Obesity Surgery

, Volume 19, Issue 8, pp 1139–1142 | Cite as

Is There Any Role of Resecting the Stomach to Ameliorate Weight Loss and Sugar Control in Morbidly Obese Diabetic Patients?

  • Eldo E. FrezzaEmail author
  • Susan E. Wozniak
  • Laura Gee
  • Mitchell Wacthel



Among the restrictive procedures the role of restrictive vs. resecting the stomach is still ambiguous. This study evaluate which is the role of the stomach with respect to blood glucose levels (BG) and percent excess weight loss (EWL) over the 18 months after restrictive procedures in morbid obese diabetic patients.


We retrospectively compared a group of patients who underwent partial gastrectomy (just part of the gastric body) with gastric banding (GBSR; n = 27), sleeve gastrectomy (part of gastric body and complete fundus resection; LSG; n = 53) to laparoscopic gastric banding (LAGB; n = 100). Differences among groups at 3, 6, 12, and 18 months were evaluated by analysis of variance. The three cohorts were diabetic patients similar in BMI, age, and gender.


At 12 and 18 months, LSG had higher EWL (P < 0.05) and lower BG (P < 0.05) than did either LAGB or GBSR. There were no operative deaths. Complications: LAGB—two staple-line oozing, two wound infections; LSG—one hemorrhage, two staple-line oozing, two leaks; GBSR—one hemorrhage, two wound infections. All complications were readily treated.


LSG provides better weight loss and glucose control at 1 year and 1.5 years after surgery than does either LAGB or GBSR, suggesting that gastric fundus resection plays an important, not yet well-defined, role.


