ObjectiveTo explore a surgery of effective weight loss concentrating on gut hormone release. MethodsWistar rats were fed with high-fat diet for inducing obesity and which randomly divided into sleeve gastrectomy plus decent jejunoileal bypass (SJB) group (n=12), sleeve gastrectomy (SG) group (n=12), and sham operation (SO) group (n=11), the body weight reduction, food intake, plasma ghrelin level, and glucagon like peptide-1 (GLP-1) level were compared among three groups. ResultsThere were no differences of the body weight and food intake before operation among three groups (Pgt;0.05). Compared with the SO group, the body weight descended and the food intake decreased obviously on 1-8 weeks after operation in the SJB group (Plt;0.05), the body weight of rats on 1-8 weeks after operation in the SJB group significantly descended as compared with the SG group (Plt;0.05), and the food intake of rats on week 3, 6, 7, and 8 in the SJB group signicantly decreased as compared with the SG group (Plt;0.05). There were no differences of the levels of the plasma ghrelin and GLP-1 before operation among three groups (Pgt;0.05). Compared with SO group, the plasma ghrelin level decreased and the GLP-1 level increased in the SJB group and the SG group, meanwhile the SJB group significantly decreased level of plasma ghrelin and elevated level of plasma GLP-1 as compared with the SG group on week 8 after operation(Plt;0.05). ConclusionThe data demonstrate that SJB could represent an effective way of losing weight by interfering with food intake and obesity related hormone levels.
ObjectiveTo investigate the effect of sleeve gastrectomy on preventing adipose infiltration and LOX-1 expression in aortic epithelium of high-fat-diet-induced obese rats. MethodsTwenty-four Wistar rats were randomized into normal chow group (CO group), high-fat diet group (HD group), and high-fat diet combined with sleeve gastrectomy group (SG group). Rats of three groups before operation and CO group after operation were fed with normal diet, rats of HD and SG group were fed with high-fat diet. Body weight of all the rats were examined on day 10, 20, and 30 after operation, respectively. Animals were sacrificed on day 30 after operation and plasma HDL and LDL were detected by ELISA, LOX-1 and LOX-1 mRNA expression in aortic epithelium were measured by Western blot and real-time RT-PCR, respectively. Immunochemical histological Nile red stain was adopted in adipose infiltration examination of aorta. ResultsThe body weights in HD group were much higher than those of other groups （Plt;0.01）. The HDL in CO, HD, and SG groups was (32.9±6.2) mg/dl, (43.4± 4.0) mg/dl, and (37.5± 4.3) mg/dl, respectively. The LDL in CO, HD, and SG groups was (31.8±4.5) mg/dl, (53.3±5.1) mg/dl, and (40.5±3.7 ) mg/dl, respectively. The HDL and LDL values in HD group were higher than those of other two groups (Plt;0.05, Plt;0.01). The LOX-1 protein and mRNA expressions in HD group were much higher than those of other groups (Plt;0.01). Adipose staining in HD group was also ber than that of other groups. ConclusionsHigh-fat diet can induce elevation of LOX-1 protein and mRNA expression in aorta. Sleeve gastrecto my can relieve plasma LDL level, as a result, LOX-1 protein and mRNA expression should be down-regulated.
Objective To investigate the clinical application value of unsymmetrical four-port laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of 114 patients with obesity who were admitted to Mianyang Central Hospital from June 2021 to May 2022 were retrospective analyzed. All the 114 patients underwent unsymme-trical four-port LSG, and were observed their surgical and postoperative conditions, complications and follow-up the patient’s esthetic satisfaction of wounds at 3 months after surgery. Results All 114 patients underwent unsymmetrical four-port LSG successfully, without conversion to open surgery. The operative time was 68–160 min, average (104.2±26.1) minutes; volume of intraoperative blood loss was 2–50 mL, average (10.7±7.6) mL; the duration of postoperative hospital stay was 3–6 d, average (4.0±0.7) days. Of the 114 patients, 8 patients (7.0%) had fat liquefaction of wounds, 68 patients (59.6%) had postoperative nausea and vomiting in the 24 hours after operation, and all patients had no serious complications such as gastrointestinal bleeding, intraperitoneal hemorrhage, or gastric leakage. One hundred and fourteen patients were followed-up for 3–14 months, with a median follow-up of 6 months. Forty patients (35.1%) had hair loss, 3 patients (2.6%) had mild anemia. Of the 114 patients, 2 (1.8%) were dissatisfied with the cosmetic effects of wounds, 64 (56.1%) were satisfied, and 48 (42.1%) were very satisfied. The satisfaction rate was 98.2% (112/114). Conclusion The unsymmetrical four-port LSG is safe and feasible, it does not affect esthetic satisfaction of wounds.
