Advertisement

The Effects of Laparoscopic Sleeve Gastrectomy on Obesity-Related Hypertriglyceridemia-Induced Acute Pancreatitis

  • Yongyan Song
  • Huan Deng
  • Jie Zhou
  • Ji Sun
  • Xiaoming Zhang
  • Yixing Ren
Original Contributions
  • 21 Downloads

Abstract

Background

Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is a significant clinical problem and is characterized by high recurrence rate compared with non-HTG-AP. The objective of this study was to investigate the effects of laparoscopic sleeve gastrectomy (LSG) on obesity-related HTG-AP.

Methods

Twenty-nine patients with obesity-related HTG-AP were admitted to our hospital and treated with the conventional therapy or LSG surgery according to the wishes of patients. Clinical data and the recurrence rate of AP were collected at baseline and at four different time points (3, 6, 9, and 12 months) after the treatments for all patients.

Results

Of the 29 patients, 28 patients (19 patients with conventional therapy and 9 patients with LSG surgery) completed the 12-month follow-up. Clinical data and the severity scores of AP were comparable at baseline when the patients were admitted to the intensive care unit. The LSG group experienced a large weight loss (percent total weight loss, 26.87 ± 1.44%; percent excess weight loss, 79.56 ± 1.37%) and triglyceride reduction (from 15.77 ± 1.02 to 1.36 ± 0.09 mmol/L), and no recurrence was observed at 12 months after the surgery. In the conventional treatment group, however, body weight was not changed although triglyceride was significantly decreased (from 17.34 ± 1.29 to 8.25 ± 1.12 mmol/L), and more importantly, 47.4% of the patients had at least one recurrence of AP in 12 months after the treatment.

Conclusions

LSG might be an effective way to cure obesity-related HTG-induced AP since it prevents the recurrence of this disease. Further randomized studies will be needed to standardize this way of treatment.

