Laparoscopic sleeve gastrectomy with ileal interposition (“neuroendocrine brake”)—pilot study of a new operation

Paula, Aureo Ludovico de; Macedo, António; Prudente, Alcyr S.; Queiroz, Luiz Paulo; Schraibman, Vladimir; Pinus, J

doi:10.1016/j.soard.2006.03.005

Cited by 96 publications

(61 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is associated with improved glycemic controlFwith or without concomitant weight loss depending on the rodent model or humans studiedFin the absence of any gastric restriction or malabsorption. [42][43][44][45] Whether improved glucose tolerance results primarily from enhanced insulin secretion, as predicted from increases in the incretin GLP-1, or from improved insulin sensitivity is unclear, and findings from different experiments support both possibilities.…”

Section: The Lower Intestinal Hypothesismentioning

confidence: 99%

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

2009

View full text Add to dashboard Cite

Bariatric surgery is currently the most effective method to promote major, sustained weight loss. Roux-en-Y gastric bypass (RYGB), the most commonly performed bariatric operation, ameliorates virtually all obesity-related comorbid conditions, the most impressive being a dramatic resolution of type 2 diabetes mellitus (T2DM). After RYGB, 84% of patients with T2DM experience complete remission of this disease, and virtually all have improved glycemic control. Increasing evidence indicates that the impact of RYGB on T2DM cannot be explained by the effects of weight loss and reduced energy intake alone. Weightindependent antidiabetic actions of RYGB are apparent because of the very rapid resolution of T2DM (before weight loss occurs), the greater improvement of glucose homeostasis after RYGB than after an equivalent weight loss from other means, and the occasional development of very late-onset, pancreatic b-cell hyperfunction. Several mechanisms probably mediate the direct antidiabetic impact of RYGB, including enhanced nutrient stimulation of L-cell peptides (for example, GLP-1) from the lower intestine, intriguing but still uncharacterized phenomena related to exclusion of the upper intestine from contact with ingested nutrients, compromised ghrelin secretion, and very probably other effects that have yet to be discovered. Research designed to prioritize these mechanisms and identify potential additional mechanisms promises to help optimize surgical design and might also reveal novel pharmaceutical targets for diabetes treatment. Keywords: diabetes; gastric bypass; bariatric surgery; ghrelin; GLP-1 Bariatric operations traditionally have been thought to cause weight loss through gastric restriction and/or intestinal malabsorption. Restrictive operations such as adjustable gastric banding (AGB) create a small pouch in the proximal stomach to reduce functional gastric capacity and retard gastric emptying. Malabsorptive procedures such as biliopancreatic diversion (BPD) leave much of the stomach intact but divert ingested food from the stomach to the ileum; thus, only a small segment of the distal bowel can absorb nutrients. The typical proximal Roux-en-Y gastric bypass (RYGB) creates gastric restriction and also causes food to bypass most of the stomach and a short segment of the proximal intestine, primarily the duodenum, leaving enough intact small bowel in digestive continuity to avoid clinically significant malabsorption. RYGB causes weight loss through gastric restriction and additional mechanisms involving changes in gut hormones and other processes under active investigation. 1-14 RYGB and BPD produce the highest and most rapid rates of remission of type 2 diabetes mellitus (T2DM). Remission of diabetes after RYGBAlthough bariatric surgery was designed to facilitate weight loss, anecdotal reports of rapid postoperative remission of T2DM emerged as early as the 1970s. In 1995, Pories et al. 4 reported long term results from 608 severely obese patients who underwent gastric bypass, with a 93% follow-up rate ov...

show abstract

Section: The Lower Intestinal Hypothesismentioning

confidence: 99%

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

2009

View full text Add to dashboard Cite

show abstract

“…Novos procedimentos cirúrgicos têm sido descritos com o objetivo de promover controle da diabete tipo 7,14,58 . Esses procedimentos utilizam os conhecimentos já adquiridos pelas cirurgias bariátricas tradicionais.…”

Section: Novos Procedimentosunclassified

“…De Paula et al 14 demonstraram os resultados da interposição ileal associada à gastrectomia vertical (sleeve) por via laparoscópica em 19 pacientes com IMC médio de 40,2 kg/m . Desses, cinco tinham diabete tipo 2, três estavam em uso de hipoglicemiantes por via oral e dois de insulina.…”

