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Changes of Ghrelin/GOAT axis and m TOR pathway in the hypothalamus after sleeve gastrectomy in obese type-2 diabetes rats

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World Journal of Gastroenterology 2017年第34期23卷 6231-6241页

作者： Qiang Wang Wei Tang Wen-Sheng Rao Xin Song Cheng-Xiang Shan Wei Zhang Department of General Surgery Changzheng HospitalSecond Military Medical University Department of Surgery University of Tokyo Hospital

AIM To examine the changes of the ghrelin/ghrelin O-acyltransferase(GOAT) axis and the mammalian target of rapamycin(m TOR) pathway in the hypothalamus after sleeve gastrectomy.METHODS A total of 30 obese type-2 diabetes Sprague-Dawley(SD) rats, 6 wk of age, fed with high-sugar and highfat fodder for 2 mo plus intraperitoneal injection of streptozotocin were randomly divided into three groups: non-operation group(S0 group, n = 10), sham operation group(Sh group, n = 10) and sleeve gastrectomy group(SG group, n = 10). Data of body mass, food intake, oral glucose tolerance test(OGTT), acylated ghrelin(AG) and total ghrelin(TG) were collected and measured at the first day(when the rats were 6 wk old), preoperative day 3 and postoperative week 8. The m RNA expression of preproghrelin, GOAT and neuropeptide Y(NPY), and protein expression of ghrelin, GOAT, GHSR and the m TOR pathway(p-Akt, p-m TOR and p-S6) were measured in the hypothalamus.RESULTS SG can significantly improve metabolic symptoms by reducing body mass and food intake. The obese rats showed lower serum TG levels and no change in AG, but the ratio of AG/TG was increased. When compared with the S0 and Sh groups, the SG group showed decreased TG(1482.03 ± 26.55, 1481.49 ± 23.30 and 1206.63 ± 52.02 ng/L, respectively, P 0.05). As a result, the ratio of AG/TG further increased in the SG group(0.103 ± 0.009, 0.105 ± 0.013 and 0.12 ± 0.016, respectively, P 0.05) in the hypothalamus. The protein levels of p-Akt, p-m TOR and p-S6 were higher in the SG group, which indicated that the hypothalamic m TOR pathway was activated after SG at the postoperative week 8. CONCLUSION The reduction of ghrelin expression and act

关键词： Ghrelin Ghrelin O-acyltransferase Type-2 糖尿病视下丘肥胖袖子 gastrectomy rapamycin 的哺乳动物的目标

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Effects of sleeve gastrectomy plus trunk vagotomy compared with sleeve gastrectomy on glucose metabolism in diabetic rats

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World Journal of Gastroenterology 2017年第18期23卷 3269-3278页

作者： Teng Liu Ming-Wei Zhong Yi Liu Xin Huang Yu-Gang Cheng Ke-Xin Wang Shao-Zhuang Liu San-Yuan Hu Department of General Surgery Qilu Hospital of Shandong University Health and Family Planning Commission of Shandong Provincial Medical Guidance Center

AIM To investigate the effects of sleeve gastrectomy plus trunk vagotomy(SGTV) compared with sleeve gastrectomy(SG) in a diabetic rat model.METHODS SGTV, SG, TV and Sham operations were performed on rats with diabetes induced by high-fat diet and streptozotocin. Body weight, food intake, oral glucose tolerance test, homeostasis model assessment of insulin resistance(HOMA-IR), hepatic insulin signaling(IR, IRS1, IRS2, PI3 K and AKT), oral glucose stimulatedinsulin secretion, GLP-1 and ghrelin were compared at various postoperative times.RESULTS Both SG and SGTV resulted in better glucose tolerance, lower HOMA-IR, up-regulated hepatic insulin signaling, higher levels of oral glucose-stimulated insulin secretion, higher postprandial GLP-1 and lower fasting ghrelin levels than the TV and Sham groups. No significant differences were observed between the SG and SGTV groups. In addition, no significant differences were found between the TV and Sham groups in terms of glucose tolerance, HOMA-IR, hepatic insulin signaling, oral glucose-stimulated insulin secretion, postprandial GLP-1 and fasting ghrelin levels. No differences in body weight and food intake were noted between the four groups.CONCLUSION SGTV is feasible for diabetes control and is independent of weight loss. However, SGTV did not result in a better improvement in diabetes than SG alone.

