Skip to main content
SpringerLink
Log in

Influence of Additional Resection of the Gastric Fundus on Excessive Weight Loss in Laparoscopic Very Very Long Limb Roux-en-Y Gastric Bypass

  • Clinical Report
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. The effect of the procedure is based on restriction, malabsorption and changes in hormonal axis. Ghrelin is an important appetite hormone which is produced mainly in the gastric fundus. By adding a resection of the gastric fundus, we hypothesized that excessive weight loss will be more prominent and the satiety feelings less pronounced compared to standard RYGB. A total of 73 patients with standard very very long limb (VVLL) RYGB (group A) were compared with 44 patients with VVLL RYGB with resection of the fundus (group B). Outcome measures were excessive weight loss (EWL), body mass index (BMI), early postoperative morbidity, change of co-morbidities, and appetite reduction as assessed by an appetite questionnaire over a postoperative period of 24 months. Groups were comparable in basic preoperative descriptions. Additional fundus resection did not influence EWL (group A 66.1 % vs. group B 70.6 %, p = 0.383) or BMI (group A 29 kg/m2 vs. group B 27 kg/m2, p = 0.199). No significant difference in morbidity or change of co-morbidities occurred. The appetite and satiety questionnaire showed no difference between group A and group B, respectively. Adding a resection of the gastric fundus in RYGB did not alter the clinical results, i.e., increased excessive weight loss, decrease of appetite, or increase of satiety. The value of removing a part of the ghrelin-producing cells might be overestimated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. National Institutes of Health. Consensus statement: gastrointestinal surgery for severe obesity. Nutrition. 1996;12:397–402.

    Article  Google Scholar 

  2. Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009;2:CD003641.

    PubMed  Google Scholar 

  3. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19(12):1605–11.

    Article  PubMed  Google Scholar 

  4. Akkary E. Bariatric surgery evolution from the malabsorptive to the hormonal era. Obes Surg. 2012;22(5):827–31.

    Article  PubMed  Google Scholar 

  5. MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated gastric bypass. Ann Surg. 2000;231:524–8.

    Article  PubMed  CAS  Google Scholar 

  6. Meguid MM, Ramos EJ, Suzuki S, et al. A surgical rat model of human Roux-en-Y gastric bypass. J Gastrointest Surg. 2004;8:621–30.

    Article  PubMed  Google Scholar 

  7. Clark GW, Wittgrove AC. Laparoscopic Roux en-Y gastric bypass. Surg Laparosc Endosc. 1998;8(5):406–7.

    Article  PubMed  CAS  Google Scholar 

  8. Sarr MG. Open Roux-en-Y gastric bypass: indications and technique. J Gastrointest Surg. 2004;8:390–2.

    Article  PubMed  Google Scholar 

  9. Nelson WK, Fatima J, Houghton SG, et al. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery. 2006;140(4):517–22.

    Article  PubMed  Google Scholar 

  10. Bueter M, Seyfried F, Germer CT. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery. 2006;140(4):517–22.

    Article  Google Scholar 

  11. Bueter M, Ashrafian H, le Roux CW. Mechanisms of weight loss after gastric bypass and gastric banding. Obes Facts. 2009;2(5):325–31.

    Article  PubMed  Google Scholar 

  12. Brolin RE, LaMarca LB, Kenler HA, et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg. 2002;6:195–203.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Vincent RP, le Roux CW. Changes in gut hormones after bariatric surgery. Clin Endocrinol. 2008;69:173–9.

    Article  CAS  Google Scholar 

  15. Kojima M, Hosoda H, Date Y, et al. Ghrelin is a growth hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60.

    Article  PubMed  CAS  Google Scholar 

  16. Frühbeck G, Diez Caballero A, Gil MJ, et al. Fundus functionality and ghrelin concentrations after bariatric surgery. N Engl J Med. 2004;350:308–9.

    Article  PubMed  Google Scholar 

  17. Wang G, Lee HM, Englander E, et al. Ghrelin—not just another stomach hormone. Regul Pept. 2002;105:75Y81.

    Article  Google Scholar 

  18. Tena-Sempere M, Barreiro ML, Gonzalez LC, et al. Novel expression and functional role of ghrelin in rat testis. Endocrinology. 2002;143:717Y725.

    Article  Google Scholar 

  19. Gaytan F, Barreiro ML, Chopin LK, et al. Immunolocalization of ghrelin and its functional receptor, the type 1a growth hormone secretagogue receptor, in the cyclic human ovary. J Clin Endocrinol Metab. 2003;88:879Y887.

    Article  Google Scholar 

  20. Caminos JE, Gualillol O, Lago F, et al. The endogenous growth hormone secretagogue (ghrelin) is synthesized and secreted by chondrocytes. Endocrinology. 2005;146:1285Y1292.

    Google Scholar 

  21. Morinigo R, Casamitjana R, Moize V, et al. Short-term effects of gastric bypass surgery on circulating ghrelin levels. Obes Res. 2004;12:1108–16.

    Article  PubMed  Google Scholar 

  22. Stoeckli R, Chanda R, Langer I, et al. Changes of body weight and plasma ghrelin levels after gastric banding and gastric bypass. Obes Res. 2004;12:346–50.

    Article  PubMed  CAS  Google Scholar 

  23. Vendrell J, Broch M, Vilarrasa N, et al. Resistin, adiponectin, ghrelin, leptin, and proinflammatory cytokines: relationships in obesity. Obes Res. 2004;12:962–71.

