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Obesity Surgery

, Volume 19, Issue 4, pp 490–494 | Cite as

A Prospective Randomized Study Comparing Patients with Morbid Obesity Submitted to Laparotomic Gastric Bypass with or without Omentectomy

  • Attila CsendesEmail author
  • Fernando Maluenda
  • Ana Maria Burgos
Research Article

Abstract

Background

Visceral fat, especially the greater omentum, seems to be an important factor in the development of some metabolic disturbances such as insulin resistance, hyperglycemia, and dyslipidemia. Therefore, we wanted to evaluate the influence of resecting or leaving in situ the greater omentum in a group of patients with morbid obesity.

Methods

Seventy patients with morbid obesity were submitted to laparotomic resectional gastric bypass and an omentectomy was randomly performed in some patients. Body mass index (BMI), serum levels of sugar, insulin, total cholesterol, and triglycerides were determined prior to surgery and followed up on for 2 years afterwards.

Results

Two years after surgery, no differences were seen in BMI levels in either group. Blood sugar levels, serum insulin, total cholesterol levels, and serum triglycerides had similar values in both groups. Arterial hypertension had similar behavior.

Conclusions

Based on these results, omentectomy is not justified as part of bariatric surgery. Its theoretical advantages are not reflected in this prospective random trial.

Keywords

Morbid obesity Gastric bypass Omentectomy 

References

  1. 1.
    Bjorntorp P. Metabolic implications of body fat distribution. Diabetes Care. 1991;24:1132–43.CrossRefGoogle Scholar
  2. 2.
    Kotamisligil GS, Asner P, Caro JF, et al. Increased adipose tissue expression of tumor necrosis factor alpha in human obesity and insulin resistance. J Clin Invest. 1995;95:2409–15.CrossRefGoogle Scholar
  3. 3.
    Fain JN, Madan AK, Hiler ML, et al. Comparison of the release of adipokines by adipose tissue, adipose tissue matrix, and adipocytes from visceral and subcutaneous abdominal adipose tissues of obese subjects. Endocrinology 2004;145:2273–82.CrossRefGoogle Scholar
  4. 4.
    Fried SK, Bunkin DA, Greenberg AG. Omental and subcutaneous tissues of obese subjects release interlenkin 6: depot difference and regulation by glucocarticoids. J Clin Endocrinol Metab. 1998;83:847–50.PubMedGoogle Scholar
  5. 5.
    Kissehah AH, Krakowerg R. Regional adiposity and morbidity. Physiol Rev. 1994;74:761–811.CrossRefGoogle Scholar
  6. 6.
    Arner P. All fat is not alike. Lancet 1998;351:1301–2.CrossRefGoogle Scholar
  7. 7.
    Fobi MAL, Lee H, Holness R, et al. Gastric bypass operation for obesity. World J Surg. 1998;22:925–93.CrossRefGoogle Scholar
  8. 8.
    Mason EE. Development and future of gastroplasties for morbid obesity. Arch Surg. 2003;138:361–6.CrossRefGoogle Scholar
  9. 9.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.CrossRefGoogle Scholar
  10. 10.
    Csendes A, Burdiles P, Papapietro K, et al. Results of gastric bypass plus resection of the distal excluded gastric segment in patients with morbid obesity. J Gastrointest Surg. 2005;9:121–31.CrossRefGoogle Scholar
  11. 11.
    Csendes A, Burdiles P, Rojas J, et al. A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery 2002;131:401–7.CrossRefGoogle Scholar
  12. 12.
    Petrescu O, Fan X, Gentileschi P, et al. Long-chain fatty acid uptake is upregulated in omental adipocytes from patients undergoing bariatric surgery for obesity. Inter J Obes. 2005;29:196–203.CrossRefGoogle Scholar
  13. 13.
    Bakker AHF, Nighius J, Berurman WA, et al. Low number of omental preadipocytes with high leptin and low adiponectine secretion is associated with high fasting plasma glucose levels in obese subjects. Diabet, Obesity, Metabol. 2006;8:585–8.CrossRefGoogle Scholar
  14. 14.
    Santoro S, Velhote MC, Malzoin CE, et al. Preliminary results from digestive adaptation; a new surgical proposal for treating obesity, based on physiology and evolution. Sao Paulo Med J. 2006;124:192–7.CrossRefGoogle Scholar
  15. 15.
    Agca B, Paksoy M, Palat E, et al. Influence of omentectomy on peritoneal defense mechanism in an experimental model of intra-abdominal injection. Europ Surg Res. 2003;35:35–40.CrossRefGoogle Scholar
  16. 16.
    Yoo KY, Lim SC, Kim YH, et al. Sucessful weaning from mechanical ventilation after abdominal lipectomy and omentectomy in an obese patient with multiple rib fractures. Brit J Aanesth. 2006;96:269–70.CrossRefGoogle Scholar
  17. 17.
    Thorne A, Lonngvist F, Apelman J, et al. A pilot study of long term effects of a marvel obesity treatment: omentectomy in connection with adjustable gastric banding. Intern J Obes. 2002;26:193–9.CrossRefGoogle Scholar
  18. 18.
    Santoro S, Malzoin CE, Velhote MC, et al. Digestive adaptation with intestinal reserve: a neuroendocrine-based operation for morbid obesity. Obes Surg. 2006;16:1380–2.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Attila Csendes
    • 1
    • 2
    Email author
  • Fernando Maluenda
    • 1
  • Ana Maria Burgos
    • 1
  1. 1.Department of Surgery, University HospitalUniversity of ChileSantiagoChile
  2. 2.Department of SurgeryHospital J. J. AguirreSantiagoChile

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