Gut Hormones After Roux-en-Y Gastric Bypass (RYGBP) Plus Gastric Fundus Resection
Condition: Morbid Obesity
MeSH terms: Obesity, Morbid
Study type: Interventional

Summary: 
      -  Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is considered a combination of
           restriction-malabsorption procedure and one of the most common operative procedures
           implemented.

        -  Over the last years increasing evidence suggests that the beneficial effects of
           bariatric operations might be related to the suppression of appetite caused by the
           release of the anorectic gut hormones such as peptide-YY (PYY) and glucagon-like
           peptide-1 (GLP-1)by the L cells of the distal gut and the suppression of the orexigenic
           hormone ghrelin released by the stomach.Obese people have a blunted rise in PYY and
           GLP-1 after a meal, possibly resulting in impaired satiety and hence greater food
           intake.

        -  In the present study the investigators sought to evaluate the effects of the resection
           of the gastric fundus, the main source of ghrelin production, on the secretion of
           ghrelin, PYY, GLP-1 and insulin and in addition on glucose levels, appetite and weight
           loss, in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass.
    

Detailed description: 
      Twenty four patients were included prospectively in the study. After randomization, 12
      patients underwent LRYGBP and 12 LRYGBP plus gastric fundus resection (LRYGBP+FR).

      All human studies were performed according to the principles of the Declaration of Helsinki.
      The local Research and Ethics Commitee at the University Hospital of Patras approved the
      study. Written informed consent was obtained from all patients.

      All the operations were performed by the same surgeon laparoscopically. The RYGBP procedures
      were performed creating a small isolated lesser curve-based gastric pouch (20 ± 5 ml) and a
      150cm Roux limb. The gastroenteroanastomosis was conducted with a 25 mm circular stapler. The
      dissection of the fundus of the stomach in the (LRYGBP+FR) group was done with the use of
      EndoGia No 60.

      The subjects were studied before and at 3, 6 and 12 months after the operation. All the
      patients underwent an oral glucose tolerance test (OGTT) with 75 g glucose, preoperatively.
      In addition, venous blood was collected after an overnight 12 hour fast and 30, 60 and 120
      min after the administration of a 300 kcal mixed meal.The meal was consumed in ten minutes
      and consisted of 18% protein, 55% carbohydrate and 27% fat (Resource energy drink, Nestle
      Nutrition, France). Plasma levels of PYY, GLP-1, ghrelin and insulin were determined at every
      time point of the study. All patients underwent complete clinical evaluation during follow-up
      including nutritional, behavioral and anthropometric parameters. Visual analogue scales (VAS)
      were used to measure hunger, nausea, fullness and aversion to food, before and 30, 60 and 120
      min after the consumption of the meal. Weight loss evaluation was based on postope¬rative
      body weight, body mass index (BMI) and % excess weight loss (EWL %).

      Insulin resistance was approximated using the homeostatic model assessment for insulin
      resistance (HOMA IR). The following formula was used in its calculation:

      HOMA IR = (fasting glucose [mmole] /lt X fasting insulin [μU/ml])/22.5). The insulinogenic
      index, a commonly used indicator of pancreatic β-cell function, was calculated as the ratio
      of increment of insulin concentrations to that of glucose concentrations at 30 minutes after
      meal ingestion (Δ [ins30 - ins0] / Δ [Glu30 -Glu0]).
    

Intervention name(s): Roux-en-Y gastric bypass (LRYGBP); LRYGBP+gastric fundus resection
Intervention type(s): Procedure; Procedure
Intervention description(s): Twelve patients underwent laparoscopic Roux-en-Y gastric bypass; Twelve patients underwent laparoscopic Roux-en-Y gastric bypass and gastric fundus resection
Other intervention name(s): LRYGBP
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Basic Science
Keywords: weight loss; appetite; ghrelin; PYY; GLP-1; insulin; laparoscopic; Roux-en-Y gastric bypass; gastric fundus resection