 ± 32.2 g) were divided in four groups: group 1: controls; group 2: sham operation; group 3: total splenectomy; group 4: subtotal splenectomy with upper pole preservation; subgroups A (cholesterol reducing chow) and B (cholesterol‐rich mixture) were established, and diet was given during 90 days. Total cholesterol (Tchol), high‐density lipoprotein (HDL), low‐density lipoprotein (LDL), very‐low‐density lipoprotein (VLDL), and triglycerides were documented. Results: After total splenectomy, hyperlipidemia ensued with cholesterol‐reducing chow. Tchol, LDL, VLDL, triglycerides, and HDL changed from 56.4 ± 9.2, 24.6 ± 4.7, 9.7 ± 2.2, 48.6 ± 11.1, and 22.4 ± 4.3 mg/dL to 66.9 ± 11.4, 29.9 ± 5.9, 10.9 ± 2.3, 54.3 ± 11.4, and 26.1 ± 5.1 mg/dL, respectively. Upper pole preservation inhibited abnormalities of Tchol, HDL, VLDL, and triglycerides, and LDL decreased (23.6 ± 4.9 vs. 22.1 ± 5.1, P = 0.002). Higher concentrations were triggered by splenectomy and cholesterol‐enriched diet (Tchol 59.4 ± 10.1 vs. 83.9 ± 14.3 mg/dL, P = 0.000), and upper‐pole preservation diminished without abolishing hyperlipidemia (Tchol 55.9 ± 10.0 vs. 62.3 ± 7.8, P = 0.002). Conclusions: After splenectomy, hyperlipidemia occurred with both diets. Preservation of the upper pole tended to correct dyslipidemia in modality A and to attenuate it in subgroup B. © 2008 Wiley‐Liss, Inc. Microsurgery, 2009.     

Microbial Flora of the Stomach after Gastric Bypass for Morbid Obesity

Background The normal stomach is virtually sterile but the effect of Roux-en-Y gastric bypass (RYGBP) on bacterial flora in the used (very small proximal pouch) and unused (large bypassed) gastric chambers is not known. In a prospective study, this variable was documented. Methods Bariatric subjects (n = 37) were submitted to endoscopic examination of both gastric reservoirs via FUJINON enteroscope model EN-450P5, 7.3 ± 1.4 years after RYGBP. Age was 42.4 ± 9.9 years (70.2% females), preoperative BMI was 53.5 ± 10.6, and current BMI was 32.6 ± 7.8 kg/m². Methods included quantitative culture of gastric secretion along with gastric pH and lactulose/hydrogen breath test. Results None of the subjects displayed diarrhea, malabsorption or other complaints suggestive of GI bacterial overgrowth. Elevated counts of bacteria and fungi were identified in both chambers, with predominance of aerobes and anaerobes, but not molds and yeasts, in the proximal stomach. Gram-positive cocci, bacilli and coccobacilli represented the majority of the isolates. Gastric pH was neutral (pH 7.0 ± 0.2) in the proximal pouch, whereas the distal chamber mostly but not always conserved the expected acidity (pH 3.3 ± 2.2, P < 0.001). The breath test for bacterial overgrowth was positive in 40.5% of the population. Conclusions 1) Frequent colonization of both gastric chambers was detected; 2) Aerobes, anaerobes and fungi were represented in both situations; 3) Gastric pH as well as bacterial count was higher in the functioning proximal stomach; 4) Breath test was positive in 40.5% of the subjects; 5) Clinical manifestation such as diarrhea, malabsorption or pneumonia were not demonstrated; 6) Further histologic and microbiologic studies of both the stomach and the small bowel are recommended.     

What to Expect in the Excluded Stomach Mucosa after Vertical Banded Roux-en-Y Gastric Bypass for Morbid Obesity

Mucosal alterations after vertical banded Roux-en-Y gastric bypass have not been clearly evaluated. The aim of this paper was to analyze the histological findings and the presence of Helicobacter pylori in the excluded stomach. Forty consecutive patients who underwent Roux-en-Y gastric bypass longer than 36 months were selected for double-balloon enteroscopy. The excluded stomach was reached in 35/40 patients (88%). Morphological alterations were analyzed through hematoxilin and eosin and the presence of H. pylori was confirmed with Giemsa staining. Thirty patients (86%) were female, and the mean age was 43 years old. The mean postoperative time was 78 months (36-110 months). Histologically, all patients had chronic gastritis in the bypassed stomach, with pangastritis in 33/35 (94%). Five cases (5/35, 14%) presented atrophy and four of them also had intestinal metaplasia. Helicobacter pylori was detected in 7/35 (20%) of the excluded stomach and in 12/35 (34%) of the functional pouch. All patients positive for H. pylori in the excluded stomach were also positive in the functional pouch, p = 0.0005. Helicobacter pylori is still present in the excluded stomach after Roux-en-Y gastric bypass and might be considered for treatment. Histological findings indicated high prevalence of atrophy and intestinal metaplasia in this selected population.