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Comparison of various prediction models in the effect of laparoscopic sleeve gastrectomy on type 2 diabetes mellitus in the Chinese population 5 years after surgery

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Chinese Medical Journal 2024年第3期137卷 320-328页

作者： Chengyuan Yu Liang Wang Guangzhong Xu Guanyang Chen Qing Sang Qiqige Wuyun Zheng Wang Chenxu Tian Nengwei Zhang Surgery Centre of Diabetes Mellitus Peking University Ninth School of Clinical MedicineBeijing 100038China Department of Surgery Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China

Background:The effect of bariatric surgery on type 2 diabetes mellitus(T2DM)control can be assessed based on predictive models of T2DM *** models have been externally verified ***,long-term validated results after laparoscopic sleeve gastrectomy(LSG)surgery are *** best model for the Chinese population is also ***:We retrospectively analyzed Chinese population data 5 years after LSG at Beijing Shijitan Hospital in China between March 2009 and December *** independent t-test,Mann–Whitney U test,and chi-squared test were used to compare characteristics between T2DM remission and non-remission *** evaluated the predictive efficacy of each model for longterm T2DM remission after LSG by calculating the area under the curve(AUC),sensitivity,specificity,Youden index,positive predictive value(PPV),negative predictive value(NPV),and predicted-to-observed ratio,and performed calibration using Hosmer–Lemeshow test for 11 prediction ***:We enrolled 108 patients,including 44(40.7%)men,with a mean age of 35.5 *** mean body mass index was 40.3±9.1 kg/m^(2),the percentage of excess weight loss(%EWL)was(75.9±30.4)%,and the percentage of total weight loss(%TWL)was(29.1±10.6)%.The mean glycated hemoglobin A1c(HbA1c)level was(7.3±1.8)%preoperatively and decreased to(5.9±1.0)%5 years after *** 5-year postoperative complete and partial remission rates of T2DM were 50.9%[55/108]and 27.8%[30/108],*** models,i.e.,"ABCD",individualized metabolic surgery(IMS),advanced-DiaRem,DiaBetter,Dixon et al’s regression model,and Panunzi et al’s regression model,showed a good discrimination ability(all AUC>0.8).The"ABCD"(sensitivity,74%;specificity,80%;AUC,0.82[95%confidence interval[CI]:0.74–0.89]),IMS(sensitivity,78%;specificity,84%;AUC,0.82[95%CI:0.73–0.89]),and Panunzi et al’s regression models(sensitivity,78%;specificity,91%;AUC,0.86[95%CI:0.78–0.92])showed good *** the Hosmer–Lemeshow g

关键词： Type 2 diabetes mellitus Risk prediction models External validation sleeve gastrectomy Bariatric surgery

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Novel subtype of obesity influencing the outcomes of sleeve gastrectomy:Familial aggregation of obesity

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World Journal of Gastroenterology 2024年第13期30卷 1887-1898页

作者： Ze-Yu Wang Yun-Fei Qu Tian-Ming Yu Zeng-Lin Liu Yu-Gang Cheng Ming-Wei Zhong San-Yuan Hu Department of General Surgery The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan HospitalJinan 250000Shandong ProvinceChina Department of Postgraduate Shandong First Medical University and Shandong Academy of Medical SciencesJinan 250000Shandong ProvinceChina Department of General Surgery Shandong Provincial Qianfoshan HospitalCheeloo College of Medicine Shandong UniversityJinan 250000Shandong ProvinceChina State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine Lunan Pharmaceutical Group Co.Ltd.Linyi 276005Shandong ProvinceChina

BACKGROUND Differences in the preoperative characteristics and weight loss outcomes after sleeve gastrectomy(SG)between patients with familial aggregation of obesity(FAO)and patients with sporadic obesity(SO)have not been *** To explore the impact of SG on weight loss and the alleviation of obesity-related comorbidities in individuals with *** A total of 193 patients with obesity who underwent SG were *** with FAO/SO were matched 1:1 by propensity score matching and were categorized into 4 groups based on the number of first-degree relatives with obesity(1 SO vs 1FAO,2SO vs 2FAO).The baseline characteristics,weight loss outcomes,prevalence of obesity-related comorbidities and incidence of major surgeryrelated complications were compared between *** We defined FAO as the presence of two or more first-degree relatives with *** with FAO did not initially show significant differences in baseline data,short-term postoperative weight loss,or obesity-related comorbidities when compared to patients with SO ***,distinctions between the two groups became evident at the two-year mark,with statistically significant differences in both percentage of total weight loss(P=0.006)and percentage of excess weight loss(P<0.001).The FAO group exhibited weaker remission of type 2 diabetes mellitus(T2DM)(P=0.031),hyperlipidemia(P=0.012),and non-alcoholic fatty liver disease(NAFLD)(P=0.003)as well as a lower incidence of acid reflux(P=0.038).CONCLUSION FAO patients is associated with decreased mid-to-long-term weight loss outcomes;the alleviation of T2DM,hyperlipidemia and NAFLD;and decreased incidence of acid reflux postoperatively.

