Gastric Mucosal Changes and Ghrelin Expression and Their Relation to Weight Reduction After Sleeve Gastrectomy
Journal of Surgery
Volume 6, Issue 2, April 2018, Pages: 36-42
Received: Feb. 6, 2018; Accepted: Feb. 24, 2018; Published: Mar. 19, 2018
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Sabry Ahmed Mahmoud, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Ahmed Fadaly Hussein, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Waleed Omar, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Emad Abdallah, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Wagdi Elkashef, Pathology Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mohamed Anwar, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Sameh Emile, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
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Background: Weight loss after laparoscopic sleeve gastrectomy (LSG) is usually attributed to the volume restrictive effect of the procedure in addition to specific hormonal changes. Objective: The present study aimed to investigate the changes in plasma ghrelin levels, the number of ghrelin producing cells and histopathological changes in the remaining pouch after LSG. Methods: The present study included 27 patients with morbid obesity. The plasma ghrelin levels were measured before and six months after LSG and the change in their levels was assessed in relation to body mass index (BMI) after LSG. Immunohistochemical staining of cellular ghrelin was used to evaluate the number and distribution of ghrelin producing cells in the resected specimen and the mucosal changes in the remaining gastric pouch after LSG were assessed at 6 months postoperatively. Results: The mean age of patients was 33.9± 21.9 years. At six months after LSG, BMI decreased from 52.6± 12.8 to 40.8± 7.2 Kg/m2 (p= 0.0001). The plasma ghrelin level decreased significantly from 564.1± 15 to 434.7± 22.6 at six months after LSG. There was strong positive correlation between BMI after LSG and plasma ghrelin level (R= 0.906, p= <0.0001). A significant improvement in the inflammatory parameters was noticed by histopathologic examination. The mean ghrelin positive cell per specimen decreased significantly from 25.37± 3.5 to 13.7 ± 2.12. Conclusion: There was good positive correlation between weight loss and lowering of plasma ghrelin level, also complete removal of the fundus was associated with more weight loss.
Sleeve Gastrectomy, Mucosal Changes, Ghrelin, Weight Loss
To cite this article
Sabry Ahmed Mahmoud, Ahmed Fadaly Hussein, Waleed Omar, Emad Abdallah, Wagdi Elkashef, Mohamed Anwar, Sameh Emile, Gastric Mucosal Changes and Ghrelin Expression and Their Relation to Weight Reduction After Sleeve Gastrectomy, Journal of Surgery. Vol. 6, No. 2, 2018, pp. 36-42. doi: 10.11648/j.js.20180602.12
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Fontaine KR, Redden DT, Wang C, et al. (2003): Years of life lost due to obesity. JAMA; 289:187–193.
Buchwald H, Avidor Y, Braunwald E, et al. (2004): Bariatric surgery: asystematic review and meta-analysis. JAMA; 292:1724–37.
Cottam D, Mattar S, Schauer P (2003): Laparoscopic era of operations for morbid obesity. Arch Surg; 138: 367-75.
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.
de Zwaan M, Mitchell JE, Howell LM et al. Characteristics of morbidly obese patients before gastric bypass surgery. Compr Psychiatry 2003; 44:428-34.
Tschop M, Wawarta R, Riepl RL, et al. Post-prandial decrease of circulating human ghrelin levels. J Endocrinol Invest. 2001; 24: RC19–21.
Shiiya T, Nakazato M, Mizuta M, et al. Plasma ghrelin levels in lean and obese humans and the effect of glucose on ghrelin secretion. J Clin Endocrinol Metab. 2002; 87:240–4.
Date Y, Kojima M, Hosoda H, et al. Ghrelin, a novel growth hormone-releasing acylated peptide, is synthesized in a distinct endocrine cell type in the gastrointestinal tracts of rats and humans. Endocrinology. 2000; 141:4255–61.
Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002; 346:1623–30.
Vrabie C, Cojocaru M, Waller M, Sindelaru R, Copaescu C. The main histopathological gastric lesions in obese patients who underwent sleeve gastrectomy. Dicle Med J Cilt / Vol 37, No 2, 97-103.