ObjectiveTo investigate the effect of the remnant stomach after gastric bypass (GB) surgery on the weight loss and glucose metabolism in rats with obese and type 2 diabetes mellitus (T2DM).MethodsHigh fat feeding for one month combined with intraperitoneal injection of low-dose streptozotocin was used to induce obese rats with T2DM. Twenty-four rats with obese and type T2DM successfully established were randomly divided into resectional gastric bypass (R-GB) group, GB surgery (GB group), and sham operation (SO) group, eight rats in each group. The weight loss and anti-diabetic effect of the R-GB and GB were compared. Body weight, food intake, and fasting blood glucose (FBG) were measured at week 1 before operation and week 1–8 after the operation. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed using tail venous blood at week 1 before operation and on week 8 after operation (at 0, 30, 60, 90, and 120 min). The levels of serum glucagon like peptide-1 (GLP-1), gastrin, insulin, and glucagon at week 1 before operation and at week 8 after operation were detected, meanwhile the homeostasis model assessment insulin resistance (HOMA-IR) index was calculated.Results① The body weight and food intake of the rats in the R-GB group and GB group were lower than those in the SO group after operation (P<0.05) and which were lower than before operation (P<0.05), but the differences were not significant between the R-GB group and GB group after operation (P>0.05). ② The levels of FBG in the R-GB group only at week 1–4 after operation were lower than those before operation (P<0.05), while which in the GB group at week 1–8 after operation were lower than those before operation and were lower than in the SO group (P<0.05), but which in the R-GB group only at week 2–4 after operation were lower than in the SO group and which were higher than that in the GB group from 3 to 8 weeks after operation (P<0.05). ③ The area under receiver operating characteristic curves (AUCs) of blood glucoses of OGTT and ITT and HOMA-IR index at week 8 after operation were lower than those before operation (P<0.05) in the GB group and which were lower than those the other two groups (P<0.05). ④ The AUC of gastrin level at week 8 after operation was lower than that before operation in the R-GB group and which lower than that in the other two groups (P<0.05). The AUC values of insulin and glucagon levels at week 8 after operation were lower than those before operation in the GB group and which lower than those in the other two groups (P<0.05). The AUC of GLP-1 level at week 8 after operation was higher than that before operation in the GB group and which higher than that in the other two groups (P<0.05).ConclusionsGB could remarkably improve glucose metabolism and weight loss in obese rat with T2DM. Gastric remnant gastrectomy following GB has a remarkable anti-diabetic effect, but it doesn’t effect on weight loss.
Laparoscopic sleeve gastrectomy (LSG) is an effective and lasting method for treating obesity, type 2 diabetes and other obesity related metabolic diseases. The symmetrical three-port LSG has been proven to be a simple, safe, and effective surgical procedure. However, China still lacks standardized surgical operation guidelines for this method. This guideline provides a detailed description of the various steps and key details of the symmetrical three-port LSG, aiming to standardize and normalize the symmetrical three-port LSG in the bariatric and metabolic field in China, and to provide standardized surgical procedures for clinical surgeons in this field.