关键词： Obesity Bariatric surgery sleeve gastrectomy Family history Weight loss

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Functional Roux-en-Y Gastric Bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional Cases of sleeve gastrectomy

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Surgical Science 2024年第3期15卷 135-158页

作者： Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Paulo Reis Esselin de Melo Rui Ribeiro Paula Volpe Carlos Eduardo Domene Victor Dib Institute Manaus Brazil Gastrobese Clinic Passo Fundo Brazil Paulo Reis Institute of Bariatric Surgery Goi&#226nia Brazil Alfredo Nasser University Center (UNIFAN) Goi&#226nia Brazil Lusíadas Amadora Hospital Lisboa Portugal Integrated Center for Advanced Medicine (CIMAMED) S&#227o Paulo Brazil

Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous sleeve gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-sleeve gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution

关键词： Roux-en-Y Gastric Bypass sleeve gastrectomy Jejuno Gastric Bypass Vagus Nerve Vagotomy Bariatric Surgery

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Management and outcomes of gastric leak after sleeve gastrectomy:results from the 2010-2020 national registry

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Chinese Medical Journal 2023年第16期136卷 1967-1976页

作者： Mengyi Li Na Zeng Yang Liu Xitai Sun Wah Yang Yanjun Liu Zhongqi Mao Qiyuan Yao Xiangwen Zhao Hui Liang Wenhui Lou Chiye Ma Jinghai Song Jianlin Wu Wei Yang Pin Zhang Liyong Zhu Peirong Tian Peng Zhang Zhongtao Zhang for the Greater China Metabolic and Bariatric Surgery Database(GC-MBD)study group Department of General Surgery Beijing Friendship HospitalCapital Medical University&National Clinical Research Center for Digestive DiseasesBeijing 100050China School of Public Health Peking UniversityBeijing 100191China Department of General Surgery Nanjing Drum Tower HospitalNanjingJiangsu 210008China Department of Metabolic and Bariatric Surgery The First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong 510630China Center of Gastrointestinal and Minimally Invasive Surgery Department of General SurgeryThe Third People’s Hospital of Chengdu&The Affiliated Hospital of Southwest Jiaotong UniversityChengduSichuan 610014China Department of General Surgery The First Affiliated Hospital of Soochow UniversitySuzhouJiangsu 215006China Center for Obesity and Metabolic Surgery Huashan HospitalFudan UniversityShanghai 200030China Department of Metabolic and Bariatric Surgery Xiaolan People’s Hospital of ZhongshanZhongshanGuangdong 528415China Department of General Surgery First Affiliated Hospital with Nanjing Medical UniversityNanjingJiangsu 226399China Department of General Surgery Zhongshan HospitalShanghai 200032China Department of Gastrointestinal Surgery Dongfang Hospital of ShaghaiShanghai 200120China Department of General Surgery Beijng HospitalBeijing 100730China Department of Gastrointestinal Surgery Zibo Central HospitalZiboShandong 255020China Department of Hepatobiliary Surgery First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710061China Department of Bariatric and Metabolic Surgery Shanghai Jiao Tong University affiliated Sixth People’s HospitalShanghai 200233China Department of Gastrointestinal Surgery The Third Xiangya Hospital of Central South UniversityChangshaHunan 410013China 不详

Background:Management of gastric leak after sleeve gastrectomy(SG)is challenging due to its unpredictable *** aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world ***:To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry.A cumulative sum analysis was used to identify a fitting curve of gastric leak *** Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant *** logistic regression analysis was conducted to determine the predictors of acute ***:A total of 78 cases of SG leaks were collected with an incidence of 0.5%(78/15,721)from this registry(6 patients who had the primary SG in non-participating centers).After accumulating 260 cases in a bariatric surgery center,the leak rate decreased to a stably low value of under 1.17%.The significant differences presented in sex,waist circumference,and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population(P=0.005,=0.026,50%,whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment(P=0.013).Precise dissection in the His angle area was independently associated with a lower acute leak rate,whereas preservation≥2 cm distance from the His angle area was an independent risk ***:Male sex,elevated waist circumference,hypoproteinaemia,and type 2 diabetes are risk factors of gastric leaks after *** surgical

