Impact of Restrictive (Sleeve Gastrectomy) vs Hybrid Bariatric Surgery (Roux-en-Y Gastric Bypass) on Lipid Profile Cholesterol absorption decreases after Roux-en-Y gastric bypass but not after gastric banding. Progressive rise in gut hormone levels after Roux‐en‐Y gastric bypass suggests gut adaptation and explains altered satiety Weight loss induced by very low calorie diet is associated with a more beneficial systemic inflammatory profile than by Roux-en-Y gastric bypass. Impact of Roux-en-Y gastric bypass on lipid and inflammatory profiles. Effect of a Roux-en-Y Gastric Bypass on the Pharmacokinetics of Oral Morphine Using a Population Approach Roux-en-Y gastric bypass surgery of morbidly obese patients induces swift and persistent changes of the individual gut microbiota Fat malabsorption and increased intestinal oxalate absorption are common after Roux-en-Y gastric bypass surgery. Comparison of Changes in Lipid Profile after Bilio-intestinal Bypass and Gastric Banding in Patients with Morbid Obesity Factorial study of the effects of atorvastatin and fish oil on dyslipidaemia in visceral obesity. Early effects of gastric bypass on endothelial function, inflammation, and cardiovascular risk in obese patients The Effect of Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients on Pharmacokinetics of (Acetyl)Salicylic Acid and Omeprazole: the ERY-PAO Study Enoxaparin thromboprophylaxis in gastric bypass patients: extended duration, dose stratification, and antifactor Xa activity. Evolution of Glycolipid Profile After Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass: Results of a Prospective Randomized Clinical Trial The Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Surgery on Dietary Intake, Food Preferences, and Gastrointestinal Symptoms in Post-Surgical Morbidly Obese Lebanese Subjects: A Cross-Sectional Pilot Study Laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity: experience with 50 patients. Comparable early changes in gastrointestinal hormones after sleeve gastrectomy and Roux-En-Y gastric bypass surgery for morbidly obese type 2 diabetic subjects Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: a randomized controlled trial. Atherogenic forms of dyslipidaemia in women with polycystic ovary syndrome. Changes in Gut Microbiome after Bariatric Surgery Versus Medical Weight Loss in a Pilot Randomized Trial Body weight, insulin resistance, and serum adipokine levels 2 years after 2 types of bariatric surgery. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial Influence of a Forced Air Warming System on Morbidly Obese Patients Undergoing Roux-en-Y Gastric Bypass
Background Few studies have evaluated the impact of hybrid versus purely restrictive bariatric surgery on lipid profile , with the results being contradictory . The effect of laparoscopic sleeve gastrectomy ( LSG ) and laparoscopic Roux-en-Y gastric bypass ( LRYGB ) on lipid profile was compared . Methods A nonr and omized prospect i ve cohort study was conducted on severely obese patients undergoing bariatric surgery .  Indication for the type of surgical procedure was based on clinical criteria . Patients on lipid-lowering drugs and those that could not be matched for age , sex , and body mass index were excluded . Finally , 51 patients who underwent LSG and 51 undergoing LRYGB completed this study . Results During the first year post-surgery , no differences in percentage of excess weight loss and triglyceride reduction were found between groups . After LRYGR , low-density lipoprotein ( LDL ) cholesterol concentrations fell significantly ( 125.9 ± 29.3 to 100.3 ± 26.4 mg/dl , p < 0.001 ) , whereas no significant changes were observed in the LSG group ( 118.6 ± 30.7 to 114.6 ± 33.5 mg/dl , p = 0.220 ) . High-density lipoprotein ( HDL ) cholesterol increase was significantly greater after LSG ( 15.4 ± 13.1 mg/dl ) compared with LRYGB ( 9.4 ± 14.0 mg/dl , p = 0.032 ) . Factors independently associated with LDL cholesterol reduction were higher baseline total cholesterol and undergoing LRYGB . A greater increase in HDL cholesterol was associated with LSG , older age , and baseline HDL cholesterol . Conclusions LRYGB produces an overall improvement in lipid profile , with a clear benefit in all lipid fractions . Although LSG does not alter LDL cholesterol levels , its effect on HDL cholesterol is comparable to or greater than that obtained with malabsorptive techniques The differences in cholesterol metabolism after the 2 most common forms of obesity surgery , Roux-en-Y gastric bypass ( RYGB ) and gastric b and ing ( GB ) , have not been well characterized . In this study , effects of RYGB and GB on cholesterol absorption and synthesis were investigated . To this aim , 1-year follow-up of cholesterol metabolism in 2 nonr and omized cohorts undergoing either RYGB ( n = 29 ; age , 45.2 + /- 7.7 years ; body mass index [ BMI ] , 46.0 + /- 6.1 kg/m(2 ) ) or GB ( n = 26 ; age , 45.9 + /- 8.6 years ; BMI , 50.1 + /- 7.7 kg/m(2 ) ) was performed in a university hospital center specializing in the treatment of morbid obesity .  