关键词：袖子 gastrectomy 箱子 vagotomy 葡萄糖新陈代谢 GLP-1 Ghrelin

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Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

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World Journal of Gastroenterology 2017年第13期23卷 2269-2275页

作者： Fabrizio Rebecchi Marco E Allaix Marco G Patti Francisco Schlottmann Mario Morino Department of Surgical Sciences University of Torino Center for Esophageal Diseases and Swallowing University of North Carolina

Laparoscopic sleeve gastrectomy(LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease(GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h p H monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve(both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Rouxen-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX? Reflux Management System procedure and the Stretta? procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of p H monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5^(th) International Consensus Conference on sleeve gastrectomy.

关键词：袖子 gastrectomy Gastroesophageal 倒流疾病的肥胖监视的回廊 pH 食道的 manometry

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Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity:A prospective study

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World Journal of Gastrointestinal Surgery 2017年第4期9卷 109-117页

作者： Carlos Hoyuela Department of General and Digestive Surgery Hospital PlatóUniversitat Autònoma de Barcelona08006 BarcelonaSpain

AIM To prospectively evaluate the postoperative morbimortality and weight loss evolution of patients who underwent a laparoscopic sleeve gastrectomy(LSG) as a primary bariatric procedure during 5 years of follow-up. METHODS Since 2006,data from patients undergoing a highly restrictive primary LSG have been prospectively registered in a database and analysed. Preoperative co-morbid conditions,operating time,hospital stay,early and late complications rate and evolution of weight loss after 5 years of follow-up were analysed.RESULTS A total of 156 patients were included,74.3% of whom were women. The mean age was 43.2 ± 13.1 years and the mean body mass index(BMI) was 41.5 ± 7.9 kg/m^2. Seventy patients(44.8%) presented a BMI under 40 kg/m^2. The mortality rate was 0%. The leakage rate was 1.2%,and the total 30-d morbidity rate was 5.1%(8/156). With a mean follow-up of 32.7 ± 28.5(range 6-112) mo,the mean percent of excess of weight loss(%EWL) was 82.0 ± 18.8 at 1 year,76.7 ± 21.3 at 3 years and 60.3 ± 28.9 at 5 years. The mean percent of excess of BMI loss(%EBMIL) was 94.9 ± 22.4 at 1 year,89.4 ± 27.4 at 3 years and 74.8 ± 29.4 at 5 years. Patients with preoperative BMI less than 40 kg/m^2 achieved greaterweight loss than did the overall study population. Diabetes remitted in 75% of the patients and HTA improved in 71.7%. CPAP masks were withdrawn in all patients with obstructive sleep apnoea.CONCLUSION LSG built with a narrow 34 F bougie and starting 3 cm from the pylorus proved to be safe and highly effective in terms of weight loss as a stand-alone procedure,particularly in patients with a preoperative BMI lower than 40 kg/m^2.

关键词：袖子 gastrectomy 疾病的肥胖 Bariatric 外科肥胖外科 Laparoscopy 长期的结果 5 年的结果

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Repair of an aberrant subclavian arterioesophageal fistula following esophageal stent placement

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World Journal of Gastrointestinal Surgery 2014年第6期6卷 117-121页

作者： Maen Aboul Hosn Fady Haddad Fadi El-Merhi Bassem Safadi Ali Hallal Division of General Surgery Department of Surgery American University of Beirut Riad El-Solh Beirut 1107 2020 Lebanon Division of Vascular Surgery Department of Sur-gery American University of Beirut Riad El-Solh Beirut 1107 2020 Lebanon Department of Diagnostic Radiology American University of Beirut Riad El-Solh Beirut 1107 2020 Lebanon

A fistula formation between the esophagus and an aberrant right subclavian artery is a rare but fatal com-plication that has been mostly described in the setting of prolonged nasogastric intubation and foreign body erosion. We report a case of a young morbidly obese patient who underwent sleeve gastrectomy that was complicated by a postoperative leak at the level of the gastroesophageal junction. A covered esophageal stent was placed endoscopically to treat the leak. The pa-tient developed massive upper gastrointestinal bleeding secondary to the erosion of the stent into an aberrant retroesophageal right subclavian artery twelve days after stent placement. She was ultimately treated by endovascular stenting of the aberrant right subclavian artery followed by thoracotomy and esophageal repair over a T-tube. This case report highlights the multidis-ciplinary approach needed to diagnose and managesuch a devastating complication. It also emphasizes the need for imaging studies prior to stent deployment to delineate the vascular anatomy and rule out the possi-bility of such an anomaly in view of the growing popu-larity of esophageal stents, especially in the setting of a leak.

关键词：异常锁骨下的动脉 Arterioesophageal 管食道的 stent 食道的修理 Angioplasty 袖子 gastrectomy 漏

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