Objective To investigate effect of metabolic surgery on type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) 27.5–32.5 kg/m2. Methods The clinical data of 43 T2DM patients with BMI 27.5–32.5 kg/m2 underwent metabolic surgery from October 2014 to October 2016 in the Third Xiangya Hospital of Central South University were analyzed retrospectively. The related indexes such as BMI, blood glucose level, blood lipid level were analyzed before and after metabolic surgery. Results All the patients underwent metabolic surgery successfully. Among them, 35 cases underwent laparoscopic gastric bypass surgery while 8 cases underwent laparoscopic sleeve gastrectomy without related complications after operation. Compared with preoperative indexes, the BMI, fasting blood glucose, HbA1c, triglyceride, and total cholesterol on the postoperative different time were all significantly decreased (P<0.05) except for the HbA1c on the postoperative 1-week, the high density lipoprotein level on the postoperative 12-month was significantly increased (P<0.05). The OGTT 30, 60, and 120 min blood glucose levels on the postoperative 1-week and 3-month, and 60 and 120 min blood glucose levels on the postoperative 6-month and 12-month were all significantly decreased (P<0.05). The OGTT-IRT 60 min insulin level on the postoperative 3-month and the 30 min insulin levels on the postoperative 6- and 12-month were all significantly increased (P<0.05). The levels of OGTT-CRT 30 and 60 min C peptide on the postoperative 6-month and the level of 30 min C peptide on the postoperative 12-month were all significantly increased (P<0.05). Conclusions Metabolic surgery is effective in treatment of T2DM patients with BMI 27.5–32.5 kg/m2, and levels of blood glucose and blood lipids can be improved significantly. Synthesis and release of insulin by islet cells can be ameliorated.
ObjectiveTo compare and analyze the therapeutic effect of robotic and laparoscopic radical resection of rectal cancer for obese patients with rectal adenocarcinoma. MethodsThe retrospective cohort study was conducted. The clinicopathologic data of 217 obese patients with rectal adenocarcinoma who were treated in the First Affiliated Hospital of Zhengzhou University from October 2017 to January 2020 were collected, 104 patients received radical resection of rectal cancer assisted by Da Vinci robotic surgical system and were assigned to the robot group, 113 patients underwent laparoscopic-assisted radical resection of rectal cancer and were assigned to the laparoscope group. The perioperative indexes, pathological examination, and postoperative recovery of urogenital function were compared. ResultsThere were no significant differences between the two groups in the gender, age, body mass index, distance from lower edge of tumor to anal edge, tumor diameter, American Association of Anesthesiologists classification, preoperative complications, preoperative carcinoembryonic antigen level, tumor differentiation, and TNM stage (P>0.05). The operations were successfully completed in all patients and there was no conversion to laparotomy and perioperative death. There were no significant differences between the two groups in the operation time, first exhaust time, first eating liquid food time, first getting out of bed activity time, drainage tube placement time, prophylactic stoma rate, and postoperative complications (P>0.05). The intraoperative blood loss and total hospital stay in the robot group were less than those of the laparoscope group (P<0.05). The International Prostate Symptom Score of the robot group was lower than that of the laparoscope group at 3, 6, and 12 months after operation (P<0.05). The International Index of Erectile Function-15 score of male patients and Female Sexual Function Index-19 score of female patients in the robot group were higher than those in the laparoscope group at 3, 6, and 12 months after operation (P<0.05). ConclusionsRobotic surgery is safe and effective in treatment of obese patients with rectal adenocarcinoma. Compared with laparoscopic surgery, robotic surgery could benefit patients more in protecting postoperative genitourinary function.
