Skip to main content
Top
Published in: Obesity Surgery 8/2009

01-08-2009 | Research

Is There Any Role of Resecting the Stomach to Ameliorate Weight Loss and Sugar Control in Morbidly Obese Diabetic Patients?

Authors: Eldo E. Frezza, Susan E. Wozniak, Laura Gee, Mitchell Wacthel

Published in: Obesity Surgery | Issue 8/2009

Login to get access

Abstract

Background

Among the restrictive procedures the role of restrictive vs. resecting the stomach is still ambiguous. This study evaluate which is the role of the stomach with respect to blood glucose levels (BG) and percent excess weight loss (EWL) over the 18 months after restrictive procedures in morbid obese diabetic patients.

Methods

We retrospectively compared a group of patients who underwent partial gastrectomy (just part of the gastric body) with gastric banding (GBSR; n = 27), sleeve gastrectomy (part of gastric body and complete fundus resection; LSG; n = 53) to laparoscopic gastric banding (LAGB; n = 100). Differences among groups at 3, 6, 12, and 18 months were evaluated by analysis of variance. The three cohorts were diabetic patients similar in BMI, age, and gender.

Results

At 12 and 18 months, LSG had higher EWL (P < 0.05) and lower BG (P < 0.05) than did either LAGB or GBSR. There were no operative deaths. Complications: LAGB—two staple-line oozing, two wound infections; LSG—one hemorrhage, two staple-line oozing, two leaks; GBSR—one hemorrhage, two wound infections. All complications were readily treated.

