Weight Loss After Laparoscopic Adjustable Gastric Banding is not Caused by Altered Gastric Emptying

Jong, Justin R. de; Ramshorst, Bert van; Gooszen, Hein G.; Smout, A. J. P. M.; Buul, M. M. C. Tiel-Van

doi:10.1007/s11695-008-9746-x

Cited by 42 publications

(29 citation statements)

References 25 publications

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“…We observed a decrease of %EWL and %EBL which was maintained throughout the whole six-month follow-up. From this perspective, our results in the LSG group are similar to Armstrong and Malley's [32] as well as Karamanakos' [33] and in the LAGB group to Ponce's [34] and Jong's results [35]. Short-term observations of global studies indicate that the efficiency of both techniques is varied.…”

Section: Discussionsupporting

confidence: 73%

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

Hady

Gołaszewski

Zbucki

et al. 2012

Folia Histochem Cytobiol.

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Abstract:The aim of this study was to assess the impact of laparoscopic gastric banding and laparoscopic sleeve gastrectomy on the concentration of ghrelin, insulin, glucose, triglycerides, total and HDL-cholesterol, as well as AST and ALT levels in plasma in patients with obesity. The research includes 200 patients operated using LAGB (34 men average age 37.0 ± 12.6 years and 66 women average age 39.18 ± 12.17 years) and LSG (48 men average age 47.93 ± 9.24 years and 52 women, 19 ± 9.33 years). The percentage of effective weight loss, effective BMI loss, concentration of ghrelin, insulin, glucose, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol, ALT, AST and HOMA IR values was taken preoperatively and at 7 th day, 1 month, 3 and 6 months after surgery. Both after LSG and after LAGB, statistically significant reduction in BMI, serum insulin, glucose and HOMA IR was noticed in comparison to the preoperative values. Post LAGB, patients showed an increase of ghrelin, while LSG proved ghrelin decreased. Correlations between glucose and BMI loss, and between insulin and BMI loss in both cases are more favorable in the LSG group. Lipid parameters, AST and ALT have undergone declines or increases in the particular time points. Both techniques cause weight loss and this way lead to changes in the concentration of ghrelin, as well as to the improvement of insulin, glucose, cholesterol and triglycerides metabolism. They reduce metabolic syndrome and multiple comorbidities of obesity.

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Section: Discussionsupporting

confidence: 73%

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

Hady

Gołaszewski

Zbucki

et al. 2012

Folia Histochem Cytobiol.

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“…5 The evaluations of GE following LAGB appear to agree QJ;that overall semi-solid GE and function of the stomach below the band is not affected by LAGB. Events in the region of the LAGB and esophageal-gastric junction are less well defined; however, it does not appear to retain food in this region.…”

Section: Gastric Emptying In Lagb Patientsmentioning

confidence: 77%

“…5 In addition, the size of the gastric pouch above the LAGB does not appear large enough to accommodate even the smallest of meals.…”

Section: Introductionmentioning

confidence: 99%

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

Burton

Brown

2011

Int J Obes

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Laparoscopic adjustable gastric banding (LAGB) has rapidly emerged as a popular bariatric procedure because of its safety, efficacy, durability and adjustability. Despite widespread use, there is limited understanding of how it induces weight loss. Previously, it has been classified as a restrictive procedure, physically limiting the patient to a small meal that subsequently slowly empties into the distal stomach. However, the tiny pouch of stomach created above the LAGB appears to be unable to accommodate even the smallest of meals. Therefore, the key mechanism has been hypothesized to be the induction of satiety via, as yet, undefined pathways. The critical question remains: what are the key physiological changes that lead to satiety and weight loss? In successful LAGB patients, a consistent intraluminal pressure at the level of the LAGB of 26.9±19.8 mm Hg is observed. Studies using semi-solid swallows combined with intraluminal pressure recordings have demonstrated that semi-solid transit across the resistance of the LAGB is mediated by repeated esophageal peristaltic contractions (mean 4.5±2.9) that produce episodic flow, interspersed by reflux events. Failed transit results in obstruction and regurgitation, whereas dilatation of the supraband stomach induces severe and intolerable reflux. Overall gastric emptying does not appear to be significantly altered following LAGB. Focused investigations have shown that the supraband stomach is empty of an ingested meal 1-2 min after intake ceases. Considerable progress has been made in understanding the mechanical physiological effects of the LAGB on esophageal and proximal gastric function. These have been correlated with patient outcomes and sensations. On the basis of recent data, it appears that the LAGB activates the peripheral satiety mechanism without physically restricting the meal size. Therefore, it should not be classified as a restrictive procedure. The precise mechanism of weight loss with the LAGB remains to be delineated.

