Following RYGB and JIB, a pleiotropic endocrine response may contribute to the improved glycemic control, appetite reduction, and long-term changes in body weight.
Background: Bariatric surgery is the most effective treatment for achieving long-term weight loss in morbidly obese patients. This study investigated prospective changes in gut hormones and metabolic indices after Roux-en-Y gastric bypass (RYGB).Methods: Six patients were seen before, and at 1, 3 and 6 months after operation. Blood was collected after a 12-h fast and at regular intervals after a mixed 420-kcal meal. Hormonal responses were determined, and comparisons between basal levels and areas under the curve were made. Visual analogue scores were used to assess satiety, hunger and nausea.Results: Mean body mass index decreased from 48·3 kg/m 2 before surgery to 36·4 kg/m 2 6 months after RYGB. This was accompanied by a decrease in fasting leptin (P < 0·001) and insulin (P = 0·021) levels. At 1, 3 and 6 months after operation, progressively increasing peptide YY (P < 0·001), enteroglucagon (P = 0·045) and glucagon-like peptide 1 (P = 0·042) responses were observed. There was no change in fasting ghrelin levels (P = 0·144). Postprandial satiety was significantly increased by 1 month after surgery and this was maintained until the end of the study (P < 0·001).Conclusion: RYGB resulted in substantial weight loss with enhanced postprandial satiety, a sustained weight plateau, and proportionate reduction in fasting insulin and leptin levels. Lack of the expected increase in appetite and food intake as components of a counter-regulatory response may be explained by gut adaptation and the consequent graded rise in the levels of gut hormones that promote satiety.
Background: The SARS-CoV2 virus pandemic pandemic has been characterized for its rapid global dispersion. Obesity is an independent risk factor for the most severe cases of COVID-19. The impact in Argentina differs from others since it was able to anticipate public health interventions in order to atten the contagion curve. Early quarantine achieved better control of the pandemic and, following the recommendations of scienti c societies in countries with higher affectation, elective bariatric surgeries (BS) and in-person consults were suspended. Objective: Bariatric surgeons were surveyed to assess the impact of the pandemic and the measures undertaken on the practice of BS in Argentina. Method: Between April 17 and 21, 2020, an online survey in Google forms was disseminated to bariatric surgeons residing in Argentina. It consists of 40 speci c and non-speci c questions regarding BS practice and COVID pandemic. Consent to participate was obtained from surgeons by completing the survey. Results: 83 surgeons averaging 47.17 years of age responded the survey. Together they performed 10515 BS in 2019. More than 65% stated that more than 50% of their income derives from this activity, and more than 40% depend on more than 75% of it. The average hospital stay was 1.6 days and 85% reported using Intensive Care Unit (ICU) in less than 1% of their patients. According to the scores of hospital affectation issued by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), 54% reported being in Phase I and 34% had not yet been affected by the pandemic. All, except one, suspended the elective BS 7.7 days on average before the appearance of the rst local case. 95.7% offer virtual consults, but 48% obtain no retribution for them. 26% would consider performing BS without a previous endoscopic evaluation. 90% of the surgeons surveyed (75) continue performing other types of surgeries via laparoscopy. In case of operating a patient without suspected SARS-CoV-2 virus infection, 80% would use N95 masks and 56.6% would use face protection shields; two thirds would use smoke lters for the pneumoperitoneum and only 10.8% would continue with the usual protection measures. To restart the elective activity, 56.6% proposed that the hospital should be in phase 0 or I, that the patient should meet certain characteristics for their selection and that the scienti c society must recommend the way to restart of the activity. Patient selection criteria with greater consensus were testing to rule out asymptomatic COVID-positive patients, epidemiology, absence of chronic lung disease, age under 60, and immunological integrity. 19.2% regard sleeve gastrectomy as the ideal BS during the pandemic, and 88% of the surgeons would not change their chosen BS technique based on infection risk. Conclusion: Elective BS is currently suspended in Argentina, although epidemiologically the conditions in the country are not unfavorable. Economic impact for those involved is signi cant. Short-term vision is pessimistic, but recommendations originati...
RYGB leads to increased GLP-2 and mucosal crypt cell proliferation. Other gut hormones from l-cells remain elevated for at least 2 years in humans. These findings may account for the restoration of the absorptive surface area of the gut, which limits malabsorption and contributes to the long-term weight loss after RYGB.
Laparoscopic splenectomy is feasible in patients with giant spleens. However, it is associated with greater morbidity, and the advantages of minimal access surgery in this subgroup of patients are not so clear.
Even moderate obesity leads to endothelial dysfunction. In severely obese subjects, FMD is normalized by weight loss. This improvement in FMD is associated with a decline in inflammatory markers, blood pressure and insulin. The improvement in FMD occurred despite patients remaining significantly obese. These results suggest that an integrated approach to improving endothelial function in obese humans may be necessary.
MAT represent an important source of arterial thrombembolism. A diagnostic workup of the aorta, preferably by means of CT or MRI, should be performed in all patients in whom other sources of embolization have been ruled out. The ideal therapeutic approach to these patients still awaits prospective evaluation. However, based on our experience, MAT can be successfully treated with a definitive surgical procedure in selected patients, with low mortality and morbidity.
Post-surgical improvements in health status may not only be a result of the non-specific consequences of surgery brought about by weight loss, but also a result of the specific impact of the surgical procedure itself. By enforcing a reduction in the amount of food that can be eaten, restrictive surgery seems to generate changes in the individuals' relationship to food and may help to re-establish a perception of control over eating behavior.
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