Serum markers of cholesterol synthesis ( cholestenol , desmosterol , and lathosterol ) and cholesterol absorption ( campesterol , sitosterol , avenasterol , and cholestanol ) were measured preoperatively and at follow-up and expressed as ratios to cholesterol . As expected based on observed weight loss ( 25 % after RYGB and 17 % after GB , P < .001 between groups ) , both operations decreased serum levels of cholesterol synthesis markers by 12 % to 28 % ( all Ps < .001 ) . A decrease in cholesterol absorption markers was only observed after RYGB ( -26 % for sitosterol ) and not after GB ( + 16 % , P = 2 x 10(-6 ) for difference between the groups ) . The difference in sitosterol ratio between the groups remained significant after adjustment for age , BMI , fasting insulin levels , and nutritional status ( P = 2 x 10(-4 ) ) , indicating a specific effect related to RYGB . We conclude that decrease in cholesterol absorption is a novel beneficial effect of RYGB . Together with an improved control of blood glucose , this may contribute to a better cardiovascular risk profile after RYGB Bariatric surgery is the most effective treatment for achieving long‐term weight loss in morbidly obese patients . This study investigated prospect i ve changes in gut hormones and metabolic indices after Roux‐en‐$\font\ss = cmss10 scaled 1000 \hbox{\ss Y}$ gastric bypass ( RYGB ) INTRODUCTION Weight loss interventions such as Roux-en-Y gastric bypass ( RYGB ) and very low calorie diets ( VLCD ) lead to improvement of glucose metabolism in obese individuals with type-2 diabetes . Weight loss can also positively influence the unfavorable inflammatory profile associated with obesity . However , a direct comparison of the effect of VLCD and RYGB on systemic inflammation is lacking . METHODS Systemic inflammation was investigated in age- and BMI -matched morbidly obese T2DM women by determining the number and activation- or memory status of peripheral blood leukocytes by flow cytometry , in addition to measuring circulating levels of cytokines and CRP . Systemic inflammation was assessed one month before and three months after RYGB ( n=15 ) or VLCD ( n=12 ) . An age matched group of lean women ( n=12 ) was studied as control group . RESULTS Three months after the intervention , CRP and leptin levels were reduced whereas adiponectin levels were increased both by RYGB and VLCD .  TNF-α levels were increased by RYGB , but reduced by VLCD .  IL-2 and IL-6 levels were reduced and IL-4 levels were increased by VLCD but not affected by RYGB . The number of activated peripheral cytotoxic T ( CD8+CD25 + ) and B ( CD19+CD38 + ) cells was significantly higher after RYGB than after VLCD . CONCLUSION In conclusion , RYGB and VLCD have differential effects on the activation status of peripheral leukocytes and levels of cytokines in obese women with T2DM , despite comparable weight loss three months after the intervention . VLCD seems to have more favorable effects on the inflammatory profile as compared to RYGB OBJECTIVE To evaluate the behavior of acute phase proteins and lipid profile in patients undergoing Roux-en-Y gastric bypass .  METHODS We conducted a prospect i ve study , consisting of three moments : M1 - preoperative ( 24 hours before surgery ) ; M2 - 30 days after surgery ; and M3 - 180 days after surgery . We carried measured height and BMI , as well as determined the concentrations of acute phase proteins ( C-reactive protein ( CRP ) , albumin and Alpha-1-acid glycoprotein ) and total cholesterol , LDL-c , HDL-c and triacylglycerol . RESULTS participants comprised 25 individuals , with a mean age of 39.28 ± 8.07 , 72 % female . At all times of the study there was statistically significant difference as for weight loss and BMI . We found a significant decrease in CRP concentrations between the moments M1 and M3 ( p = 0.041 ) and between M2 and M3 ( p = 0.018 ) . There was decrease in Alpha-1-GA concentrations between M1 and M2 ( p = 0.023 ) and between M1 and M3 ( p = 0.028 ) . The albumin values increased , but did not differ between times . Total cholesterol and triacylglycerol decreased significantly ay all times . LDL-c concentrations decreased and differed between M1 and M2 ( p = 0.001 ) and between M1 and M3 ( p = 0.001 ) . HDL-c values increased , however only differing between M1 and M2 ( p = 0.050 ) . CONCLUSION Roux-en-Y gastric bypass promoted a decrease in plasma concentrations of CRP and Alpha-1-acid glycoprotein , improving lipid and inflammatory profiles Background and Objectives Obesity and opioid use for chronic pain in obese individuals are both important public health concerns . The pharmacokinetics of oral morphine after Roux-en-Y gastric bypass ( RYGB ) are unknown . Therefore , we aim ed to study the pharmacokinetics of oral morphine in morbidly obese patients before and after RYGB surgery , to identify the effects of RYGB and the subsequent reversal of morbid obesity on the pharmacokinetic parameters of morphine . Methods The pharmacokinetics of oral morphine  ( 30 mg ) were studied in 30 obese patients before ( Visit 1 ) and then 7–15 days ( Visit 2 ) and 6 months ( Visit 3 ) after RYGB . A population pharmacokinetic model was used to describe the time course of the plasma morphine concentration , to study the effect of RYGB on morphine pharmacokinetics and to estimate inter-patient variability . Results The oral morphine time to maximum plasma concentration ( tmax ) was twofold lower and maximum plasma concentration ( Cmax ) was 1.7 times higher at Visit 2 , and tmax was 7.5 times lower and Cmax 3.3 times higher at Visit 3 than at Visit 1 . The mean oral morphine area under the plasma concentration – time curve ( AUC ) increased significantly ( 1.55-fold ) between Visits 1 and 3 . Changes in body mass index ( BMI ) after RYGB were clearly associated with decreased apparent oral morphine clearance and apparent central and peripheral morphine volumes of distribution . None of the other anthropometric parameters explained the inter-subject variability in morphine exposure better than BMI . Conclusion RYGB and the BMI reduction that followed it dramatically increased the rate of morphine absorption and slightly increased morphine exposure . The dose of immediate-release forms of morphine may be divided in obese patients after RYGB to prevent adverse events due to early and high morphine plasma peaks Background Roux-en-Y gastric bypass ( RYGB ) is an effective means to achieve sustained weight loss for morbidly obese individuals . Besides rapid weight reduction , patients achieve major improvements of insulin sensitivity and glucose homeostasis . Dysbiosis of gut microbiota has been associated with obesity and some of its co-morbidities , like type 2 diabetes , and major changes of gut microbial communities have been hypothesized to mediate part of the beneficial metabolic effects observed after RYGB . Here we describe changes in gut microbial taxonomic composition and functional potential following RYGB . Methods We recruited 13 morbidly obese patients who underwent RYGB  , carefully phenotyped them , and had their gut microbiomes quantified before ( n = 13 ) and 3 months ( n = 12 ) and 12 months ( n = 8) after RYGB . Following shotgun metagenomic sequencing of the fecal microbial DNA purified from stools , we characterized the gut microbial composition at species and gene levels followed by functional annotation . Results In parallel with the weight loss and metabolic improvements , gut microbial diversity increased within the first 3 months after RYGB and remained high 1 year later . RYGB led to altered relative abundances of 31 species ( P < 0.05 , q < 0.15 ) within the first 3 months , including those of Escherichia coli , Klebsiella pneumoniae , Veillonella spp . , Streptococcus spp . , Alistipes spp . , and Akkermansia muciniphila . Sixteen of these species maintained their altered relative abundances during the following 9 months . Interestingly , Faecalibacterium prausnitzii was the only species that decreased in relative abundance . Fifty-three microbial functional modules increased their relative abundance between baseline and 3 months ( P < 0.05 , q < 0.17 ) . These functional changes included increased potential ( i ) to assimilate multiple energy sources using transporters and phosphotransferase systems , ( ii ) to use aerobic respiration , ( iii ) to shift from protein degradation to putrefaction , and ( iv ) to use amino acids and fatty acids as energy sources . Conclusions Within 3 months after morbidly obese individuals had undergone RYGB , their gut microbiota featured an increased diversity , an altered composition , an increased potential for oxygen tolerance , and an increased potential for microbial utilization of macro- and micro-nutrients . These changes were maintained for the first year post-RYGB.Trial registration Current controlled trials ( ID NCT00810823 , NCT01579981 , and NCT01993511 ) BACKGROUND Hyperoxaluria and increased calcium oxalate stone formation occur after Roux-en-Y gastric bypass ( RYGB ) surgery for morbid obesity . The etiology of this hyperoxaluria is unknown . We hypothesized that after bariatric surgery , intestinal hyperabsorption of oxalate contributes to increases in plasma oxalate and urinary calcium oxalate supersaturation . METHODS We prospect ively examined oxalate metabolism in 11 morbidly obese subjects before and 6 and 12 months after RYGB ( n = 9 ) and biliopancreatic diversion-duodenal switch ( BPD-DS ) ( n = 2 ) . We measured 24-hour urinary supersaturations for calcium oxalate , apatite , brushite , uric acid , and sodium urate ; fasting plasma oxalate ; 72-hour fecal fat ; and increases in urine oxalate following an oral oxalate load . RESULTS Six and 12 months after RYGB , plasma oxalate and urine calcium oxalate supersaturation increased significantly compared with similar measurements obtained before surgery ( all P ≤ .02 ) . Fecal fat excretion at 6 and 12 months was increased ( P = .026 and .055 , 0 vs 6 and 12 months ) . An increase in urine oxalate excretion after an oral dose of oxalate was observed at 6 and 12 months ( all P ≤ .02 ) . Therefore , after bariatric surgery , increases in fecal fat excretion , urinary oxalate excretion after an oral oxalate load , plasma oxalate , and urinary calcium oxalate supersaturation values were observed . CONCLUSION Enteric hyperoxaluria is often present in patients after the operations  of RYGB and BPD-DS  that utilize an element of intestinal malabsorption as a mechanism for weight loss Background : The presence of hypercholesterolemia is currently not considered a selection criteria for performing gastric restrictive or diversionary bariatric surgery . Methods : We prospect ively investigated the effects of the bilio-intestinal