Conclusions

LSG provides better weight loss and glucose control at 1 year and 1.5 years after surgery than does either LAGB or GBSR, suggesting that gastric fundus resection plays an important, not yet well-defined, role.
Literature
1.
go back to reference Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. JAMA. 2004;292:1724–37.CrossRef Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. JAMA. 2004;292:1724–37.CrossRef
2.
go back to reference Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle and the risk of type 2 diabetes mellitus in women. The New England Journal of Medicine. 2001;345(11):790–7.CrossRef Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle and the risk of type 2 diabetes mellitus in women. The New England Journal of Medicine. 2001;345(11):790–7.CrossRef
3.
go back to reference Pinkney JH, Sjostrom CD, Gale EAM. Should surgeons treat diabetes in severely obese people? Lancet. 2001;357:1357–9.CrossRef Pinkney JH, Sjostrom CD, Gale EAM. Should surgeons treat diabetes in severely obese people? Lancet. 2001;357:1357–9.CrossRef
4.
go back to reference Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.CrossRef Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.CrossRef
5.
go back to reference Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236:554–9.CrossRef Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236:554–9.CrossRef
6.
go back to reference King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.CrossRef King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.CrossRef
7.
go back to reference Chan BS, Tsang MW, Lee VW, et al. Cost of Type 2 diabetes mellitus in Hong Kong Chinese. Int J Clin Pharmacol Ther. 2007;45:455–68.CrossRef Chan BS, Tsang MW, Lee VW, et al. Cost of Type 2 diabetes mellitus in Hong Kong Chinese. Int J Clin Pharmacol Ther. 2007;45:455–68.CrossRef
8.
go back to reference Shak JR, Roper J, Perez-Perez GI, et al. The effect of laparoscopic gastric banding surgery on plasma levels of appetite-control, insulinotropic, and digestive hormones. Obes Surg. 2008;18(9):1089–96.CrossRef Shak JR, Roper J, Perez-Perez GI, et al. The effect of laparoscopic gastric banding surgery on plasma levels of appetite-control, insulinotropic, and digestive hormones. Obes Surg. 2008;18(9):1089–96.CrossRef
9.
go back to reference Parikh M, Ayoung-Chee P, Romanos E, et al. Comparison of rates of resolution of diabetes mellitus after gastric banding, gastric bypass, and biliopancreatic diversion. J Am Coll Surg. 2007;205(5):631–5.CrossRef Parikh M, Ayoung-Chee P, Romanos E, et al. Comparison of rates of resolution of diabetes mellitus after gastric banding, gastric bypass, and biliopancreatic diversion. J Am Coll Surg. 2007;205(5):631–5.CrossRef
10.
go back to reference Parikh MS, Shen R, Weiner M, et al. Laparoscopic bariatric surgery in superobese patients (BMI > 50) is safe and effective: a review of 332 patients. Obes Surg. 2005;15(6):858–63.CrossRef Parikh MS, Shen R, Weiner M, et al. Laparoscopic bariatric surgery in superobese patients (BMI > 50) is safe and effective: a review of 332 patients. Obes Surg. 2005;15(6):858–63.CrossRef
11.
go back to reference Parikh MS, Laker S, Weiner M, et al. Objective comparison of complications resulting from laparoscopic bariatric procedures. J Am Coll Surg. 2006;202(2):252–61.CrossRef Parikh MS, Laker S, Weiner M, et al. Objective comparison of complications resulting from laparoscopic bariatric procedures. J Am Coll Surg. 2006;202(2):252–61.CrossRef
12.
go back to reference Ren CJ. Controversies in bariatric surgery: evidence-based discussions on laparoscopic adjustable gastric banding. J Gastrointest Surg. 2004;8(4):396–7. discussion 404-5.CrossRef Ren CJ. Controversies in bariatric surgery: evidence-based discussions on laparoscopic adjustable gastric banding. J Gastrointest Surg. 2004;8(4):396–7. discussion 404-5.CrossRef
13.
go back to reference Ren CJ, Fielding GA. Laparoscopic adjustable gastric banding: surgical technique. J Laparoendosc Adv Surg Tech A. 2003;13(4):257–63.CrossRef Ren CJ, Fielding GA. Laparoscopic adjustable gastric banding: surgical technique. J Laparoendosc Adv Surg Tech A. 2003;13(4):257–63.CrossRef
14.
go back to reference Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–23. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–23.
15.
go back to reference Marceau P, Biron S, Bourque RA, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3:29–35.CrossRef Marceau P, Biron S, Bourque RA, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3:29–35.CrossRef
16.
go back to reference Frezza EE, Wachtel MS. Analysis of the results of sleeve gastrectomy for morbid obesity and the role of ghrelin. Surgery Today. 2008;38(6):481–3.CrossRef Frezza EE, Wachtel MS. Analysis of the results of sleeve gastrectomy for morbid obesity and the role of ghrelin. Surgery Today. 2008;38(6):481–3.CrossRef
17.
go back to reference Silecchia G, Boro C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obesity Surgery. 2006;16:1138–44.CrossRef Silecchia G, Boro C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obesity Surgery. 2006;16:1138–44.CrossRef
18.
go back to reference Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.CrossRef Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.CrossRef
19.
go back to reference Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG). Obes Surg. 2007;8:5. Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG). Obes Surg. 2007;8:5.
20.
go back to reference Frezza EE, Herbert H, Wachtel MS. Combined laparoscopic gastric banding and stomach reduction (GBSR). Initial experience after one year. Obes Surg. 2008;18:690–4.CrossRef Frezza EE, Herbert H, Wachtel MS. Combined laparoscopic gastric banding and stomach reduction (GBSR). Initial experience after one year. Obes Surg. 2008;18:690–4.CrossRef
