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Laparoscopic sleeve gastrectomy with second-stage Roux-en-Y gastric bypass are feasible and effective procedures based on short-term results. This two-stage approach is a reasonable alternative for surgical treatment of the high-risk supersuper obese patient.

ObjectiveThe objective of this study was to quantify hormones that regulate energy and glucose homeostasis in order to establish possible mechanisms for the greater efficacy of Roux-en-Y gastric bypass (RYGB) compared with laparascopic adjustable gastric banding (LAGB) in achieving weight loss and improved insulin sensitivity.DesignLongitudinal study of patients undergoing LAGB (n=15) and RYGB (n=28) who were studied prior to surgery and at 2, 12, 26 and 52 wks afterwards.MeasurementsFasting blood samples were drawn at each visit. Postprandial blood samples were also obtained prior to surgery and at 26 and 52 wks. Samples were assayed for peptide YY (PYY), ghrelin, glucagon-like peptide-1 (GLP-1), glucose, insulin, leptin, thyrotropic hormone (TSH), free T4 and free T3.ResultsAt one year there was greater weight loss in RYGB compared with LAGB patients (30% vs 15%), but final body mass index was similar (34 vs 33 kg/m2). At wk 52, area under the curve (AUC) for PYY in RYGB subjects was greater than LAGB (P<0.01). GLP-1 levels at 30 min post-meal were three-fold greater after RYGB compared with LAGB (P<0.001). Conversely, ghrelin AUC increased after LAGB at wk 52 (P<0.05) but tended to decrease after RYGB. Fasting glucose, insulin, and leptin, and HOMA-IR decreased in both groups over time but were significantly lower at wk 52 after RYGB compared with LAGB. The change in leptin correlated significantly with weight loss in LAGB (r=0.86) and RYGB (r=0.77), however, HOMA-IR correlated significantly with weight loss only in LAGB (r=0.78), and not RYGB (r=0.15). There was a significant decrease in free T3 (P<0.01) after RYGB.ConclusionsDifferences in levels of gut hormones may play a role in promoting greater weight loss and insulin sensitivity after RYGB compared with LAGB, however, weight loss may be limited by decreases in free T3 and leptin.

Outpatient thyroidectomy may be undertaken safely in a carefully selected patient population provided that certain precautionary measures are taken to maximize communication and minimize the likelihood of complications.

Aim-The Aim of this study was to measure circulating levels of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and glucagon in patients who had undergone adjustable gastric banding (BND) or Roux-en-Y gastric bypass (RYGB) in order to understand differences in glucose and insulin regulation after these procedures.Methods-This was a cross-sectional study of three groups of women matched for age and body mass index: 1) overweight controls (OW, n = 13); 2) BND (n = 10); and 3) RYGB (n = 13). Venous blood was drawn in the fasted state and throughout a 3-h period after a liquid meal.Results-Fasting glucose was similar between surgery groups, however, fasting insulin concentrations were greater in BND (10.0 μU/ml) compared with RYGB (6.2 μU/ml; P<0.05). Glucose at 60 minutes was significantly lower in RYGB (70 mg/dl; range 38-82) compared with BND (83 mg/dl; range 63-98). GLP-1 levels at 30 minutes were over three-fold higher in RYGB (96 pmol/l) compared with BND and OW (28 pmol/l) controls. GLP-1 and insulin concentrations correlated at 30 minutes only in RYGB (r=0.66; P=0.013). GIP levels at 30 minutes were lower in RYGB (20 pmol/l) compared with BND (31 pmol/l) and OW (33 pmol/l) controls. Peak glucagon levels were similar between groups.Conclusions/interpretation-Exaggerated postprandial GLP-1 and blunted GIP secretion after RYGB may contribute to greater weight loss and improved glucose homeostasis in comparison to BND.

clinicaltrials.gov Identifier: NCT00641251.

Research Methods and Procedures:Four groups of women were studied: lean (n ϭ 8; mean BMI, 21.6 kg/m 2 ); BND (n ϭ 9; BMI, 35.8; 25% weight loss), RYGBP (n ϭ 9; BMI, 34.2; 36% weight loss), and controls matched for BMI to the surgical groups (n ϭ 11; BMI, 34.4). Results: Fasting total peptide YY (PYY) and PYY immunoreactivity were similar among all groups, but the postprandial response in the RYGBP group was exaggerated, such that 30 minutes after the meal, total and PYY (3-36) levels were 2-to 4-fold greater compared with all other groups. Maximal postprandial suppression of total ghrelin was blunted in the BND group (13%) compared with RYGBP (27%). Postprandial suppression of octanoylated ghrelin was also less in BND (29%) compared with RYGBP (56%). Fasting insulin was lower in RYGBP (6.6 U/mL) compared with BND (10.0 U/mL). Compared with lean controls, leptin concentrations were significantly higher in BND but not in RYGBP. There was a greater increase in post-meal satiety in the RYGBP group compared with BND and overweight controls. Discussion: The differences between RYGBP and BND subjects in postprandial concentrations of PYY and ghrelin would be expected to promote increased satiety and earlier meal termination in RYGBP and may aid in greater weight loss. The differences in insulin and leptin concentrations associated with these procedures may also reflect differences in insulin sensitivity and energy partitioning.