bypass ( BI-bypass ) with a wide cholecysto-jejunal anastomosis and of adjustable gastric b and ing ( AGB ) on blood lipid concentrations in obese patients . To clarify the mechanism of the hypocholesterolemic effect of the BI-bypass , daily fecal sterol excretion was measured by gas-liquid chromatography ( GLC ) . Results : At 1 year after BI-bypass compared to baseline , the hypercholesterolemic ( n=18 ) and the normocholesterolemic ( n=19 ) patients significantly reduced total ( −38 % and −27 % , respectively ) , LDL ( −47 % and −24 % , respectively ) and HDL ( −11 % and −13 % , respectively ) cholesterol and total / HDL cholesterol ratio ( −25 % and −13 % , respectively ) . At 1 year after AGB , the total / HDL cholesterol ratio was significantly decreased ( −11 % ) compared to baseline in hypercholesterolemic ( n=12 ) but not in normocholesterolemic ( n=6 ) patients , while total and LDL cholesterol were not affected in both groups . At 3 years after BI-bypass compared to baseline , the hypercholesterolemic ( n=9 ) and the normocholesterolemic ( n=11 ) patients significantly reduced total ( −43 % and −28 % , respectively ) and LDL ( −53 % and −29 % , respectively ) cholesterol and total / HDL cholesterol ratio ( −38 % and −21 % , respectively ) . The BI-bypass induced a significant ( P < 0.005 ; n=7 ) 6-fold increase in mean fecal cholesterol output . Conclusions : The BI-bypass but not the AGB leads to a persistent and marked beneficial effect on blood LDL cholesterol associated with an increased cholesterol fecal output . BI-bypass but not AGB is indicated in morbidly obese patients with hypercholesterolemia BACKGROUND Dyslipidaemia may account for increased risk of cardiovascular disease in central obesity . Pharmacotherapy is often indicated in these patients , but the optimal approach remains unclear . We investigated the effects of atorvastatin and fish oil on plasma lipid and lipoprotein levels , including remnant-like particle-cholesterol and apolipoprotein C-III , in dyslipidaemic men with visceral obesity . METHODS We carried out a 6-week r and omized , placebo-controlled , 2 x 2 factorial intervention study of atorvastatin ( 40 mg day(-1 ) ) and fish oil ( 4 g day(-1 ) ) on plasma lipids and lipoproteins in 52 obese men ( age 53 + /- 1 years , BMI 33.7 + /- 0.55 kg m(-2 ) ) with dyslipidaemia and insulin resistance . Treatment effects were analysed by general linear modelling . RESULTS Atorvastatin had significant main effects in decreasing triglycerides ( -0.38 + /- 0.02 mmol L(-1 ) , P = 0.002 ) , total cholesterol ( -1.89 + /- 0.17 mmol L(-1 ) , P = 0.001 ) , LDL-cholesterol ( -1.78 + /- 0.14 mmol L(-1 ) , P = 0.001 ) , remnant-like particle-cholesterol ( -0.08 + /- 0.04 mmol L(-1 ) , P = 0.035 ) , apolipoprotein B ( -49 + /- 4 mg dL(-1 ) , P = 0.001 ) , apolipoprotein C-III ( -12.6 + /- 6.1 mg L(-1 ) , P = 0.044 ) and in increasing HDL-cholesterol ( + 0.10 + /0- 0.04 mmol L(-1 ) , P = 0.007 ) . Fish oil had significant main effects in decreasing triglycerides ( -0.38 + /- 0.11 mmol L(-1 ) , P = 0.002 ) and in increasing HDL-cholesterol ( + 0.07 + /- 0.04 mmol L(-1 ) , P = 0.041 ) . There were no significant changes in weight or insulin resistance during the study . CONCLUSIONS Atorvastatin and fish oil have independent and additive effects in correcting dyslipidaemia in viscerally obese men . Improvement in abnormalities in remnant lipoproteins may occur only with use of atorvastatin . Combination treatment with statin and fish oil may , however , offer an optimal therapeutic approach for globally correcting dyslipidaemia in obesity Background Obesity is associated with a chronic low- grade inflammatory state , insulin resistance , and endothelial dysfunction , all of which contribute to increased risk of cardiovascular disease . We hypothesized that gastric bypass would produce rapid improvements in endothelial function , reduce inflammation , and lead to a decrease in cardiovascular risk . Methods We performed a prospect i ve study of morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass ( RYGB ) .  Clinical data , biochemical markers of inflammation , and parameters indicative of cardiovascular risk were collected preoperatively and at 3 and 6 months postoperatively . Metabolic and inflammatory mediators that were quantified included C-reactive protein , fibrinogen , PAI-1 , IL-6 , IL-10 , IL-1Ra , adiponectin , leptin , triglycerides , total cholesterol , HDL , LDL , glucose , insulin , and HbA1c . Brachial artery reactivity testing ( BART ) was performed to assess peripheral arterial endothelial function , and Framingham cardiovascular risk score ( FRS ) was calculated on all study participants pre- and postoperatively . Results Fifteen patients ( 11 female ) were enrolled ( age = 49.2 ± 10.4 years ; BMI = 48.1 ± 5.3 kg/m2 ) . Six months post RYGB , mean BMI decreased to 35.4 ± 4.5 , corresponding to 51.7 % excess weight loss ( P < 0.001 ) . Mean waist circumference decreased significantly from 132 cm at baseline to 110 cm at 3 months ( P = 0.003 ) and 107 cm at 6 months ( P < 0.001 ) . Six months after RYGB , weight loss led to significant improvements in clinical parameters indicative of cardiovascular disease or risk , including brachial artery diameter , endothelial independent