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

Abstract

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.

The influence of laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy on weight loss, plasma ghrelin, insulin, glucose and lipids

“…This applies to LAGB and LSG which have similar short-term results in terms of EWL, approximately 50-65%. The long term results of LAGB are less positive than those obtained after LSG, although the data after LSG is still poor [29,31]. Our results of weight loss do not differ from the results of other bariatric centers.…”

“…whether the cells outside the stomach compensate for the loss in ghrelinproducing cells after stomach resection. It has to be established whether such resection of fundus is effective or whether a nonresective reduction of gastric volume is enough [28,29].…”

“…This leads us to suppose that LSG would be found between these two, and would lead to more beneficial effects on diabetes than LAGB [57]. In a study comparing LAGB and LSG, Frezza et al found that LSG provides a greater weight loss and better control of glucose at 12 and 18 months than LAGB, suggesting that resection of the stomach fundus plays an important, though as yet not completely explained, role [29].…”

Effect of ghrelin on glucose regulation in mice

“…Insulin receptor substrate 1 and glucose transporter 2 gene expressions in hepatic tissues of the ghrelin Ϫ/Ϫ and Ghsr Ϫ/Ϫ were higher compared with that in WT mice. This study demonstrates that gluconeogenesis and glycogenolysis are increased and insulin sensitivity is improved by the ablation of the ghrelin or growth hormone secretagogue receptor in mice.ghrelin; growth hormone secretagogue receptor; gluconeogenesis; bariatric surgery; insulin sensitivity THE IMPROVEMENT IN INSULIN SENSITIVITY and in many cases reversal of type 2 diabetes after bariatric surgery procedures before any weight loss occurs are well established (6,14,16,30,46,60). Improved glycemic control achieved immediately after surgery but before weight loss suggests a hormonal mechanism (10, 30).…”

“…ghrelin; growth hormone secretagogue receptor; gluconeogenesis; bariatric surgery; insulin sensitivity THE IMPROVEMENT IN INSULIN SENSITIVITY and in many cases reversal of type 2 diabetes after bariatric surgery procedures before any weight loss occurs are well established (6,14,16,30,46,60). Improved glycemic control achieved immediately after surgery but before weight loss suggests a hormonal mechanism (10, 30).…”