Differential Effects of Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Bypass on Appetite, Circulating Acyl-ghrelin, Peptide YY3-36 and Active GLP-1 Levels in Non-diabetic Humans

Abstract

Laparoscopic Roux-en-Y gastric bypass (LRYGBP) reduces appetite and induces significant and sustainable weight loss. Circulating gut hormones changes engendered by LRYGBP are implicated in mediating these beneficial effects. Laparoscopic sleeve gastrectomy (LSG) is advocated as an alternative to LRYGBP, with comparable short-term weight loss and metabolic outcomes. LRYGBP and LSG are anatomically distinct procedures causing differential entero-endocrine cell nutrient exposure and thus potentially different gut hormone changes. Studies reporting the comparative effects of LRYGBP and LSG on appetite and circulating gut hormones are controversial, with no data to date on the effects of LSG on circulating peptide YY3-36 (PYY3-36) levels, the specific PYY anorectic isoform. In this study, we prospectively investigated appetite and gut hormone changes in response to LRYGBP and LSG in adiposity-matched non-diabetic patients. Anthropometric indices, leptin, fasted and nutrient-stimulated acyl-ghrelin, active glucagon-like peptide-1 (GLP-1), PYY3-36 levels and appetite were determined pre-operatively and at 6 and 12 weeks post-operatively in obese, non-diabetic females, with ten undergoing LRYGBP and eight adiposity-matched females undergoing LSG. LRYGBP and LSG comparably reduced adiposity. LSG decreased fasting and post-prandial plasma acyl-ghrelin compared to pre-surgery and to LRYGBP. Nutrient-stimulated PYY3-36 and active GLP-1 concentrations increased post-operatively in both groups. However, LRYGBP induced greater, more sustained PYY3-36 and active GLP-1 increments compared to LSG. LRYGBP suppressed fasting hunger compared to LSG. A similar increase in post-prandial fullness was observed post-surgery following both procedures. LRYGBP and LSG produced comparable enhanced satiety and weight loss. However, LSG and LRYGBP differentially altered gut hormone profiles.

The Importance of the Gastrointestinal Tract in Controlling Food Intake and Regulating Energy Balance

“…In contrast, the physiological role of endogenous GLP-1 in regulating feeding behavior and bodyweight is less clear-cut. 28 . Importantly, long-acting GLP-1R agonist administration has been shown to lead to sustained weight-reduction with amelioration of obesity-associated comorbidities 4 .…”

Roux-en-Y gastric bypass: effects on feeding behavior and underlying mechanisms

“…The gut hormone system has been extensively investigated in relation to the physiological changes induced by RYGBP (56). In particular, there is now a well-established body of research documenting markedly increased meal-stimulated peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) levels after RYGBP (57)(58)(59)(60)(61)(62)(63)(64)(65)(66). The enhanced gut hormone responses occur as early as one or two days after RYGBP independent of weight loss per se (67), thus implicating a process directly related to the procedure itself.…”

Comparative analysis of laparoscopic sleeve gatrectomy and laparoscopic gastric bypass surgery in patients with type 2 diabetes mellitus and impaired glucose tolerance

“…Высокая метаболическая эффективность ЛЖШ довольно просто объясняется комбинированным механизмом действия данной операции, включаю-щим рестриктивный и мальабсорбтивный компо-ненты. С другой стороны, ЛРРЖ длительное время считалась операцией с изолированным рестриктив-ным механизмом действия, однако проведенные исследования убедительно демонстрируют, что ме-ханизм действия данной операции также является комбинированным, в первую очередь, за счет сни-жения секреции грелина -биохимического меди-атора чувства голода [23][24][25]. Наиболее вероятно, что данное явление связано с удалением большей части желудка при ЛРРЖ, то есть к рестриктивному компоненту операции присоединяется резектив-ный.…”