Keywords

Laparoscopic sleeve gastrectomy Acute pancreatitis Obesity Hypertriglyceridemia 

Notes

Funding

This research was supported by the National Natural Science Foundation of China (81500396), Foundation of Sichuan Educational Committee (18CZ0023, 17ZA0172), Foundation of Sichuan Health and Family Planning Commission (18PJ496), and Foundation of North Sichuan Medical College (CBY15-QD001).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Wu D, Tang M, Zhao Y, et al. Impact of seasons and festivals on the onset of acute pancreatitis in Shanghai. China Pancreas. 2017;46(4):496–503.CrossRefPubMedGoogle Scholar
  2. 2.
    Zhu Y, Pan X, Zeng H, et al. A study on the etiology, severity, and mortality of 3260 patients with acute pancreatitis according to the revised Atlanta classification in Jiangxi, China over an 8-year period. Pancreas. 2017;46(4):504–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Frossard JL, Lescuyer P, Pastor CM. Experimental evidence of obesity as a risk factor for severe acute pancreatitis. World J Gastroenterol. 2009;15(42):5260–5.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Khatua B, El-Kurdi B, Singh VP. Obesity and pancreatitis. Curr Opin Gastroenterol. 2017;33(5):374–82.CrossRefPubMedGoogle Scholar
  5. 5.
    Valdivielso P, Ramírez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med. 2014;25(8):689–94.CrossRefPubMedGoogle Scholar
  6. 6.
    Vipperla K, Somerville C, Furlan A, et al. Clinical profile and natural course in a large cohort of patients with hypertriglyceridemia and pancreatitis. J Clin Gastroenterol. 2017;51(1):77–85.CrossRefPubMedGoogle Scholar
  7. 7.
    Capoccia D, Coccia F, Guarisco G, et al. Long-term metabolic effects of laparoscopic sleeve gastrectomy. Obes Surg. 2018;28:2289–96.  https://doi.org/10.1007/s11695-018-3153-8.CrossRefPubMedGoogle Scholar
  8. 8.
    Hady HR, Olszewska M, Czerniawski M, et al. Different surgical approaches in laparoscopic sleeve gastrectomy and their influence on metabolic syndrome: a retrospective study. Medicine (Baltimore). 2018;97(4):e9699.CrossRefGoogle Scholar
  9. 9.
    Erol V, Yılmaz TH, Tuncalı B, et al. Changes in serum lipid levels after laparoscopic sleeve gastrectomy in morbidly obese dyslipidemic and normolipidemic patients. Acta Chir Belg. 2017:1–6.  https://doi.org/10.1080/00015458.2017.1417104.
  10. 10.
    Major P, Wysocki M, Pędziwiatr M, et al. Laparoscopic sleeve gastrectomy for the treatment of diabetes mellitus type 2 patients-single center early experience. Gland Surg. 2016;5(5):465–72.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Çetinkünar S, Erdem H, Aktimur R, et al. The effect of laparoscopic sleeve gastrectomy on morbid obesity and obesity-related comorbidities: a cohort study. Ulus Cerrahi Derg. 2015;31(4):202–6.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Huang CC, Wang W, Chen RJ, et al. Predicted coronary heart disease risk decreases in obese patients after laparoscopic sleeve gastrectomy. World J Surg. 2017;42:2173–82.  https://doi.org/10.1007/s00268-017-4416-6.CrossRefGoogle Scholar
  13. 13.
    Chinese Society for Metabolic and Bariatric Surgery. The 2014 guidelines for the surgical treatment of obesity and type 2 diabetes in China. Chin J Prac Surg. 2014;34(11):1005–10.Google Scholar
  14. 14.
    The Joint Committee on Prevention and Control of Abnormal Blood Lipid Levels in Chinese Adults. The 2016 guidelines for prevention and treatment of dyslipidemia in Chinese adults (revised edition in 2016). Chin Circul J. 2016;31(10):937–53.Google Scholar
  15. 15.
    Sandhu S, Al-Sarraf A, Taraboanta C, et al. Incidence of pancreatitis, secondary causes, and treatment of patients referred to a specialty lipid clinic with severe hypertriglyceridemia: a retrospective cohort study. Lipids Health Dis. 2011;10:157.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Pedragosa A, Merino J, Aranda JL, et al. Clinical profile of patients with very high hypertriglyceridemia from the registry of hypertriglyceridemia of the Spanish atherosclerosis society. Clin Investig Arterioscler. 2013;25(1):8–15.CrossRefPubMedGoogle Scholar
  17. 17.
    Hagman DK, Larson I, Kuzma JN, et al. The short-term and long-term effects of bariatric/metabolic surgery on subcutaneous adipose tissue inflammation in humans. Metabolism. 2017;70:12–22.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Haluzíková D, Lacinová Z, Kaválková P, et al. Laparoscopic sleeve gastrectomy differentially affects serum concentrations of FGF-19 and FGF-21 in morbidly obese subjects. Obesity (Silver Spring). 2013;21(7):1335–42.CrossRefGoogle Scholar
  19. 19.
    Ikeura T, Kato K, Takaoka M, et al. A body mass index ≥ 25 kg/m2 is associated with a poor prognosis in patients with acute pancreatitis: a study of Japanese patients. Hepatobiliary Pancreat Dis Int. 2017;16(6):645–51.CrossRefPubMedGoogle Scholar
  20. 20.
    Michalsky D, Dvorak P, Belacek J, et al. Radical resection of the pyloric antrum and its effect on gastric emptying after sleeve gastrectomy. Obes Surg. 2013;23(4):567–73.CrossRefPubMedGoogle Scholar
  21. 21.
    Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22(5):740–8.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Havel RJ. Pathogenesis, differentiation and management of hypertriglyceridemia. Adv Intern Med. 1969;15:117–54.PubMedGoogle Scholar
  23. 23.
    Yang F, Wang Y, Sternfeld L, et al. The role of free fatty acids, pancreatic lipase and Ca+ signalling in injury of isolated acinar cells and pancreatitis model in lipoprotein lipase-deficient mice. Acta Physiol (Oxf). 2009;195(1):13–28.CrossRefGoogle Scholar
  24. 24.
    Sztefko K, Panek J. Serum free fatty acid concentration in patients with acute pancreatitis. Pancreatology. 2001;1(3):230–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Zeng Y, Wang X, Zhang W, et al. Hypertriglyceridemia aggravates ER stress and pathogenesis of acute pancreatitis. Hepato-Gastroenterology. 2012;59(119):2318–26.PubMedGoogle Scholar
  26. 26.
    Huang C, Chen J, Wang J, et al. Dysbiosis of intestinal microbiota and decreased antimicrobial peptide level in Paneth cells during hypertriglyceridemia-related acute necrotizing pancreatitis in rats. Front Microbiol. 2017;8:776.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Xie C, Stevens DC, Sturm T. Safe and effective triglyceride-lowering therapy for hypertriglyceridemia associated pancreatitis: insulin mono-therapy in a non-diabetic patient. S D Med. 2018;71(1):26–8.PubMedGoogle Scholar
  28. 28.
    Hammond DA, Finlay L. Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin, heparin, and Gemfibrozil: a case series. Hosp Pharm. 2017;52(10):675–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Nasa P, Alexander G, Kulkarni A, et al. Early plasmapheresis in patients with severe hypertriglyceridemia induced acute pancreatitis. Indian J Crit Care Med. 2015;19(8):487–9.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Milone M, Lupoli R, Maietta P, et al. Lipid profile changes in patients undergoing bariatric surgery: a comparative study between sleeve gastrectomy and mini-gastric bypass. Int J Surg. 2015;14:28–32.CrossRefPubMedGoogle Scholar
  31. 31.
    Ruiz-Tovar J, Zubiaga L, Llavero C, et al. Serum cholesterol by morbidly obese patients after laparoscopic sleeve gastrectomy and additional physical activity. Obes Surg. 2014;24(3):385–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Preclinical MedicineNorth Sichuan Medical CollegeNanchongPeople’s Republic of China
  2. 2.School of Medical ImagingNorth Sichuan Medical CollegeNanchongPeople’s Republic of China
  3. 3.Department of General Surgery, Institute of Hepato-Biliary-Pancreas and Intestinal DiseaseAffiliated Hospital of North Sichuan Medical CollegeNanchongPeople’s Republic of China
  4. 4.Sichuan Key Laboratory of Medical Imaging, Department of RadiologyAffiliated Hospital of North Sichuan Medical CollegeNanchongPeople’s Republic of China

Personalised recommendations