    Article  PubMed  CAS  Google Scholar 

  24. Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20(5):535–40.

    Article  PubMed  Google Scholar 

  25. Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.

    Article  PubMed  Google Scholar 

  26. Cohen R, Uzzan B, Bihan H, et al. Ghrelin levels and sleeve gastrectomy in super-super-obesity. Obes Surg. 2005;15:1501–2.

    Article  PubMed  Google Scholar 

  27. Chronaiou A, Tsoli M, Kehagias I, Leotsinidis M, et al. Lower ghrelin levels and exaggerated postprandial peptide-YY, glucagon-like peptide-1, and insulin responses, after gastric fundus resection, in patients undergoing Roux-en-Y gastric bypass: a randomized clinical trial. Obes Surg. 2012;22:1761–70.

    Article  PubMed  Google Scholar 

  28. Chang VT, Hwang SS, Feuerman M. Validation of the Edmonton symptom assessment scale. Cancer. 2000;88:2164–71.

    Article  PubMed  CAS  Google Scholar 

  29. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  PubMed  CAS  Google Scholar 

  30. Rawlins ML, Teel 2nd D, Hedgcorth K, et al. Revision of Roux-en-Y gastric bypass to distal bypass for failed weight loss. Surg Obes Relat Dis. 2011;7(1):45–9.

    Article  PubMed  Google Scholar 

  31. Stefanidis D, Kuwada TS, Gersin KS. The importance of the length of the limbs for gastric bypass patients—an evidence-based review. Obes Surg. 2011;21(1):119–24.

    Article  PubMed  Google Scholar 

  32. Livingston EH. Obesity and its surgical management. Am J Surg. 2002;184(2):103–13.

    Article  PubMed  Google Scholar 

  33. Odstrcil EA, Martinez JG, Santa Ana CA, et al. The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass. Am J Clin Nutr. 2010;92(4):704–13.

    Article  PubMed  CAS  Google Scholar 

  34. Langer FB, Bohdjalian A, Shakeri-Manesch S, et al. Eating behavior in laparoscopic sleeve gastrectomy—correlation between plasma gherlin levels and hunger. Eur Surg. 2008;40:1–5.

    Article  Google Scholar 

  35. Borg CM, le Roux CW, Ghatei MA, et al. Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety. Br J Surg. 2006;93:210–5.

    Article  PubMed  CAS  Google Scholar 

  36. Mancini MC, Costa AP, de Melo ME, et al. Effect of gastric bypass on spontaneous growth hormone and ghrelin release profiles. Obesity (Silver Spring). 2006;14:383–7.

    Article  CAS  Google Scholar 

  37. Couce ME, Cottam D, Esplen J, et al. Is ghrelin the culprit for weight loss after gastric bypass surgery? A negative answer. Obes Surg. 2006;16:870–8.

    Article  PubMed  Google Scholar 

  38. Meier CA, Bobbioni E, Gabay C, et al. IL-1 receptor antagonist serum levels are increased in human obesity: a possible link to the resistance to leptin? J Clin Endocrinol Metab. 2002;87:1184–8.

    Article  PubMed  CAS  Google Scholar 

  39. Sundbom M, Holdstock C, Engstrom BE, et al. Early changes in ghrelin following Roux-en-Y gastric bypass: influence of vagal nerve functionality? Obes Surg. 2007;17:304–10.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. Tritos NA, Mun E, Bertkau A, et al. Serum ghrelin levels in response to glucose load in obese subjects post-gastric bypass surgery. Obes Res. 2003;11:919–24.

    Article  PubMed  CAS  Google Scholar 

  42. Morinigo R, Casamitjana R, Moize V, et al. Short-term effects of gastric bypass surgery on circulating ghrelin levels. Obes Res. 2004;12:1108–16.

    Article  PubMed  Google Scholar 

  43. Carrasco F, Rojas P, Csendes A, et al. Changes in ghrelin concentrations one year after resective and non-resective gastric bypass: associations with weight loss and energy and macronutrient intakes. Nutrition. 2012;28:757–61.

    Article  PubMed  CAS  Google Scholar 

  44. Chacko SK, Haymond MW, Sun Y, et al. Effect of ghrelin on glucose regulation in mice. Am J Physiol Endocrinol Metab. 2012;302(9):E1055–62.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Prof. Adrian Esterman, Ph.D., and Salome Dell-Kuster for their support with the statistical analysis.

Conflict of Interest

T. Delko, T. Koestler, M. Peev, D. Oertli, and U. Zingg declare that there are no financial or other relationships that may lead to a conflict of interest involved in this study. The manuscript has been read and approved by all authors.

Author information

Authors and Affiliations

  1. Department of Surgery, Limmattal Hospital Zurich-Schlieren, Urdorferstrasse 100, 8952, Zurich, Switzerland

    T. Delko, T. Köstler, M. Peev & U. Zingg

  2. Department of Surgery, University Hospital Basel, Basel, Switzerland

    T. Delko & D. Oertli

Authors
  1. T. Delko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Köstler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Peev
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Oertli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Zingg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. Zingg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Delko, T., Köstler, T., Peev, M. et al. Influence of Additional Resection of the Gastric Fundus on Excessive Weight Loss in Laparoscopic Very Very Long Limb Roux-en-Y Gastric Bypass. OBES SURG 23, 279–286 (2013). https://doi.org/10.1007/s11695-012-0805-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-012-0805-y

Keywords

Search

Navigation