Goitein D, Lederfein D, Tzioni R, Berkenstadt H, Venturero M, Rubin M. Mapping of Ghrelin Gene Expression and Cell Distribution in the Stomach of Morbidly Obese Patients—a Possible Guide for Efficient Sleeve Gastrectomy Construction. OBES SURG (2012) 22:617–622. DOI 10.1007/s11695-011-0585-9.
Bohdjalian A, Langer FB, Shakeri-Leidenmuhler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010; 20:535–40.
Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005; 15:1024–9.
Ariyasu H, Takaya K, 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 Endocrinol Metab. 2001; 86:4753–8.
Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008; 18:1083–8.
le Roux CW1, Neary NM, Halsey TJ, Small CJ, Martinez-Isla AM, Ghatei MA, et al. Ghrelin does not stimulate food intake in patients with surgical procedures involving vagotomy. J Clin Endocrinol Metab. 2005 Aug; 90 (8):4521-4. Epub 2005 May 24.
Safaan T & Bashah M & El Ansari W & Karam M. Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens: Prevalence, Risk Factors, and Value of Routine Histopathologic Examination. OBES SURG (2017) 27:1741–1749.
AbdullGaffar B, Raman L, Khamas A, et al. Should we abandon routine microscopic examination in bariatric sleeve gastrectomy specimens? Obes Surg. 2016; 26 (1):105–10.
Clapp B. Histopathologic findings in the resected specimen of a sleeve gastrectomy. JSLS. 2015; 19 (1):e2013.00259. doi:10.4293 /JSLS.2013.00259.
Raess PW, Baird-Howell M, Aggarwal R, et al. Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management. Surg Obes Relat Dis. 2015; 11 (5):1020–3.
Lauti M, Gormack SE, Thomas JM, et al. What does the excised stomach from sleeve gastrectomy tell us? Obes Surg. 2016; 26 (4): 839–42.
Almazeedi S, Al-Sabah S, Al-Mulla A, et al. Gastric histopathologies in patients undergoing laparoscopic sleeve gastrectomies. Obes Surg. 2013; 23:314–9.
Ohanessian SE, Rogers AM, Karamchandan DM. Spectrum of gastric histopathologies in severely obese American patients undergoing sleeve gastrectomy. Obes Surg. 2016; 26 (3):595–602.
Lohsiriwat VL, Vongjirad A, Lohsiriwat D. Value of routine histopathologic examination of three common surgical specimens: appendix, gallbladder, and hemorrhoid. World J Surg. 2009; 33 (10): 2189–93.
van Vliet JL, van Gulik TM, Verbeek PC. Is it necessary to send gallbladder specimens for routine histopathological examination after cholecystectomy? The use of macroscopic examination. Dig Surg. 2013; 30 (4–6):472–5.
Onzi TR1, d'Acampora AJ, de Araújo FM, Baratieri R, Kremer G, Lyra HF Jr, Leitão JT. Gastric histopathology in laparoscopic sleeve gastrectomy: pre- and post-operative comparison. Obes Surg. 2014 Mar; 24 (3):371-6. doi: 10.1007/s11695-013-1107-8.
Renshaw AA, Rabaza JR, Gonzalez AM, et al. Helicobacter pylori infection in patients undergoing gastric bypass surgery for morbid obesity. Obes Surg. 2001; 11 (3):281–3. doi:10.1381/ 096089201321336601.
Gnanapavan S, Kola B, Bustin SA, et al. The tissue distribution of the mRNA of ghrelin and subtypes of its receptor, GHS-R, in humans. J Clin Endocrinol Metab. 2002; 87:2988.
Givon-Madhala O, Spector R, Wasserberg N, et al. Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients. Obes Surg. 2007; 17:722–7.
Baltasar A, Serra C, Perez N, et al. Re-sleeve gastrectomy. Obes Surg. 2006; 16:1535–8.
Goitein D, Goitein O, Feigin A, et al. Sleeve gastrectomy: radiologic patterns after surgery. Surg Endosc. 2009; 23:1559–63.
Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010; 252:319–24.
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