Skip to main content
SpringerLink
Log in

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

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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. JAMA. 2004;292:1724–37.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  3. Pinkney JH, Sjostrom CD, Gale EAM. Should surgeons treat diabetes in severely obese people? Lancet. 2001;357:1357–9.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  5. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236:554–9.

    Article  Google Scholar 

  6. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  13. Ren CJ, Fielding GA. Laparoscopic adjustable gastric banding: surgical technique. J Laparoendosc Adv Surg Tech A. 2003;13(4):257–63.

    Article  Google Scholar 

  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.

    CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  19. Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG). Obes Surg. 2007;8:5.

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  22. Frezza EE, Mammarappallil J, Witt C, et al. (2009) Routine postoperative gastrographin contrast swallow studies after laparoscopic gastric banding. Archives of Surgery. In Press

  23. Frezza EE, Wachtel MS. A simple venous thromboembolism prophylaxis protocol for patients undergoing bariatric surgery. Obes Res. 2006;14:1–5.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  25. Fielding GA, Ren CJ. Laparoscopic adjustable gastric band. Surg Clin N Am. 2005;85:129–40.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  28. Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  35. Higgens SC, Gueorguiev M, Korbonits M. Ghrelin, the peripheral hunger hormone. Ann Med. 2007;39:116–36.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  37. Cigaina V. Gastric pacing as therapy for morbid obesity: preliminary results. Obes Surg. 2002;12:12S–6S.

    Article  Google Scholar 

  38. Miller K, Holler E, Hell E. Intragastric stimulation (IGS) for treatment of morbid obesity. Zentralbl Chir. 2002;175:1049–54.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Eldo E. Frezza, Susan E. Wozniak, Laura Gee & Mitchell Wacthel

  2. Center for Metabolic and Bariatric Disease, Second Street, Lubbock, TX, 79416, USA

    Eldo E. Frezza

Authors
  1. Eldo E. Frezza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan E. Wozniak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Gee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mitchell Wacthel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eldo E. Frezza.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Frezza, E.E., Wozniak, S.E., Gee, L. et al. Is There Any Role of Resecting the Stomach to Ameliorate Weight Loss and Sugar Control in Morbidly Obese Diabetic Patients?. OBES SURG 19, 1139–1142 (2009). https://doi.org/10.1007/s11695-009-9868-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-009-9868-9

Keywords

Search

Navigation