Evaluation of Weight Reduction, Diabetic State and Satiety Hormones After Laparoscopic Greater Curvature Plication in Morbidly Obese Diabetic Patients
Journal of Surgery
Volume 6, Issue 2, April 2018, Pages: 43-49
Received: Feb. 6, 2018;
Accepted: Feb. 24, 2018;
Published: Mar. 19, 2018
Views 1525 Downloads 60
Waleed Omar, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Mohammad Hamed, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Sabry Ahmed Mahmoud, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Hosam Elbanna, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Mahmoud Abdelnaby, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Sameh Emile, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Mohamed Anwar, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Bariatric surgery proved effective in the treatment of morbid obesity and its associated comorbidities. The aim of this study was to assess weight loss and changes in glucose homeostasis and satiety hormones and to evaluate improvement in diabetic status in morbidly obese patients with type two diabetes mellitus (T2DM) at 6 and 12 months after laparoscopic greater curvature plication (LGCP). Twenty patients with morbid obesity with T2DM were operated upon with LGCP. Weight loss was assessed by the decrease in BMI and percentage of excess weight loss at 6 and 12 months after LGCP. Fasting and postprandial blood glucose levels, HbA1c, fasting serum insulin, serum ghrelin and glucagon-like peptide 1 (GLP-1) levels were measured before and at 6 and 12 months postoperatively. The mean age of patients was 37.6 years. There was significant decrease in BMI from 45.4 to 40.1 at 6 months (p= 0.0008) and then to 36.4 at 12 month (p< 0.0001). The mean fasting blood glucose decreased significantly from 134.8 preoperatively to 120.8 at 6 months (p< 0.0001) and then to 109.5 at 12 months (p< 0.0001). The mean preoperative HbA1c declined from 6.8 before LGCO to 6.3 at 6 months (p< 0.0001) then to 5.9 at 12 months (p< 0.0001). The mean fasting insulin level decreased from 20.5 preoperatively to 17.4 at 6 months (p< 0.0001) then to 16.7 at 12 months (p< 0.0001). The mean baseline ghrelin level decreased significantly from 551.7 preoperatively to 441.5 at 6 months (p< 0.0001) then to 422.5 at 12 months (p< 0.0001). The mean GLP-1 declined from 33.7 before surgery to 33.5 at 6 months (p= 0.76) then to 33.1 at 12 months (p= 0.36). LGCP is an effective bariatric procedure that achieved satisfactory weight loss and significant improvement in the glycemic control as demonstrated by improvement in laboratory markers as serum glucose, insulin, and ghrelin hormone levels.
Sabry Ahmed Mahmoud,
Evaluation of Weight Reduction, Diabetic State and Satiety Hormones After Laparoscopic Greater Curvature Plication in Morbidly Obese Diabetic Patients, Journal of Surgery.
Vol. 6, No. 2,
2018, pp. 43-49.
Tsigosa C, Hainer V, Basdevant A, Finer N, Fried M, Mathus-Vliegen E, Micic D, Maislos M, Roman G, Schutz Y, Toplak H and Zahorska-Markiewicz B. Management of obesity in adults: European Clinical Practice Guidelines. Eur J Obes. 2008; 2:106–16.
Wing R, Phelan S (2004) Science-based solutions to obesity: what are the roles of academia, government, industry, and health care? Proceedings of a Symposium, Boston, Massachusetts, USA, 10–11 March 2004 and Anaheim, California, USA, 2 October 2004.
Rucker D, Padwal R, Li SK, Curioni C and Lau Dc. Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ. 2007; 335 (7631):1194–9.
Dixon JB, le Roux CW, Rubino F and Zimmet P. Bariatric surgery for type 2 diabetes. Lancet. 2012; 379 (9833):2300–11. PMID: 22683132. 21.
Wilkinson LH, Peloso OA. Gastric (reservoir) reduction for morbid obesity. Arch Surg. 1981; 116 (5):602–5.
Skrekas G, Antiochos K and Stafyla VK. Laparoscopic gastric greater curvature plication: results and complications in a series of 135 patients. Obes Surg. 2011; 21 (11):1657–63.
Brethauer SA, Harris JL, Kroh M and Schauer PR. Laparoscopic gastric plication for treatment of severe obesity. Surg Obes Relat Dis. 2011; 7 (1): 15–22.
Bradnova O, Kyrou I, Hainer V, Vcelak J, Halkova T, Sramkova P, Dolezalova K, Fried M, McTernan P, Kumar S, Hill M, Kunesova M, Bendlova B and Vrblkov J. Laparoscopic Greater Curvature Plication in Morbidly Obese Women with Type 2 Diabetes: Effects on Glucose Homeostasis, Postprandial Triglyceridemia and Selected Gut Hormones. Obes Surg. 2014 May;24(5):718-26. doi: 10.1007/s11695-013-1143-4.