21.
go back to reference Frezza EE, Barton A, Herbert H, et al. Laparoscopic sleeve gastrectomy with endoscopic guidance in morbid obesity. Surg Obes Relat Dis. 2008;4:575–9.CrossRef Frezza EE, Barton A, Herbert H, et al. Laparoscopic sleeve gastrectomy with endoscopic guidance in morbid obesity. Surg Obes Relat Dis. 2008;4:575–9.CrossRef
22.
go back to reference Frezza EE, Mammarappallil J, Witt C, et al. (2009) Routine postoperative gastrographin contrast swallow studies after laparoscopic gastric banding. Archives of Surgery. In Press Frezza EE, Mammarappallil J, Witt C, et al. (2009) Routine postoperative gastrographin contrast swallow studies after laparoscopic gastric banding. Archives of Surgery. In Press
23.
go back to reference Frezza EE, Wachtel MS. A simple venous thromboembolism prophylaxis protocol for patients undergoing bariatric surgery. Obes Res. 2006;14:1–5.CrossRef Frezza EE, Wachtel MS. A simple venous thromboembolism prophylaxis protocol for patients undergoing bariatric surgery. Obes Res. 2006;14:1–5.CrossRef
24.
go back to reference Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy—results after 1 and 3 years. Obes Surg. 2006;16:1450–56.CrossRef Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy—results after 1 and 3 years. Obes Surg. 2006;16:1450–56.CrossRef
25.
go back to reference Fielding GA, Ren CJ. Laparoscopic adjustable gastric band. Surg Clin N Am. 2005;85:129–40.CrossRef Fielding GA, Ren CJ. Laparoscopic adjustable gastric band. Surg Clin N Am. 2005;85:129–40.CrossRef
26.
go back to reference Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15(7):1024–9.CrossRef Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15(7):1024–9.CrossRef
27.
go back to reference Moon HS, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–75.CrossRef Moon HS, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–75.CrossRef
28.
go back to reference Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.CrossRef Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.CrossRef
29.
go back to reference Frühbeck G, Diez-Caballero A, Gil MJ, et al. The decrease in plasma ghrelin concentrations following bariatric surgery depends on the functional integrity of the fundus. Obes Surg. 2004;14:606–12.CrossRef Frühbeck G, Diez-Caballero A, Gil MJ, et al. The decrease in plasma ghrelin concentrations following bariatric surgery depends on the functional integrity of the fundus. Obes Surg. 2004;14:606–12.CrossRef
30.
go back to reference Ariyasu H, Takaya D, Tagami T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrin Metab. 2001;86:4753–8.CrossRef Ariyasu H, Takaya D, Tagami T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrin Metab. 2001;86:4753–8.CrossRef
31.
go back to reference Banks WA, Tschoep M, Robinson SM, et al. Extent and direction of ghrelin transport across the blood–brain-barrier is determined by its unique primary structure. J Pharm Exp Ther. 2002;302:822–7.CrossRef Banks WA, Tschoep M, Robinson SM, et al. Extent and direction of ghrelin transport across the blood–brain-barrier is determined by its unique primary structure. J Pharm Exp Ther. 2002;302:822–7.CrossRef
32.
go back to reference Horvath TL, Diano S, Sotonyi HM, et al. Minireview: ghrelin and the regulation of energy balance—a hypothalamic perspect. Endocrinology. 2001;142:4163–9.CrossRef Horvath TL, Diano S, Sotonyi HM, et al. Minireview: ghrelin and the regulation of energy balance—a hypothalamic perspect. Endocrinology. 2001;142:4163–9.CrossRef
33.
go back to reference Lin E, Gletsu N, Fugate K, et al. The effects of gastric surgery on systemic ghrelin levels in the morbidly obese. Arch Surg. 2004;139:780–4.CrossRef Lin E, Gletsu N, Fugate K, et al. The effects of gastric surgery on systemic ghrelin levels in the morbidly obese. Arch Surg. 2004;139:780–4.CrossRef
34.
go back to reference Wren AM, Small CJ, Ward HL, et al. The novel hypothalamic peptide ghrelin stimulates food intake and growth hormone secretion. Endocrinology. 2000;141:4325–8.CrossRef Wren AM, Small CJ, Ward HL, et al. The novel hypothalamic peptide ghrelin stimulates food intake and growth hormone secretion. Endocrinology. 2000;141:4325–8.CrossRef
35.
go back to reference Higgens SC, Gueorguiev M, Korbonits M. Ghrelin, the peripheral hunger hormone. Ann Med. 2007;39:116–36.CrossRef Higgens SC, Gueorguiev M, Korbonits M. Ghrelin, the peripheral hunger hormone. Ann Med. 2007;39:116–36.CrossRef
36.
go back to reference Xing J, Brody F, Brodskey J, et al. Gastric electrical-stimulation effects on canine gastric emptying, food intake, and body weight. Obes Res. 2003;11:41–7.CrossRef Xing J, Brody F, Brodskey J, et al. Gastric electrical-stimulation effects on canine gastric emptying, food intake, and body weight. Obes Res. 2003;11:41–7.CrossRef
37.
go back to reference Cigaina V. Gastric pacing as therapy for morbid obesity: preliminary results. Obes Surg. 2002;12:12S–6S.CrossRef Cigaina V. Gastric pacing as therapy for morbid obesity: preliminary results. Obes Surg. 2002;12:12S–6S.CrossRef
38.
go back to reference Miller K, Holler E, Hell E. Intragastric stimulation (IGS) for treatment of morbid obesity. Zentralbl Chir. 2002;175:1049–54.CrossRef Miller K, Holler E, Hell E. Intragastric stimulation (IGS) for treatment of morbid obesity. Zentralbl Chir. 2002;175:1049–54.CrossRef
Metadata
Title
Is There Any Role of Resecting the Stomach to Ameliorate Weight Loss and Sugar Control in Morbidly Obese Diabetic Patients?
Authors
Eldo E. Frezza
Susan E. Wozniak
Laura Gee
Mitchell Wacthel
Publication date
01-08-2009
Publisher
Springer New York
Published in
Obesity Surgery / Issue 8/2009
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-009-9868-9

Other articles of this Issue 8/2009

Obesity Surgery 8/2009 Go to the issue