ObjectiveTo summarize the mechanism of effects of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) and the research progress of LSG in combination with fundoplication on obesity with GERD. MethodThe literatures of studies relevant to relation between LSG and GERD and effect of LSG combined with fundoplication on obesity accompanying GERD at home and abroad were searched and reviewed. ResultsAlthough there was considerable disagreement over the effect of LSG on GERD, the evidence showed that the LSG alone might worsen the existing GERD or promote new GERD, which mainly due to the destruction of the lower esophageal sphincter, deactivation of His angle, elevated intragastric pressure, and shape of sleeve stomach. Currently, the LSG in combination with fundoplication had been gradually applied in the clinical treatment of obese patients with GERD. And the short-term results of follow-up showed that the effects of weight loss and anti-reflux could be obtained, which needed to be evaluated by more studies and longer follow-up. ConclusionsThere is a risk of worsening existing GERD or promoting new GERD after LSG surgery. The LSG in combination with fundoplication is safe and feasible, which not only makes up for the adverse effects of LSG only on GERD after surgery, but also achieves the same similar effect of weight loss as LSG, providing a new choice for obese patients with GERD.
ObjectiveTo investigate effects of sleeve gastrectomy (SG)-transit bipartition (SG-TB) and simple SG on bariatric and anti-diabetic and protective effect on esophagus reflux. MethodsA total of 36 male Sprague-Dawley rats were used to successfully induce the obesity with type 2 diabetes mellitus (T2DM) model by dietary feeding and receiving intraperitoneal injection of streptozotocin (35 mg/kg), then were randomly averagely divided into SG, SG-TB, and sham operation (SO) groups according to the surgical methods, and 8 rats from each procedure were randomly selected and included to use for experimental observation. The observation period was 12 weeks. The changes of terminal esophageal mucosa were observed at the 12th week after operation. The body weight and food intake were measured every 2 weeks after operation. The fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) blood glucose levels were measured before operation and at the 4th and 12th week after operation. And the changes of glucagon like peptide-1 (GLP-1) and insulin levels were measured before operation and at the 12th week after operation. ResultsThere were no significant differences in all indexes among the 3 groups before operation (P>0.05). ① No esophageal papillomatosis was observed in the SG-TB group at the 12th week after operation, but more severe esophageal papillomatosis was observed in the SG group, and the mucosal height in the SG-TB group was lower than that in the SG group (P<0.05). ② From the 4th week after operation, the body weight and food intake of the SG-TB group and SG group were lower than the SO group (P<0.05), and their changes of these two groups over time were generally stable. While no significant difference was found in the reduction of body weight between the SG-TB group and the SG group (P>0.05), however the food intakes of the SG-TB group were higher than the SG group at the 10th and 12th week after operation (P<0.05). ③ The levels of FBG, OGTT and ITT blood glucoses in the SG-TB group and SG group were lower than in the SO group at the 4th and 12th week after operation (P<0.05) and remained stable after operation. However, no significant difference was found in the FBG and ITT blood glucose level between the SG-TB group and the SG group (P>0.05), while the level of OGTT blood glucose in the SG-TB group was lower than that in the SG group at the 12th week after operation (P<0.05). ④ The levels of GLP-1 in the SG-TB group and SG group were higher than in the SO group and still higher than before operation (P<0.05), while the insulin levels were lower than in the SO group and lower than before operation (P<0.05). ConclusionsFrom preliminary results of this study, change of terminal esophageal mucosa after SG-TB is weaker than that of SG operation, and it is found that SG-TB surgery shows a better trend in blood glucose control as compared with SG operation. However, due to the limitations of sample size, further research and anti-reflux effect of SG-TB operation still need to be verified.
With the swift evolution of bariatric and metabolic surgery, additional procedures building upon sleeve gastrectomy have consistently surfaced. Recent studies suggest that sleeve gastrectomy with jejunojejunal bypass (SG-JJB) yields superior short-term weight reduction outcomes compared to sleeve gastrectomy alone, with weight loss and glycemic control effects akin to Roux-en-Y gastric bypass, and without significant complications. As a result, SG-JJB is regarded as a safe and efficacious bariatric procedure, noted for its technical simplicity and reversibility, presenting substantial clinical utility. Nonetheless, high-quality, multicenter, large-sample, long-term follow-up randomized controlled trials are essential to further ascertain its long-term efficacy and safety, and to facilitate its standardized implementation. This article seeks to review the advancements in SG-JJB research, evaluate its effectiveness and safety in managing obesity and associated comorbidities, and explore its future developmental trajectory.