关键词： sleeve gastrectomy Gastric leak National registry

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Fibroblast growth factor 15,induced by elevated bile acids,mediates the improvement of hepatic glucose metabolism after sleeve gastrectomy

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World Journal of Gastroenterology 2023年第21期29卷 3280-3291页

作者： Meng Wei Wei-Bo Cao Ru-Dong Zhao Dan-Ping Sun Yi-Ze Liang Ya-Di Huang Ze-Wei Cheng JunOuyang Wen-Shuo Yang Wen-Bin Yu Department of General Surgery Qilu Hospital of Shandong UniversityJinan 250012Shandong ProvinceChina

BACKGROUND Fibroblast growth factor(FGF)15/19,which is expressed in and secreted from the distal ileum,can regulate hepatic glucose metabolism in an endocrine *** levels of both bile acids(BAs)and FGF15/19 are elevated after bariatric ***,it is unclear whether the increase in FGF15/19 is induced by ***,it remains to be understood whether FGF15/19 elevations contribute to improvements in hepatic glucose metabolism after bariatric *** To investigate the mechanism of improvement of hepatic glucose metabolism by elevated BAs after sleeve gastrectomy(SG).METHODS By calculating and comparing the changes of body weight after SG with SHAM group,we examined the weight-loss effect of *** oral glucose tolerance test(OGTT)test and area under the curve of OGTT curves were used to assess the anti-diabetic effects of *** detecting the glycogen content,expression and activity of glycogen synthase as well as the glucose-6-phosphatase(G6Pase)and phosphoenolpyruvate carboxykinase(Pepck),we evaluated the hepatic glycogen content and gluconeogenesis *** examined the levels of total BA(TBA)together with the farnesoid X receptor(FXR)-agonistic BA subspecies in systemic serum and portal vein at week 12 *** the histological expression of ileal FXR and FGF15 and hepatic FGF receptor 4(FGFR4)with its corresponding signal pathways involved in glucose metabolism were *** After surgery,food intake and body weight gain of SG group was decreased compare with the SHAM *** hepatic glycogen content and glycogen synthase activity was significantly stimulated after SG,while the expression of the key enzyme for hepatic gluconeogenesis:G6Pase and Pepck,were *** levels in serum and portal vein were both elevated after SG,the FXR-agonistic BA subspecies:Chenodeoxycholic acid(CDCA),lithocholic acid(LCA)in serum and CDCA,DCA,LCA in portal vein were all higher in SG group than that in SHAM ***,the ileal

关键词： sleeve gastrectomy Fibroblast growth factor 15 Bile acids Hepatic glucose metabolism Type 2 diabetes mellitus

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sleeve gastrectomy Associated with Antral Lesion Resection and Roux-en-Y Antrojejunal Reconstruction

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Surgical Science 2023年第5期14卷 360-376页

作者： Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Carlos Eduardo Domene Paulo Reis Esselin de Melo Rui Ribeiro Gabriela Trentin Scortegagna Elinton Adami Chaim Victor Dib Institute Manaus Brazil Gastrobese Clinic Passo Fundo Brazil Integrated Center for Advanced Medicine (CIMA) S&#227o Paulo Brazil Paulo Reis Institute of Bariatric Surgery Goi&#226nia Brazil General Surgery Unit Alfredo Nasser University Center (UNIFAN) Goi&#226nia Brazil Luziadas Hospital Lisboa Portugal Department of Surgery Faculty of Medical Sciences (FCM) at UNICAMP Campinas Brazil

