Skip to main content
SpringerLink
Log in

Bariatric Surgery Evolution from the Malabsorptive to the Hormonal Era

  • Review
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

While bariatric procedures continued to evolve and develop since the 1950s, their classification has not matched this evolution. The procedures are commonly classified into restrictive, malabsorptive, or combined. In this day and age, we recognize different mechanisms of action of the bariatric procedures. This article aims to review and update the old classifications based on our current understanding of the hormonal aspects of the various bariatric procedures and the role of gut hormones in weight loss and treatment of the associated metabolic comorbidities. The article suggests the need for a new classification of the bariatric procedures, based on the mechanism of action, involving the hormonal aspects of the procedure.

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

Similar content being viewed by others

References

  1. Kremen A, Linner J, Nelson C. An experimental evaluation of the nutritional importance of proximal and distal small intestine. Ann Surg. 1954;140:439–48.

    Article  PubMed  CAS  Google Scholar 

  2. Griffen Jr W, Bivins B, Bell R. The decline and fall of jejunoileal bypass. Surg Gynecol Obstet. 1983;157:301–8.

    PubMed  Google Scholar 

  3. Payne J, DeWind L. Surgical treatment of obesity. Am J Surg. 1969;118:141–7.

    Article  PubMed  CAS  Google Scholar 

  4. Rucker R, Chan E, Horstmann J, et al. Searching for the best weight reduction operation. Surgery. 1984;96:624–31.

    PubMed  Google Scholar 

  5. Payne J, Dewind L, Commons R. Metabolic observations in patients with jejunocolic shunts. Am J Surg. 1963;106:273–89.

    Article  PubMed  CAS  Google Scholar 

  6. Scopinaro N, Gianetta E, Adami G, et al. Biliopancreatic diversion for obesity at eighteen years. Surgery. 1996;119:261–8.

    Article  PubMed  CAS  Google Scholar 

  7. Marceau P, Biron S, Bourque R, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3:29–35.

    Article  PubMed  Google Scholar 

  8. Kuzmak L, Yap I, McGuire L, et al. Surgery for morbid obesity using an inflatable gastric band. AORN J. 1990;51:1307–24.

    Article  PubMed  CAS  Google Scholar 

  9. 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 

  10. Yang J, Zhao T, Goldstein J, et al. Inhibition of ghrelin O-acyltransferase (GOAT) by octanoylated pentapeptides. Proc Natl Acad Sci U S A. 2008;105:10750–5.

    Article  PubMed  CAS  Google Scholar 

  11. De Vriese C, Gregoire F, Lema-Kisoka R, et al. Ghrelin degradation by serum and tissue homogenates: identification of the cleavage sites. Endocrinology. 2004;145:4997–5005.

    Article  PubMed  Google Scholar 

  12. Cummings D, Purnell J, Frayo R, et al. A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes. 2001;50:1714–9.

    Article  PubMed  CAS  Google Scholar 

  13. Drazen D, Vahl T, D’Alessio D, et al. Effects of a fixed meal pattern on ghrelin secretion: evidence for a learned response independent of nutrient status. Endocrinology. 2006;147:23–30.

    Article  PubMed  CAS  Google Scholar 

  14. Taheri S, Lin L, Austin D, et al. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1:e62.

    Article  PubMed  Google Scholar 

  15. Wren A, Seal L, Cohen M, et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86:5992.

    Article  PubMed  CAS  Google Scholar 

  16. Nagaya N, Itoh T, Murakami S, et al. Treatment of cachexia with ghrelin in patients with COPD. Chest. 2005;128:1187–93.

    Article  PubMed  CAS  Google Scholar 

  17. Cummings D, Weigle D, Frayo R, 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 

  18. Halem H, Taylor J, Dong J, et al. Novel analogs of ghrelin: physiological and clinical implications. Eur J Endocrinol. 2004;151:S71–5.

    Article  PubMed  CAS  Google Scholar 

  19. Kobelt P, Helmling S, Stengel A, et al. Anti-ghrelin Spiegelmer NOX-B11 inhibits neurostimulatory and orexigenic effects of peripheral ghrelin in rats. Gut. 2006;55:788–92.

    Article  PubMed  CAS  Google Scholar 

  20. Zorrilla E, Iwasaki S, Moss J, et al. Vaccination against weight gain. Proc Natl Acad Sci U S A. 2006;103:13226–31.

    Article  PubMed  CAS  Google Scholar 

  21. Cytos Biotechnology. Phase I/IIa clinical trial with obese individuals shows no effect of CYT009-GhrQb on weight loss. Cytos Biotechnology. Press release November 7, 2006. Retrieved 2 June 2009.

  22. Tan T, Vanderpump M, Khoo B, et al. Somatostatin infusion lowers plasma ghrelin without reducing appetite in adults with Prader–Willi syndrome. J Clin Endocrinol Metab. 2004;89:4162–5.

    Article  PubMed  CAS  Google Scholar 

  23. Adrian T, Bloom S, Bryant M, et al. Distribution and release of human pancreatic polypeptide. Gut. 1976;17:940–4.

    Article  PubMed  CAS  Google Scholar 

  24. Lieverse R, Masclee A, Jansen J, et al. Plasma cholecystokinin and pancreatic polypeptide secretion in response to bombesin, meal ingestion andmodified sham feeding in lean and obese persons. Int J Obes Relat Metab Disord. 1994;18:123–7.