vasodilation , and FRS . Favorable improvements in the proinflammatory markers CRP ( P = 0.01 ) and leptin ( P = 0.005 ) , the anti-inflammatory mediator adiponectin ( P = 0.002 ) , and insulin sensitivity ( HOMA-IR , P = 0.007 ) were evident at 3 months . At 6 months , improvements in CRP , leptin , and fasting insulin were maintained and fibrinogen levels also decreased ( P = 0.047 ) . Adiponectin continued to increase at 6 months ( P = 0.004 ) . Conclusion Gastric bypass is associated with early reversal of endothelial dysfunction , a more favorable inflammatory milieu , and , most importantly , a reduction in cardiovascular risk Background Data on the absorption of orally administered drugs following  Roux-en-Y gastric bypass ( RYGB ) surgery in obese patients are limited and inconclusive . As it is difficult to predict changes in absorption , studies on frequently used drugs in this population are necessary . Acetylsalicylic acid ( ASA ) and omeprazole are two commonly prescribed drugs in obese patients . Methods In this repeated measures study , omeprazole and salicylic acid ( SA ) serum concentrations were measured before and after RYGB in 34 morbidly obese subjects .  Time to maximum concentration ( Tmax ) , lag time ( Tlag ) , maximum concentration ( Cmax ) , and area under the serum concentration versus time curve ( AUC ) were calculated for both drugs to determine possible differences in drug absorption after the procedure . Results For SA , Tmax significantly decreased after RYGB , while both Cmax and AUC0–24 significantly increased . For omeprazole , both Tmax and Tlag significantly decreased after RYGB , while Cmax significantly increased . Mean AUC0–12 significantly decreased post-surgery . The difference in AUC0–12 before and after surgery varied between subjects . Conclusions Our study shows a faster absorption of both ASA and omeprazole after RYGB . The exposure to ASA is higher post-surgery , but the st and ard dose of 80 mg does not need to be modified , considering its range in effective dose . The exposure to omeprazole is , on average , decreased after surgery . Clinicians should be aware to increase the dose of omeprazole if symptoms suggest inadequate response BACKGROUND Morbidly obese patients undergoing gastric bypass surgery are at risk for postoperative venous thromboembolism . Evidence -based recommendations regarding the dosing and duration of thromboprophylaxis are lacking for morbidly obese surgical patients . The aims of this study were to evaluate the safety and efficacy of an extended duration , body mass index ( BMI ) -stratified enoxaparin thromboprophylaxis regimen in patients undergoing Roux-en-Y gastric bypass  and to determine the result ant antifactor Xa ( AFXa ) activity in morbidly obese surgical patients . METHODS In this prospect i ve open trial , 223 patients ( 75 % female , mean BMI 50.4 kg/m2 ) undergoing Roux-en-Y gastric bypass  were assigned to receive enoxaparin 40 mg ( BMI < or=50 kg/m2 ) , n = 124 ) or 60 mg ( BMI > 50 kg/m2 ) , n = 99 ) every 12 hours during hospitalization and once daily for 10 days after discharge . The AFXa levels were monitored serially , and dose adjustments were made for results outside the target prophylactic range ( .2-.4 IU/mL + /- 10 % ) after the third dose . The safety and efficacy outcomes were major bleeding and venous thromboembolism . RESULTS Roux-en-Y gastric bypass was performed laparoscopically in 208 subjects ( 93 % ) . The duration of surgery averaged 99.5 + /- 31 minutes , and the median length of hospitalization was 3 days . Target prophylactic AFXa concentration was achieved by 74 % of patients after the third enoxaparin dose ; none reached the full anticoagulation concentration . One patient developed nonfatal venous thromboembolism ( .45 % ) . Four patients required transfusion ( 1.79 % ) . Bleeding was not associated with a high AFXa concentration . CONCLUSION This BMI -stratified , extended enoxaparin dosing regimen provided well-tolerated , effective prophylaxis against venous thromboembolism in patients undergoing gastric bypass surgery Background This study aims to report glycolipid changes after  sleeve gastrectomy ( SG ) or Roux-en-Y gastric bypass ( RYGB )  in the setting of a prospect i ve r and omized clinical trial . Methods One hundred patients were r and omly assigned to RYGB ( n = 45 ) and SG ( n = 55 )  . Fasting glucose , insulin , glycated hemoglobin ( HbA1c% ) , triglycerides , and serum cholesterol ( total , HDL , and LDL ) were evaluated at inclusion and after 1 , 3 , 6 , and 12 months . The index for homeostasis model assessment of insulin resistance ( HOMA-IR ) and β cell function ( HOMA-B ) were assessed . Results Mean postoperative 1- , 3- , 6- , and 12-month excess weight loss was 25.39 , 43.47 , 63.75 , and 80.38 % after RYGB and 25.25 , 51.32 , 64.67 , and 82.97 % after SG , respectively . Mean fasting glucose and fasting serum insulin were similarly and statistically significantly reduced in both RYGB and SG . Mean HOMA-IR improved in both groups , particularly in case of high preoperative values , and mean HOMA-B improved at 1 year after RYGB . HbA1c% dropped from 5.66 % ( SD = 0.61 ) to 5.57 % ( SD = 0.32 ) after RYGB and from 5.64 % ( SD = 0.43 ) to 5.44 % ( SD = 0.43 ) after SG . Total cholesterol