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Effect of Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy on Glucose and Gut Hormones: a Prospective Randomised Trial

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most common bariatric technique. Laparoscopic sleeve gastrectomy (LSG) is a restrictive procedure; the metabolic and endocrine effects of which remain unknown. We compared the effects of both procedures on glucose metabolism and fasting and meal-stimulated gut hormone levels.

Methods

Seven patients were randomised to LRYGB and eight to LSG. All patients were evaluated before and at 3 and 12 months postoperatively. Plasma levels of glucose, insulin, ghrelin, leptin, peptide YY (PYY), GLP-1 and pancreatic polypeptide were measured before and after 10 and 60 min of a standard test meal ingestion.

Results

Age, body mass index and preoperative hormone levels were similar in both groups. A significant reduction of plasma glucose and insulin levels was observed after surgery. Moreover, a normalisation of homeostatic model assessment for insulin resistance value was also seen after both procedures. The fasting and postprandial leptin levels were significantly lower in the LRYGB group. LSG was followed by a significant reduction in fasting ghrelin levels. In the LRYGB group, GLP-1 levels increased significantly after the test meal.

Conclusions

LRYGB and LSG markedly improved glucose homeostasis. Only LSG decreased fasting and postprandial ghrelin levels, whereas GLP-1 and PYY levels increased similarly after both procedures.

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Acknowledgments

This work was supported by a research grant from the Fondo de Investigación Sanitaria (nº PI 06/90639), Instituto de Salud Carlos III. Ministry of Health, Spain. The authors thank the team of the Pharmacology Unit (Professor Magi Farré and Ms. Esther Menoyo) for their expert technical help and Susana Gonzalez for patients follow-up. We also thank Marta Pulido for editorial assistance.

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Authors and Affiliations

  1. Section of Gastrointestinal Surgery, Institut de Recerca Hospital del Mar (IMIM-Hospital del Mar), Hospital Universitari del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain

    José Manuel Ramón, Silvia Salvans, Xenia Crous, Sonia Puig, Manuel Pera & Luis Grande

  2. Endocrinology and Nutrition Unit, Hospital Universitari del Mar, Barcelona, Spain

    Albert Goday & David Benaiges

  3. Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Valles, Spain

    Albert Goday & David Benaiges

  4. Service of Anaesthesiology, Hospital Universitari del Mar, Barcelona, Spain

    Lourdes Trillo

Authors
  1. José Manuel Ramón
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  2. Silvia Salvans
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  3. Xenia Crous
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  4. Sonia Puig
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  5. Albert Goday
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  8. Manuel Pera
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  9. Luis Grande
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Correspondence to José Manuel Ramón.

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Ramón, J.M., Salvans, S., Crous, X. et al. Effect of Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy on Glucose and Gut Hormones: a Prospective Randomised Trial. J Gastrointest Surg 16, 1116–1122 (2012). https://doi.org/10.1007/s11605-012-1855-0

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  • DOI: https://doi.org/10.1007/s11605-012-1855-0

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