Ramos A, Galvao Neto M, Galvao M, Evangelista LF, Campos JM and Ferraz A. Laparoscopic greater curvature plication: initial results of an alternative restrictive bariatric procedure. Obes Surg. 2010; 20 (7):913–8. PMID: 20407932.
Taha O. Efficacy of Laparoscopic Greater Curvature Plication for Weight Loss and Type 2 Diabetes: 1-Year Follow-Up. OBES SURG (2012) 22:1629–1632.
Case A, Menendez A. Sex Differences in Obesity Rates in Poor Countries: Evidence from South Africa. Economics and human biology. 2009; 7 (3):271-282. doi:10.1016/j.ehb.2009.07.002.
Ji Y1, Wang Y2, Zhu J1, Shen D1. A systematic review of gastric plication for the treatment of obesity. SurgObesRelat Dis. 2014 Nov-Dec; 10 (6):1226-32. doi: 10.1016/j.soard.2013.12.003.
Fried M, Dolezalova K, Buchwald JN, McGlennon TW, Sramkova P and Ribaric G. Laparoscopic greater curvature plication (LGCP) for treatment ofmorbid obesity in a series of 244 patients. Obes Surg. 2012; 22 (8):1298–307. PMID: 22648797.
Mui WL, Lee DW, Lam KK, et al. Laparoscopic greater curve plication in Asia: initial experience. Obes Surg. 2013; 23 (2):179–83.
Niazi M, Maleki AR, Talebpour M. Short-term outcomes of laparoscopic gastric plication in morbidly obese patients: importance of postoperative follow-up. Obes Surg. 2013; 23 (1):87–92.
Scott WR, Batterham RL. Roux-en-Y gastric bypass and laparoscopicsleeve gastrectomy: understanding weight loss and improvementsin type 2 diabetes after bariatric surgery. Am J Physiol RegulIntegr Comp Physiol. 2011; 301 (1):R15–27.
Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic andhormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012; 22 (5):740–8.
Emile SH, Elfeki H, Elalfy K, Abdallah E. Laparoscopic Sleeve Gastrectomy Then and Now: An Updated Systematic Review of the Progress and Short-term Outcomes Over the Last 5 Years. Surg Laparosc Endosc Percutan Tech. 2017 Oct; 27 (5):307-317. doi: 10.1097/SLE.0000000000000418.
Vidal J1, Jiménez A, de Hollanda A, Flores L, Lacy A. Metabolic Surgery in Type 2 Diabetes: Roux-en-Y Gastric Bypass or Sleeve Gastrectomy as Procedure of Choice? Curr Atheroscler Rep. 2015 Oct; 17 (10):58. doi: 10.1007/s11883-015-0538-1.
Broglio F, Arvat E, Benso A, et al. Ghrelin, a natural GH secretagogue produced by the stomach, induces hyperglycemia and reduces insulin secretion in humans. J Clin Endocrinol Metab. 2001; 86 (10): 5083–6.
Sun Y, Asnicar M, Saha PK, et al. Ablation of ghrelin improves the diabetic but not obese phenotype of ob/ob mice. Cell Metab. 2006; 3 (5):379–86.
Holst JJ. The physiology of glucagon-like peptide 1. Physiol Rev. 2007; 87 (4):1409–39.
Paschetta E, Hvalryg M, Musso G. Glucose-dependent insulinotropic polypeptide: from pathophysiology to therapeutic opportunities in obesity-associated disorders. Obes Rev. 2011; 12 (10):813–28.
Romero F, Nicolau J, Flores L, et al. Comparable early changes in gastrointestinal hormones after sleeve gastrectomy and RouxEn-Y gastric bypass surgery for morbidly obese type 2 diabetic subjects. SurgEndosc. 2012; 26 (8):2231–9.
Dimitriadis E, Daskalakis M, Kampa M, et al. Alterations in gut hormones after laparoscopic sleeve gastrectomy: a prospective clinical and laboratory investigational study. Ann Surg. 2013; 257 (4): 647–54.
Papamargaritis D, le Roux CW, Sioka E, et al. Changes in gut hormone profile and glucose homeostasis after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2013; 9 (2):192–201.
Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy— a “food limiting” operation. Obes Surg. 2008; 18 (10):1251–6.
Talebpour M1, Talebpour A1, Barzin G2, Shariat Moharari R2, Khajavi MR2. Effects of laparoscopic gastric plication (LGP) in patients with type 2 diabetes, one year follow-up. J Diabetes Metab Disord. 2015 Jul 17; 14:60. doi: 10.1186/s40200-015-0188-4. eCollection 2015.
Bužga M1, Maresova P2, Seidlerova A1, Zonča P1, Holéczy P1, Kuča K3. The influence of methods of bariatric surgery for treatment of type 2 diabetes mellitus. Ther Clin Risk Manag. 2016 Apr 15; 12:599-605. doi: 10.2147/TCRM.S96593. eCollection 2016.