Obesity has been growing worldwide, reaching epidemic proportions. Bariatric surgery is the most effective and durable treatment for severe obesity and related diseases. Roux-en-Y Gastric Bypass (RYGB) and sleeve gastrectomy (SG) are the most frequently performed bariatric operations, with long-term good results, in terms of weight loss and comorbidities control. Gastroesophageal Reflux Disease (GERD) is commonly associated with obesity. In general, it precludes the indication of sleeve gastrectomy, since this technique has a refluxogenic potential, as shown in many studies. In such cases, RYGB is considered the best surgery, reaching good weight loss and gastroesophageal reflux disease control. The drawback of this technique is that it leaves the remnant stomach, the duodenum, and the proximal part of the jejunum inaccessible. Besides, RYGB makes transoral endoscopic access to the biliary tree impossible. For all these reasons, this bariatric technique is not indicated in cases of gastric polyposis, gastric dysplasia, or strong family history of cancer, among others. We report a case of a morbidly obese patient with intense GERD, for whom a RYGB was precluded due to her strong family history of cancer, even knowing that it would be the best choice for reflux disease control. Instead, SG was chosen, even knowing it could worsen the gastroesophageal reflux disease. The patient signed an informed consent, after being fully enlightened about the risks. During the surgery, a small subserosal whitish lesion was detected, near the pylorus, on the anterior wall of the antrum. Thinking in a Gastrointestinal Stromal Tumor (GIST), it was resected, with a 2 cm safety margin, leaving a 4 to 5 cm hole on the gastric wall. The decision to maintain the proposed sleeve gastrectomy was made, to avoid leaving a remnant stomach, in a patient with such a strong family history of cancer. In the area of the resected lesion, an intraoperative decision was made not to just close the big ga

关键词： Roux-en-Y Gastric Bypass sleeve gastrectomy Jejunum Gastric Bypass Bariatric Surgery

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sleeve gastrectomy ameliorates endothelial function and prevents lung cancer by normalizing endothelin-1 axis in obese and diabetic rats

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World Journal of Gastroenterology 2020年第20期26卷 2599-2617页

作者： Rexiati Ruze Ya-Cheng Xiong Jian-Wen Li Ming-Wei Zhong Qian Xu Zhi-Bo Yan Jian-Kang Zhu Yu-Gang Cheng San-Yuan Hu Guang-Yong Zhang Department of General Surgery Shandong Provincial Qianfoshan HospitalShandong UniversityJinan 250014Shandong ProvinceChina Department of General Surgery Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai 200025China Department of General Surgery The First Affiliated Hospital of Shandong First Medical UniversityJinan 250014Shandong ProvinceChina Department of General Surgery Qilu Hospital of Shandong UniversityJinan 250012Shandong ProvinceChina

BACKGROUND Previous evidence has implied that obesity is an independent risk factor for developing *** closely related to obesity,type 2 diabetes mellitus provides a suitable environment for the formation and metastasis of tumors through multiple *** bariatric surgeries are effective in preventing and lowering the risk of various types of cancer,the underlying mechanisms of this effect are not clearly *** To uncover the role and effect of sleeve gastrectomy(SG)in preventing lung cancer in obese and diabetic *** SG was performed on obese and diabetic Wistar rats,and the postoperative transcriptional and translational alterations of the endothelin-1(ET-1)axis in the lungs were compared to sham-operated obese and diabetic rats and age-matched healthy controls to assess the improvements in endothelial function and risk of developing lung cancer at the postoperative 4 th,8 th,and 12 th *** risk wasalso evaluated using nuclear phosphorylation of H2 A histone family member X as a marker of DNA damage(double-strand break).RESULTS Compared to obese and diabetic sham-operated rats,SG brought a significant reduction to body weight,food intake,and fasting blood glucose while improving oral glucose tolerance and insulin *** addition,ameliorated levels of gene and protein expression in the ET-1 axis as well as reduced DNA damage indicated improved endothelial function and a lower risk of developing lung cancer after the *** Apart from eliminating metabolic disorders,SG improves endothelial function and plays a protective role in preventing lung cancer via normalized ET-1 axis and reduced DNA damage.

关键词： sleeve gastrectomy Lung cancer Endothelin-1 axis Endothelial dysfunction DNA damage Obesity

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Laparoscopic sleeve gastrectomy Outcomes

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Surgical Science 2022年第4期13卷 216-221页

作者： Mohannad Eledreesi Mohammed Alrayas Ayman Aledreesi Nawaf Alharthi Youssef Alishi Hussam Adi Abdullah Alzharani Turki Alhawiti Department of Surgery King Salman Aramed Forces Hospital Tabuk KSA

