Disruption of the Leptin-Insulin Relationship in Obese Men 24 Hours after Laparoscopic Adjustable Silicone Gastric Banding

BACKGROUND: The placement of a band to attain a tiny stomach pouch has been reported to produce early satiety in patients undergoing gastric banding. The adipocyte-derived hormone, leptin, has been shown to decrease both food intake and body weight. The aim of the present study was to assess the potential involvement of acute changes in leptin concentrations following laparoscopic adjustable silicone gastric banding (LASGB). METHODS: The study groups comprised obese male patients undergoing bariatric surgery by LASGB and overweight men undergoing laparoscopic Nissen fundoplication (NFd). Blood was drawn before surgery and 24 hours postoperatively for glucose, insulin and leptin measurements. RESULTS: In both experimental groups, a statistically significant decrease was observed in pre- and postsurgery glucose (LASGB 111 +/- 8 vs 99 +/- 6 mg/dl, P < 0.01; NFd 107 +/- 7 vs 98 +/- 5 mg/d, P < 0.01) and insulin concentrations (LASGB 39.8 +/- 11.9 vs 32.9 +/- 10.3 U/l, P < 0.01; NFd 13.2 +/- 3.3 vs 12.2 +/- 2.9 U/l, P < 0.05). However, no significant differences were observed when the percent change from pre-surgery values was analysed between both groups. Following surgery, an increase in leptin concentrations was observed in the LASGB group (23.5 +/- 4.7 vs 37.5 +/- 6.8 micrograms/l, P < 0.001) whereas a small decrease was evident in the NFd patients (12.9 +/- 4.6 vs 8.9 +/- 2.2 micrograms/l, P < 0.01). CONCLUSION: These findings strongly suggest that the short-term increase observed in plasma leptin concentrations following LASGB may play a key role in triggering an early satiety signal due to the modification of the gastrointestinal anatomy and physiology.