Section: Novos Procedimentosunclassified

Cirurgia gastrointestinal no tratamento da diabete tipo 2

Freitas

2007

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

RACIONAL: Evidências científicas demonstram o controle metabólico da diabete tipo 2 obtido com diversas intervenções sobre o sistema gastrointestinal, principalmente as operações bariátricas. OBJETIVOS: Revisar os dados da literatura referentes aos efeitos da cirurgia gastrointestinal na diabete tipo 2, especialmente os relacionados ao controle metabólico e sua fisiopatologia. MÉTODOS: Foi realizada pesquisa no Medline em páginas da internet procurando referências de artigos de maior relevância e estudos apresentados e publicados nos anais da conferência de Roma sobre os efeitos da cirurgia gastrointestinal no tratamento da diabete tipo 2 em 2007. Revisão da literatura - Entre as operações bariátricas, as derivações biliopancreáticas apresentam as mais altas taxas de controle da diabete tipo 2, seguidas pelo bypass gástrico e pela banda gástrica. Esse controle está relacionado à perda de peso e redução da ingestão de alimentos. As derivações biliopancreáticas e o bypass gástrico apresentam ainda efeito importante promovido por modificações hormonais. Os hormônios mais significativos são: o GLP-1, o GIP, o PYY, a grelina, a leptina, o IGF-1 e a adiponectina. Além dos efeitos sobre o controle do apetite no hipotálamo, os hormônios apresentam ação sobre as células β, promovem a secreção de insulina e diminuem sua resistência periférica. Duas hipóteses foram formuladas para explicar as modificações desses hormônios: a do intestino anterior, em que a exclusão do duodeno e do jejuno proximal previne a secreção de algum agente ainda não identificado que promove a resistência periférica à insulina; e a do intestino posterior, em que a derivação intestinal promove a passagem rápida do quimo até o intestino distal e induz à secreção precoce dos hormônios que promovem o controle da diabete. Além das operações bariátricas tradicionais, novos procedimentos promissores foram desenvolvidos nos últimos anos. Entre eles estão o bypass duodeno-jejunal, a interposição ileal e as ressecções intestinais associadas à gastrectomia vertical. Esses novos procedimentos ainda são considerados experimentais. CONCLUSÃO: Os procedimentos cirúrgicos sobre o trato gastrointestinal, principalmente as cirurgias bariátricas, proporcionam controle metabólico da diabete tipo 2. Entre as cirurgias bariátricas os melhores resultados são obtidos com as derivações biliopancreáticas seguidas pelo bypass gástrico e pela banda gástrica. Novos procedimentos cirúrgicos, ainda considerados experimentais, estão demonstrando resultados preliminares favoráveis ao controle metabólico da diabete tipo 2.

show abstract

“…In non-obese diabetic patients, this surgical technique has been shown to be effective in controlling diabetes mellitus type 2. [106][107][108][109][110][111] Interestingly, in the antidiabetic surgical interventions proposed by that team, [106][107][108][109][110][111] vertical gastrectomy was one of the prominent surgical techniques employed. Note that vertical gastrectomy is a restrictive (based on the marked reduction of the gastric reservoir capacity) metabolic procedure (based on the reduction of circulating levels of the orexigenic hormone ghrelin, which is produced by the fundus and greater gastric curvature) 82,91 that primarily aims to achieve weight loss.…”

Section: Introductionmentioning

confidence: 99%

“…125 Similarly, a clinical study of a surgical technique that places an ileal segment 50 cm distal to the Treitz angle showed the same endocrine stimulation and an improvement of diabetes. 111,126 Research demonstrating the ability of ileal food stimulation to release GLP-1 and cause an incretin effect is abundant in the literature. However, the histological studies investigating L cells were performed prior to the achievement of current scientific knowledge.…”

Section: Introductionmentioning

confidence: 99%

Organic consequences of ileal transposition in rats with diet-induced obesity

et al. 2011

View full text Add to dashboard Cite

INTRODUCTION:The clinical management of metabolic syndrome -especially diabetes mellitus type 2 -is notoriously complex due to the progressive nature of this disease. At present, there is a need for a surgical procedure that is effective for the treatment of diabetes mellitus type 2, even in non-obese individuals. The isolated ileal transposition theory could lead to an effective alternative therapy. This intervention has not yet been performed in humans, and there are no reports of its use in an experimental model of diet-induced metabolic syndrome. OBJECTIVES:The objective of this study is to evaluate the physiological effects of ileal transposition in rats with diet-induced metabolic syndrome. The effects of this procedure on glucose and lipid metabolism will be assessed. METHODS:Forty 12-week-old male rats (albino Rattus norvegicus, Wistar, 2BAW, heterogeneous) will be divided into four groups of 10 animals each: the ileal transposition group (TG) comprising animals on a hypercaloric-hyperlipidic diet; the sham group (SG) containing animals that receive the same diet and undergo the sham surgery; control group 1 (CG1), which will receive a hypercaloric-hyperlipidic diet and will not undergo surgery; and control group 2 (CG2), which will consume standard feed and will not undergo surgery. The surgeries will be performed in 20-week-old animals.Blood samples for laboratory testing will be collected from 12-week-old animals on the day of surgery and after eight postoperative weeks, following determination of the weights of the animals and the administration of anesthesia. The levels of serum glucose, insulin, triglycerides, total cholesterol and fractions, glucagon-like peptide-1, C-peptide and glycated hemoglobin will be assessed in all of the animals. The insulin tolerance test will be performed using PRISMA software, and insulin resistance will be calculated by the HOMA-IR indirect test. On specific days, two 20-week-old rats will be separated and randomly distributed in TG and SG. These animals will be followed until the eighth postoperative week. Subsequently, they will be euthanized, and the retroperitoneal and periepididymal fat deposits will be collected and weighed using a precision scale. In addition, the pancreas, liver and intestinal segments will be sent for pathological and immunohistochemical studies.

show abstract

Laparoscopic sleeve gastrectomy with ileal interposition (“neuroendocrine brake”)—pilot study of a new operation

Cited by 96 publications

References 11 publications

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

Cirurgia gastrointestinal no tratamento da diabete tipo 2

Organic consequences of ileal transposition in rats with diet-induced obesity

Contact Info

Product

Resources

About