Introduction: sleeve gastrectomy was first defined in 1990 as a part of the duodenal switch procedure with the formation of a narrow stomach tube along the small curvature of the stomach. Later, researchers proposed that Laparoscopic leave gastrectomy (LSG) reduced the risk profile of the duodenal switch procedure in high risk patients. Additionally, LSG was accepted as a rapid single bariatric surgical procedure due to its simplicity and efficacy. The aim of this study was to describe the outcomes of LSG at a single bariatric unit in King Salman North West Armed Forced Hospital (KSAFH), Tabuk, Saudi Arabia. Objective: To compare outcomes of primary LSG regarding pre and post operative sleep apnea, diabetes mellitus (DM), arterial hypertension (HTN), bronchial asthma, female urinary incontinence, infertility, and gastroesophageal reflux (GERD). We will assess our complications according to the Clavein-Dindo classification. We reviewed the medical records of patients who underwent LSG in King Salman Armed Forces Hospital from 1/1/2015 till 31/6/2017. Methods: This retrospective comparative study is performed in the Department of Surgery, KSAFH. All patients are instructed for follow-up at 1 week and 1, 3, 6, 12, 18, 24 months postoperatively. Laboratory tests are requested every 6 months post op. Improvement of Comorbidities assessed post-operatively. Surgical Complications reported according to the Clavein-Dindo classification. Our results were compared with international studies. Inclusion criteria (more than 14 years, morbid obese with BMI > 40 and obese class 11 with comorbidities). Exclusion criteria (less than 14 years, BMI < 35 and BMI < 40 with no medical illness, revisional cases). Results: A total of 127 patients underwent LSG at King Salman Armed Forces Hospital from 1/1/2015 till 31/5/2017. Of these, 40 were male (31.5%) and 87 were female (68.5%). The mean age was 35 years. Comorbidities included diabetes 31 (24.4%),

关键词： gastrectomy Morbid Obesity sleeve gastrectomy

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Laparoscopic sleeve gastrectomy following Pylorus-Preserving Pancreaticoduodenectomy

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Surgical Science 2023年第5期14卷 355-359页

作者： Chien-Hua Lin Jing-Jim Ou Yueh-Tsung Lee Hurng-Sheng Wu Department of Surgery Chang Bing Show Chwan Memorial Hospital Taiwan IRCAD Taiwan

Background: A 35-year-old married female (68 kg, 150 cm, BMI: 30.2) with pancreatic divisum complicated chronic pancreatitis and underwent pylorus-preserving pancreaticoduodenectomy in 2010. After that, her condition was well. However, body weight gained progressively to 76 kg (BMI: 33.7) and hypertension developed. During these two years, tried exercise and medication control for hypertension, but in vain. She received a laparoscopic sleeve gastrectomy in October 2013. The post-operative course was uneventful. Methods: We applied three ports for laparoscopic operation, including two 12 mm and one 5 mm trocars. The liver was not needed to be elevated due to adhesion. The operative time was 75 minutes. Results: The patient’s body weight was 10 kg reduced in the first two months and reduced to 59 kg 6 months later. Conclusions: We report a case that received laparoscopic sleeve gastrectomy following pylorus-preserving pancreaticoduodenectomy due to pancreatic divisum. This case encourages us to extend the indication of laparoscopic sleeve gastrectomy.

关键词： sleeve gastrectomy Morbid Obesity Obesity Pancreatectomy

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Effects of sleeve gastrectomy Surgery with Modified Jejunoileal Bypass on Body Weight, Food Intake and Metabolic Hormone Levels of Rats

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2011年第6期31卷 784-788页

作者：严玲玲朱占永吴丹周启星吴毅平 Department of Plastic Surgery Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Department of Plastic Surgery Wuhan Medical Care Center for Women and Children Department of Plastic Surgery Renmin Hospital of Wuhan University Department of Plastic Surgery Hubei Medical Care Center for Women and Children

This study examined the effects of a combined surgery of sleeve gastrectomy （SG） and modified jejunoileal bypass （JIB） on the body weight, food intake, and the plasma levels of active glucagon-like peptide-1 （GLP-1） and total ghrelin of rats. Rats were divided into 3 groups in terms of different surgical protocol： SG-JIB （n=12）, SG （n=12）, JIB （n=12） and sham surgery groups （n-10）. In SG-JIB group, rats was subjected to sleeve gastrectomy and end to side anastomosis of part of the jejunum （25 cm from the ligament of Treitz） to the ileum 25 cm proximal to the cecum. The body weight and food intake were evaluated during 10 consecutive weeks postoperatively. The levels of active GLP-1 and total ghrelin in the plasma of the rats were measured by ELISA assay. The results showed that the SG-JIB treated rats relative to SG- or JIB-treated ones produced a sustained reduction in food intake and weight gain. The level of active GLP-1 was elevated and total ghrelin level decreased in SG-JIB-treated rats as compared with SG- or JIB-treated ones. It was concluded that SG-JIB could efficiently reduce the body weight and food intake, alter obesity-related hormone levels of the rats, indicating that SG-JIB may be potentially used for the treatment of obesity.

关键词： sleeve gastrectomy modified jejunoileal bypass body weight food intake glucagon-like peptide- 1 ghrelin

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