Clinical Research

Obesity Surgery

, Volume 20, Issue 5, pp 600-609

First online:

Effects of Two Variants of Roux-en-Y Gastric Bypass on Metabolism Behaviour: Focus on Plasma Ghrelin Concentrations Over a 2-Year Follow-up

  • Noelia Pérez-RomeroAffiliated withGeneral Surgery Department, Hospital Universitari Germans Trias i Pujol Email author 
  • , Assumpta SerraAffiliated withNephrology Department, Hospital Universitari Germans Trias i Pujol
  • , Maria Luisa GranadaAffiliated withClinical Biochemistry Department, Hospital Universitari Germans Trias i Pujol
  • , Miquel RullAffiliated withGeneral Surgery Department, Hospital Universitari Germans Trias i Pujol
  • , Antonio AlastruéAffiliated withGeneral Surgery Department, Hospital Universitari Germans Trias i Pujol
  • , Maruja Navarro-DíazAffiliated withNephrology Department, Hospital Universitari Germans Trias i Pujol
  • , Ramón RomeroAffiliated withChief of Nephrology Department, Hospital Universitari Germans Trias i Pujol
  • , Jaime Fernández-LlamazaresAffiliated withCathedratic of Surgery of Barcelona Autonomous University and Chief of General Surgery Department, Hospital Universitari Germans Trias i Pujol

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Abstract

Background

To study the effects of two variants of Roux-en-Y gastric bypass (RYGBP) on plasma ghrelin concentrations according to different exposure of gastric fundus to the nutrient pathway.

Methods

A prospective longitudinal 2-year follow-up study was conducted. Ninety-six morbidly obese (MO) patients (age range: 41.6 ± 9.6 years, body mass index: 53 ± 9.5 kg/m2) were assigned to two bariatric surgical (BS) procedures: one that preserves food contact with gastric fundus (ringed RYGBP, n = 50) and the other that avoids it (modified RYGBP, n = 46). Different anthropometric and biochemical parameters were studied, focusing on ghrelin concentrations at baseline and 6, 12, and 24 months post-BS.

Results

At 24 months post-BS, all metabolic parameters studied had improved in all patients compared with those at 1-year follow-up and baseline (p < 0.05). However, high-density lipoprotein cholesterol concentrations took 2 years to normalise in 80% of patients, interleukin-6 decreased significantly in relation to baseline only after 2 years from BS (p < 0.001), and tumour necrosis factor alpha concentrations did not significantly decrease during the 2 years of follow-up. Plasma ghrelin concentrations increased in both surgical groups compare to baseline during the first year (24.6% in modified RYGBP and 36.62% in ringed RYGBP) and remained stable at the second year of follow-up, with no statistical differences between groups.

Conclusions

In the second year of follow-up after BS, morbidity continued to improve in MO patients despite a lesser weight loss in relation to the first year. An increase in plasma ghrelin concentrations was found, regardless of nutrient contact with gastric fundus. Furthermore, changes in plasma ghrelin concentrations appeared to be independent of weight loss.

Keywords

Ghrelin Bariatric surgery Gastric fundus RYGBP Weight loss