    PubMed  CAS  Google Scholar 

  25. Silvestre R, Rodriguez-Gallardo J, Jodka C, et al. Selective amylin inhibition of the glucagon response to arginine is extrinsic to the pancreas. Am J Physiol Endocrinol Metab. 2001;280:E443–9.

    PubMed  CAS  Google Scholar 

  26. Rushing P, Hagan M, Seeley R, et al. Amylin: a novel action in the brain to reduce body weight. Endocrinology. 2000;141:850–3.

    Article  PubMed  CAS  Google Scholar 

  27. Westermark P, Engstrom U, Johnson K, et al. Islet amyloid polypeptide: pinpointing amino acid residues linked to amyloid fibril formation. Proc Natl Acad Sci U S A. 1990;87:5036–40.

    Article  PubMed  CAS  Google Scholar 

  28. Paik K, Jin D, Lee K, et al. Peptide YY, cholecystokinin, insulin and ghrelin response to meal did not change, but mean serum levels of insulin is reduced in children with Prader–Willi syndrome. J Korean Med Sci. 2007;22:436–41.

    Article  PubMed  CAS  Google Scholar 

  29. Batterham R, Heffron H, Kapoor S, et al. Critical role for peptide YY in protein-mediated satiation and body-weight regulation. Cell Metab. 2006;4:223–33.

    Article  PubMed  CAS  Google Scholar 

  30. Beckh K, Mönnikes H, Loos S, et al. Low hepatic clearance of peptide YY in the perfused rat liver. Regul Pept. 1992;37:205–12.

    Article  PubMed  CAS  Google Scholar 

  31. Adrian T, Ferri G, Bacarese-Hamilton A, et al. Human distribution and release of a putative new gut hormone, peptide YY. Gastroenterology. 1985;89:1070–7.

    PubMed  CAS  Google Scholar 

  32. MDRNA. (2008). MDRNA announces phase 2 trial of PYY(3–36) does not meet weight loss endpoint. MDRNA. Press release 31 July 2008.

  33. Pedrazzini T. Importance of NPY Y1 receptor-mediated pathways: assessment using NPY Y1 receptor knockouts. Neuropeptides. 2004;38:267–75.

    Article  PubMed  CAS  Google Scholar 

  34. Bataille D, Gespach C, Tatemoto K, et al. Bioactive enteroglucagon (oxyntomodulin): present knowledge on its chemical structure and its biological activities. Peptides. 1981;2 Suppl 2:41–4.

    Article  PubMed  CAS  Google Scholar 

  35. Baggio L, Huang Q, Brown T, et al. Oxyntomodulin and glucagon-like peptide-1 differentially regulate murine food intake and energy expenditure. Gastroenterology. 2004;127:546–58.

    Article  PubMed  CAS  Google Scholar 

  36. Orskov C, Wettergren A, Holst J. Secretion of the incretin hormones glucagon-like peptide-1 and gastric inhibitory polypeptide correlates with insulin secretion in normal man throughout the day. Scand J Gastroenterol. 1996;31:665–70.

    Article  PubMed  CAS  Google Scholar 

  37. Mentlein R, Gallwitz B, Schmidt W. Dipeptidyl-peptidase IV hydrolyses gastric inhibitory polypeptide, glucagon-like peptide-1(7–36)amide, peptide histidine methionine and is responsible for their degradation in human serum. Eur J Biochem. 1993;214:829–35.

    Article  PubMed  CAS  Google Scholar 

  38. Marre M, Shaw J, Brandle M, et al. Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with type 2 diabetes (LEAD-1 SU). Diabet Med. 2009;26:268–78.

    Article  PubMed  CAS  Google Scholar 

  39. Pournaras D, Osborne A, Hawkins S, et al. The gut hormone response following Roux-en-Y gastric bypass: cross-sectional and prospective study. Obes Surg. 2010;20:56–60.

    Article  PubMed  Google Scholar 

  40. Kotidis EV, Koliakos G, Papavramidis T, et al. The effect of biliopancreatic diversion with pylorus-preserving sleeve gastrectomy and duodenal switch on fasting serum ghrelin, leptin and adiponectin levels: is there a hormonal contribution to the weight-reducing effect of this procedure? Obes Surg. 2006;16:554–9.

    Article  PubMed  Google Scholar 

  41. Beckman L, Beckman T, Earthman C. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass procedure: a review. J Am Diet Assoc. 2010;110:571–84.

    Article  PubMed  CAS  Google Scholar 

  42. Bohdjalian A, Langer F, Shakeri-Leidenmühler. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.

    Article  PubMed  Google Scholar 

  43. Tzovaras G, Papamargaritis D, Sioka E, et al. Symptoms suggestive of dumping syndrome after provocation in patients after laparoscopic sleeve gastrectomy. Obes Surg. 2011;22(1):23–8.

    Article  Google Scholar 

  44. Lee WJ, Chen CY, Chong K, et al. Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):683–90.

    Article  PubMed  Google Scholar 

Download references

Financial Disclosure

The author has no financial interest to disclose.

Author information

Authors and Affiliations

  1. Department of Bariatric and Advanced Laparoscopic Surgery, Preston Memorial Hospital, 300 S Price St, Kingwood, WV, 26537, USA

    Ehab Akkary

Authors
  1. Ehab Akkary
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ehab Akkary.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Akkary, E. Bariatric Surgery Evolution from the Malabsorptive to the Hormonal Era. OBES SURG 22, 827–831 (2012). https://doi.org/10.1007/s11695-012-0623-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-012-0623-2

Keywords

Search

Navigation