was significantly higher at 1 month ( p = 0.04 ) , 3 months ( p = 0.03 ) , and 1 year ( p = 0.005 ) after SG as compared to RYGB . LDL cholesterol decreased significantly after RYGB at 1 month ( p = 0.03 ) , 3 months ( p = 0.0001 ) , and 1 year ( p = 0.0004 ) as compared to SG . HDL cholesterol was increased at 1 year in the RYGB group but not in the SG group . Triglycerides decreased similarly in both groups . Conclusions Short-term glycemic control was comparable after SG and RYGB . An improved lipid profile was noted after RYGB in patients with abnormal preoperative values Background Data on gastrointestinal ( GI ) and dietary changes following bariatric surgery are scarce in the Middle Eastern region . The objective of this work was to retrospectively compare dietary intake , food preferences , and GI symptoms in subjects with extreme obesity after Roux-en-Y gastric bypass ( RYGB ) and sleeve gastrectomy ( SG ) . Methods Sixty subjects equally divided between RYGB and SG with a postoperative period of ≥6 months were recruited for a retrospective , non-r and omized , and observational study . All subjects completed three question naires ( GI symptoms , food preferences , and quantitative food frequency question naire ( FFQ ) ) and three 24-h recalls . Results At one year postoperatively , both surgical groups showed similar percentage of excess weight loss that exceeded 50 % . In addition , percentage of carbohydrate , protein , and sugar intake from total energy , frequency of daily consumption from the eight food categories and daily energy intake were comparable between surgical groups . RYGB subjects consumed significantly more fruits and juices from total energy ( P < 0.05 ) whereas SG subjects tended to consume more sweets and desserts . Heartburn ( P < 0.001 ) , regurgitation ( P < 0.01 ) , nausea ( P < 0.01 ) , vomiting ( P < 0.001 ) , and constipation ( P < 0.05 ) were significantly more frequent among SG subjects . Flatulence ( P < 0.001 ) and diarrhea ( P < 0.05 ) , as well as dizziness ( P < 0.001 ) , and fast heartbeat ( P < 0.05 ) after eating were significantly more frequent after RYGB . Conclusions There were no major differences in dietary intake and food preferences between RYGB and SG groups . There was a trend for sweet-eating in SG subjects with less dumping symptoms to suggest different mechanisms of action for each procedure , which might impact eating behavior BACKGROUND Roux-en-Y gastric bypass is currently considered the gold st and ard surgical option for the treatment of morbid obesity .  Open RYGB is associated with a high risk of complications . Laparoscopic RYGB has been shown to reduce perioperative morbidity and improve recovery . OBJECTIVES To review our experience with laparoscopic RYGB during a 19 month period . METHODS The data were collected prospect ively . The study group comprised all patients who underwent laparoscopic RYGB for treatment of morbid obesity as their primary operation between February 2006 and July 2007 . The reported outcome included surgical results , weight loss , and improved status of co-morbidities , with follow-up of up to 19 months . RESULTS The mean age of the 50 patients was 36.7 years . Mean body mass index was 44.7 kg/m2 ( range 35 - 76 kg/m2 ) ; mean duration of surgery was 171 minutes . There was no conversion to open surgery . The mean length of stay was 4 days ( range 2 - 7 days ) . Five patients ( 10 % ) developed a complication , but none of them required early reoperation and there were no deaths . Mean follow-up was 7 months ( range 40 days-19 months ) . The excess body weight loss was 55 % and 61 % at 6 and 12 months respectively . Diabetes resolved completely or significantly improved in all five patients with this condition , as did hypertension in eight patients out of nine . CONCLUSIONS Laparoscopic RYGB is feasible and safe . The results in terms of weight loss and correction of co-morbidities are comparable to other previously published studies . However , only surgeons with experience in advanced laparoscopic as well as bariatric surgery should attempt this procedure Background Sleeve gastrectomy ( SG ) and Roux-en-Y gastric bypass ( RYGBP ) are associated with similar type 2 diabetes mellitus ( T2DM ) resolution rates for morbidly obese subjects . However , the mechanisms underlying the resolution of T2DM after SG have not been clarified to date . This study aim ed to compare the early changes in gastrointestinal hormones involved in insulin and glucagon secretion in morbidly obese T2DM subjects undergoing SG or RYGBP . Methods This prospect i ve study investigated 12 subjects with T2DM who had undergone SG ( n = 6 ) or RYGBP ( n = 6 ) . Five body mass index ( BMI ) -matched obese non-diabetic subjects and five BMI -matched obese diabetic subjects served as control subjects .  