Influence of Additional Resection of the Gastric Fundus on Excessive Weight Loss in Laparoscopic Very Very Long Limb Roux-en-Y Gastric Bypass
Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. The effect of the procedure is based on restriction, malabsorption and changes in hormonal axis. Ghrelin is an important appetite hormone which is produced mainly in the gastric fundus. By adding a resection of the gastric fundus, we hypothesized that excessive weight loss will be more prominent and the satiety feelings less pronounced compared to standard RYGB. A total of 73 patients with standard very very long limb (VVLL) RYGB (group A) were compared with 44 patients with VVLL RYGB with resection of the fundus (group B). Outcome measures were excessive weight loss (EWL), body mass index (BMI), early postoperative morbidity, change of co-morbidities, and appetite reduction as assessed by an appetite questionnaire over a postoperative period of 24 months. Groups were comparable in basic preoperative descriptions. Additional fundus resection did not influence EWL (group A 66.1 % vs. group B 70.6 %, p = 0.383) or BMI (group A 29 kg/m2 vs. group B 27 kg/m2, p = 0.199). No significant difference in morbidity or change of co-morbidities occurred. The appetite and satiety questionnaire showed no difference between group A and group B, respectively. Adding a resection of the gastric fundus in RYGB did not alter the clinical results, i.e., increased excessive weight loss, decrease of appetite, or increase of satiety. The value of removing a part of the ghrelin-producing cells might be overestimated.
KeywordsRoux-en-Y gastric bypass Resection of the fundus Ghrelin Weight loss
The authors thank Prof. Adrian Esterman, Ph.D., and Salome Dell-Kuster for their support with the statistical analysis.
Conflict of Interest
T. Delko, T. Koestler, M. Peev, D. Oertli, and U. Zingg declare that there are no financial or other relationships that may lead to a conflict of interest involved in this study. The manuscript has been read and approved by all authors.
- 20.Caminos JE, Gualillol O, Lago F, et al. The endogenous growth hormone secretagogue (ghrelin) is synthesized and secreted by chondrocytes. Endocrinology. 2005;146:1285Y1292.Google Scholar
- 25.Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.PubMedCrossRefGoogle Scholar
- 27.Chronaiou A, Tsoli M, Kehagias I, Leotsinidis M, et al. Lower ghrelin levels and exaggerated postprandial peptide-YY, glucagon-like peptide-1, and insulin responses, after gastric fundus resection, in patients undergoing Roux-en-Y gastric bypass: a randomized clinical trial. Obes Surg. 2012;22:1761–70.PubMedCrossRefGoogle Scholar