Morbid obesity Diabetes type II Metabolic syndrome Sleeve gastrectomy 


  1. 1.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. JAMA. 2004;292:1724–37.CrossRefGoogle Scholar
  2. 2.
    Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle and the risk of type 2 diabetes mellitus in women. The New England Journal of Medicine. 2001;345(11):790–7.CrossRefGoogle Scholar
  3. 3.
    Pinkney JH, Sjostrom CD, Gale EAM. Should surgeons treat diabetes in severely obese people? Lancet. 2001;357:1357–9.CrossRefGoogle Scholar
  4. 4.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.CrossRefGoogle Scholar
  5. 5.
    Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236:554–9.CrossRefGoogle Scholar
  6. 6.
    King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.CrossRefGoogle Scholar
  7. 7.
    Chan BS, Tsang MW, Lee VW, et al. Cost of Type 2 diabetes mellitus in Hong Kong Chinese. Int J Clin Pharmacol Ther. 2007;45:455–68.CrossRefGoogle Scholar
  8. 8.
    Shak JR, Roper J, Perez-Perez GI, et al. The effect of laparoscopic gastric banding surgery on plasma levels of appetite-control, insulinotropic, and digestive hormones. Obes Surg. 2008;18(9):1089–96.CrossRefGoogle Scholar
  9. 9.
    Parikh M, Ayoung-Chee P, Romanos E, et al. Comparison of rates of resolution of diabetes mellitus after gastric banding, gastric bypass, and biliopancreatic diversion. J Am Coll Surg. 2007;205(5):631–5.CrossRefGoogle Scholar
  10. 10.
    Parikh MS, Shen R, Weiner M, et al. Laparoscopic bariatric surgery in superobese patients (BMI > 50) is safe and effective: a review of 332 patients. Obes Surg. 2005;15(6):858–63.CrossRefGoogle Scholar
  11. 11.
    Parikh MS, Laker S, Weiner M, et al. Objective comparison of complications resulting from laparoscopic bariatric procedures. J Am Coll Surg. 2006;202(2):252–61.CrossRefGoogle Scholar
  12. 12.
    Ren CJ. Controversies in bariatric surgery: evidence-based discussions on laparoscopic adjustable gastric banding. J Gastrointest Surg. 2004;8(4):396–7. discussion 404-5.CrossRefGoogle Scholar
  13. 13.
    Ren CJ, Fielding GA. Laparoscopic adjustable gastric banding: surgical technique. J Laparoendosc Adv Surg Tech A. 2003;13(4):257–63.CrossRefGoogle Scholar
  14. 14.
    Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–23.Google Scholar
  15. 15.
    Marceau P, Biron S, Bourque RA, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3:29–35.CrossRefGoogle Scholar
  16. 16.
    Frezza EE, Wachtel MS. Analysis of the results of sleeve gastrectomy for morbid obesity and the role of ghrelin. Surgery Today. 2008;38(6):481–3.CrossRefGoogle Scholar
  17. 17.
    Silecchia G, Boro C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obesity Surgery. 2006;16:1138–44.CrossRefGoogle Scholar
  18. 18.
    Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.CrossRefGoogle Scholar
  19. 19.
    Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG). Obes Surg. 2007;8:5.Google Scholar
  20. 20.
    Frezza EE, Herbert H, Wachtel MS. Combined laparoscopic gastric banding and stomach reduction (GBSR). Initial experience after one year. Obes Surg. 2008;18:690–4.CrossRefGoogle Scholar
  21. 21.
    Frezza EE, Barton A, Herbert H, et al. Laparoscopic sleeve gastrectomy with endoscopic guidance in morbid obesity. Surg Obes Relat Dis. 2008;4:575–9.CrossRefGoogle Scholar
  22. 22.
    Frezza EE, Mammarappallil J, Witt C, et al. (2009) Routine postoperative gastrographin contrast swallow studies after laparoscopic gastric banding. Archives of Surgery. In PressGoogle Scholar
  23. 23.
    Frezza EE, Wachtel MS. A simple venous thromboembolism prophylaxis protocol for patients undergoing bariatric surgery. Obes Res. 2006;14:1–5.CrossRefGoogle Scholar
  24. 24.
    Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy—results after 1 and 3 years. Obes Surg. 2006;16:1450–56.CrossRefGoogle Scholar
  25. 25.
    Fielding GA, Ren CJ. Laparoscopic adjustable gastric band. Surg Clin N Am. 2005;85:129–40.CrossRefGoogle Scholar
  26. 26.
    Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15(7):1024–9.CrossRefGoogle Scholar
  27. 27.
    Moon HS, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–75.CrossRefGoogle Scholar
  28. 28.
    Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.CrossRefGoogle Scholar
  29. 29.
    Frühbeck G, Diez-Caballero A, Gil MJ, et al. The decrease in plasma ghrelin concentrations following bariatric surgery depends on the functional integrity of the fundus. Obes Surg. 2004;14:606–12.CrossRefGoogle Scholar
  30. 30.
    Ariyasu H, Takaya D, Tagami T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrin Metab. 2001;86:4753–8.CrossRefGoogle Scholar
  31. 31.
    Banks WA, Tschoep M, Robinson SM, et al. Extent and direction of ghrelin transport across the blood–brain-barrier is determined by its unique primary structure. J Pharm Exp Ther. 2002;302:822–7.CrossRefGoogle Scholar
  32. 32.
    Horvath TL, Diano S, Sotonyi HM, et al. Minireview: ghrelin and the regulation of energy balance—a hypothalamic perspect. Endocrinology. 2001;142:4163–9.CrossRefGoogle Scholar
  33. 33.
    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.CrossRefGoogle Scholar
  34. 34.
    Wren AM, Small CJ, Ward HL, et al. The novel hypothalamic peptide ghrelin stimulates food intake and growth hormone secretion. Endocrinology. 2000;141:4325–8.CrossRefGoogle Scholar
  35. 35.
    Higgens SC, Gueorguiev M, Korbonits M. Ghrelin, the peripheral hunger hormone. Ann Med. 2007;39:116–36.CrossRefGoogle Scholar
  36. 36.
    Xing J, Brody F, Brodskey J, et al. Gastric electrical-stimulation effects on canine gastric emptying, food intake, and body weight. Obes Res. 2003;11:41–7.CrossRefGoogle Scholar
  37. 37.
    Cigaina V. Gastric pacing as therapy for morbid obesity: preliminary results. Obes Surg. 2002;12:12S–6S.CrossRefGoogle Scholar
  38. 38.
    Miller K, Holler E, Hell E. Intragastric stimulation (IGS) for treatment of morbid obesity. Zentralbl Chir. 2002;175:1049–54.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Eldo E. Frezza
    • 1
    • 2
    Email author
  • Susan E. Wozniak
    • 1
  • Laura Gee
    • 1
  • Mitchell Wacthel
    • 1
  1. 1.Department of SurgeryTexas Tech University Health Sciences CenterLubbockUSA
  2. 2.Center for Metabolic and Bariatric DiseaseLubbockUSA

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