Glucose , insulin , glucagon , glucagon-like peptide 1 ( GLP-1 ) , glucose-dependent insulinotropic polypeptide ( GIP ) , and GLP-2 were determined after a st and ardized mixed liquid meal before surgery and 6 weeks afterward . Results After 6 weeks , five of the six subjects in each surgical group presented with T2DM remission , although the area under the curve (AUC)0–120 of glucose was greater than that of the non-diabetic control subjects ( P < 0.01 ) . Postsurgically , the indices of insulin and glucagon secretion were comparable between the two surgical groups . The AUC0–120 of GLP-1 ( P < 0.05 ) and GLP-2 ( P < 0.05 ) was significantly and comparably enlarged after SG and RYGB . The postsurgical GIP response was significantly associated with the glucagon response throughout the meal test ( ρ = 0.747 ; P < 0.01 ) . Conclusions The data show that in a cohort of morbidly obese T2DM subjects , SG and RYGBP are associated with an early improvement in glucose tolerance , similar changes in insulin and glucagon secretion , and a similar GLP-1 , GIP , and GLP-2 response to a st and ardized mixed liquid meal AIMS The aim of this study was to evaluate the effect of laparoscopic Roux-en-Y gastric bypass ( RYGB ) surgery compared with usual care with and without Exenatide therapy in obese people with type 2 diabetes mellitus ( T2DM ) and hypertension . METHODS 108 obese T2DM with hypertension were enrolled and r and omly allocated to usual care ( group A ) , usual care plus Exenatide ( group B ) , and RYGB surgery ( group C ) . Demographic characteristics , metabolic parameters and cardiac structure/function along with inflammatory cytokines were measured and compared before and after 12 months . RESULTS At 12 months , diabetes remission had occurred in no patients in groups A and B versus 90 % in group C , and there was a significant decrease in requirement of antihypertensive drugs in group C compared with groups A and B ( P<0.05 ) . Other parameters ( body mass index , hemoglobin A1c , homeostasis model assessment of insulin resistance , lipids ) , inflammation index ( high sensitivity C-reactive protein , tumor necrosis factor-α , high molecular weight adiponectin ) and cardiac structure ( left ventricular mass index ) were significantly improved in groups B and C , but patients in group C had the greatest degree of improvement ( P<0.05 ) . CONCLUSION RYGB surgery improves a number of parameters including cardiovascular function in obese hypertensive people with T2DM . This is likely to be due to , at least in part , an improvement in the abnormal metabolic panel and to reduced inflammation OBJECTIVE Dyslipidaemia is very common in patients with polycystic ovary syndrome ( PCOS ) but , beyond plasma lipids , atherogenic lipoprotein ( Lp ) and apolipoprotein ( apo ) alterations are still ill defined . DESIGN We measured concentrations of apoB , Lp(a ) and small , dense low-density lipoprotein ( LDL )  in 42 patients with PCOS [ age : 28 + /- 7 years , body mass index ( BMI ): 27 + /- 5 kg/m(2 ) ] vs. 37 age- and BMI -matched healthy controls . METHODS Elevated  Lp(a ) levels  considered were those > 30 mg/dl while elevated apoB concentrations were those > 100 g/l . RESULTS Polycystic ovary syndrome showed increased triglycerides levels ( p = 0.0011 ) and lower high-density lipoprotein (HDL)-cholesterol concentrations ( p = 0.0131 ) while total- and LDL cholesterol were similar . PCOS also showed smaller LDL size ( p = 0.0005 ) , higher levels of total small , dense LDL ( p < 0.0001 ) , higher concentrations of Lp(a ) , as considered as absolute values ( p = 0.0143 ) and log-transformed ( p = 0.0014 ) , while no differences were found in apoB levels . Elevated Lp(a ) concentrations were found in 24 % of PCOS , while elevated apoB levels were relatively uncommon ( 14 % ) . Spearman correlation analysis revealed that Lp(a ) concentrations were weakly correlated only with HDL-cholesterol levels ( r = -0.378 , p = 0.0431 ) . In addition , 36 % of patients with PCOS with normal plasma lipid profile showed elevated levels of Lp(a ) , apoB or small , dense LDL . CONCLUSIONS Atherogenic Lp abnormalities may be found in one-third of women with PCOS who have a normal lipid pattern . Future prospect i ve studies are needed to test to which extent such atherogenic forms of dyslipidaemia may contribute to the increased cardiovascular risk in young women with PCOS Gut microbiota likely impact obesity and metabolic diseases . We evaluated the changes in gut microbiota after surgical versus medical weight loss in adults with diabetes and obesity . We performed 16S rRNA amplicon sequencing to identify the gut microbial composition at baseline and at 10 % weight loss in adults with diabetes who were r and omized to medical weight loss ( MWL , n = 4 ) , adjustable gastric b and ing ( AGB , n = 4 ) , or Roux-en-Y gastric bypass ( RYGB , n = 4 ) . All participants were female , 75 % reported black race with mean age of 51 years . At similar weight loss amount and glycemic improvement , the RYGB group had the most number of bacterial species ( 10 increased , 1 decreased ) that significantly changed ( p < 0.05 ) in relative abundance . Alpha-diversity at follow-up was significantly lower in AGB group compared to MWL and RYGB ( observed species for AGB vs. MWL , p = 0.0093 ; AGB vs. RYGB , p = 0.0093 ) . The relative abundance of Faecalibacterium prausnitzii increased in 3 participants after RYGB , 1 after AGB , and 1 after MWL . At similar weight loss and glycemic improvement , the greatest alteration in gut microbiota occurred after RYGB with an increase in the potentially beneficial bacterium , F. prausnitzii . Gut microbial diversity tended to decrease after AGB and increase after RYGB and