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“…After gastric fundus removal, ghrelin levels decrease in both the fasting and postprandial states, but it is not known whether these changes explain the augmentation in PYY levels that are observed. A second explanation could be that SG produces a decrease in gastric acid secretion and a faster gastric emptying rate (28), an effect not observed in other restrictive surgeries like gastric banding (29). Both of these changes would lead to a faster arrival of undigested nutrients to the duodenum and would therefore increase the PYY response to the meal.…”

Section: Discussionmentioning

confidence: 98%

Medical and Surgical Treatments for Obesity Have Opposite Effects on Peptide YY and Appetite: A Prospective Study Controlled for Weight Loss

Valderas

Irribarra

Boza

et al. 2010

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context:The effects of medical and surgical treatments for obesity on peptide YY (PYY) levels, in patients with similar weight loss, remain unclear.Objective: The objective of the study was to assess PYY and appetite before and after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and medical treatment (MED).Design: This was a prospective, controlled, nonrandomized study. Setting:The study was conducted at the Departments of Nutrition and Digestive Surgery at a university hospital.Participants: Participants included three groups of eight patients with similar body mass indexes (RYGB 37.8 Ϯ 0.8, SG 35.3 Ϯ 0.7, and MED 39.1 Ϯ 1.7 kg/m 2 , P ϭ NS) and eight lean controls (body mass index 21.7 Ϯ 0.7 kg/m 2 ). Main Outcome Measures:Total plasma PYY, hunger, and satiety visual analog scales in fasting and after ingestion of a standard test meal were measured.Results: At baseline there were no differences in the area under the curve (AUC) of PYY, hunger, or satiety in obese groups. Two months after the interventions, RYGB, SG, and MED groups achieved similar weight loss (17.7 Ϯ 3, 14.9 Ϯ 2.4, 16.6 Ϯ 4%, respectively, P ϭ NS). PYY AUC increased in RYGB (P Ͻ 0.001) and SG (P Ͻ 0.05) and did not change in MED. PYY levels decreased at fasting, 30 min, and 180 min after a standard test meal in MED (P Ͻ 0.05). Hunger AUC decreased in RYGB (P Ͻ 0.05). Satiety AUC increased in RYGB (P Ͻ 0.05) and SG (P Ͻ 0.05). Appetite did not change in MED. PYY AUC correlated with satiety AUC (r ϭ 0.35, P Ͻ 0.05).Conclusion: RYGB and SG increased PYY and reduced appetite. MED failed to produce changes. Different effects occur despite similar weight loss. This suggests that the weight-loss effects of these procedures are enhanced by an increase in PYY and satiety. O ver the last 30 yr, the prevalence of obesity has increased worldwide, becoming one of the world's most important public health problems and resulting in great efforts toward the development of strategies to treat this condition (1). However, medical interventions for obesity, including diet, physical activity, behavioral therapy, and weight loss drugs, are associated with poor weight reduction and are difficult to sustain in the long term (2). These modest results can be explained by several factors, one being that the human body responds to weight

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Weight Loss After Laparoscopic Adjustable Gastric Banding is not Caused by Altered Gastric Emptying

Cited by 42 publications

References 25 publications

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

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

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

Medical and Surgical Treatments for Obesity Have Opposite Effects on Peptide YY and Appetite: A Prospective Study Controlled for Weight Loss

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