MWL . Future studies are needed to determine the impact and durability of gut microbial changes over time and their role in long-term metabolic improvement after bariatric surgery in adults with type 2 diabetes . NCTDK089557— Clinical OBJECTIVE Bariatric surgery reverses obesity-related comorbidities , including type 2 diabetes mellitus . Several studies have already described differences in anthropometrics and body composition in patients undergoing Roux-en-Y gastric bypass compared with laparoscopic adjustable gastric b and ing  , but the role of adipokines in the outcomes after the different types of surgery is not known . Differences in weight loss and reversal of insulin resistance exist between the 2 groups and correlate with changes in adipokines . METHODS Fifteen severely obese women ( mean body mass index [ BMI ] : 46.7 kg/m(2 ) ) underwent 2 types of laparoscopic weight loss surgery ( Roux-en-Y gastric bypass=10 , adjustable gastric b and ing=5 ) .  Weight , waist and hip circumference , body composition , plasma metabolic markers , and lipids were measured at set intervals during a 24-month period after surgery . RESULTS At 24 months , patients who underwent Roux-en-Y were overweight ( BMI 29.7 kg/m(2 ) ) , whereas patients who underwent gastric b and ing remained obese ( BMI 36.3 kg/m(2 ) ) . Patients who underwent Roux-en-Y lost significantly more fat mass than patients who underwent gastric b and ing ( mean difference 16.8 kg , P<.05 ) . Likewise , leptin levels were lower in the patients who underwent Roux-en-Y ( P=.003 ) , and levels correlated with weight loss , loss of fat mass , insulin levels , and Homeostasis Model of Assessment 2 . Adiponectin correlated with insulin levels and Homeostasis Model of Assessment 2 ( r=-0.653 , P=.04 and r=-0.674 , P=.032 , respectively ) in the patients who underwent Roux-en-Y at 24 months . CONCLUSION After 2 years , weight loss and normalization of metabolic parameters were less pronounced in patients who underwent gastric b and ing  compared with patients who underwent Roux-en-Y gastric bypass . Our findings require confirmation in a prospect i ve r and omized trial Aims /hypothesisBariatric surgery is gaining acceptance as a ‘ metabolic surgical intervention ’ for patients with type 2 diabetes . The optimal form of surgery and the mechanism of action of these procedures are much debated . We compared two bariatric procedures for obese patients with type 2 diabetes and evaluated their effects on HbA1c and glucose tolerance . Methods We performed a parallel un-blinded r and omised trial of Roux-en-Y gastric bypass ( RYGB ) vs sleeve gastrectomy ( SG ) in 41 obese patients with type 2 diabetes , who were bariatric surgery c and i date s attending the obesity clinic .  HbA1c , body composition and glucose tolerance were evaluated at baseline , and at 3 and 12 months . Results Of the 41 patients , 37 completed the follow-up ( 19 RYGB , 18 SG ) . Both groups had similar baseline anthropometric and biochemical measures , and showed comparable weight loss and fat : fat-free mass ratio changes at 12 months . A similar normalisation of HbA1c levels was observed as early as 3 months post-surgery ( 6.37 ± 0.71 % vs 6.23 ± 0.69 % for RYGB vs SG respectively , p < 0.001 in both groups for baseline vs follow-up ) . Conclusions /interpretationIn this study , RYGB did not have a superior effect in comparison to SG with regard to HbA1c levels or weight loss during 12 months of follow-up . Trial registration Clinical Trials.gov NCT00667706 Funding This work was supported by grant no. 3 - 000 - 8480 from the Israel Ministry of Health Chief Scientist , the Stephen Morse Diabetes Research Foundation and by Johnson & Johnson Background : Hypothermia during and after major abdominal surgery decreases host defenses , increases the incidence of coagulopathy and may alter blood pressure , cardiac contractility and myocardial stability . Methods : We design ed a prospect i ve r and omized study to compare the benefits of a forced air warming system with warm blanket treatments in minimizing the effects of hypothermia on 64 morbidly obese patients undergoing Roux-en-Y gastric bypass .  Results : Patients in the forced air warming group ( n = 32 ) had significantly higher perioperative body core temperature , lower central venous pressure and blood pressure readings , lower incidence of shivering , less blood loss intraoperatively and achieved a higher post anesthesia Aldrete Score than those patients in the warmed blanket group ( n = 32 ) . Conclusion : The forced air warming system is safe , cost effective and beneficial in minimizing the undesirable consequences of hypothermia in morbidly obese patients undergoing Roux-en-Y gastric bypass
Conclusions RYGB surgery reverses the dyslipidaemia of obesity .
These findings support the use of RYGB in the management of high cardiovascular risk lipid profiles in morbid obesity
Background Obesity-related dyslipidaemia comprises hypercholesterolaemia , hypertriglyceridaemia , low HDL-cholesterol and normal to raised LDL-cholesterol levels .
40 % of morbidly obese surgical patients have dyslipidaemia .
Roux-en-Y gastric bypass ( RYGB ) surgery has many beneficial metabolic effects , but the full impact on plasma lipids has not been clearly defined .