Mechanisms of Weight Loss After Sleeve Gastrectomy and Adjustable Gastric Banding: Far More Than Just Restriction

Wang, Yanmin; Guo, Xiaomei; Lu, Xiao; Mattar, Samer G.; Kassab, Ghassan S.

doi:10.1002/oby.22623

Cited by 23 publications

(16 citation statements)

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“…Although it may be counterintuitive that a smaller gastric reservoir does not improve weight loss, this approach is mechanistically supported: weight loss from sleeve gastrectomy has more to do with complex physiologic (eg, gastric emptying time) and neurohormonal factors (eg, eliminating ghrelin secretion from the gastric fundus) than with simple volume restriction. [22][23][24] The decreased capacitance of narrower sleeves may thus increase reflux risk without improving weight loss. In addition, the operations studied were performed after a specialty-wide shift toward more consistent bougie sizing, between 34F and 36F, potentially leading the analysis to underestimate the potential association of bougie size with outcomes.…”

Section: Discussionmentioning

confidence: 99%

Associations Between Video Evaluations of Surgical Technique and Outcomes of Laparoscopic Sleeve Gastrectomy

et al. 2021

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In any surgical procedure, various aspects of technique may affect patient outcomes. As new procedures enter practice, it is difficult to evaluate the association of each aspect of technique with patient outcomes. OBJECTIVE To examine the associations between technique and outcomes in laparoscopic sleeve gastrectomy. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study of bariatric surgery programs participating in a statewide surgical quality improvement collaborative, 30 surgeons submitted intraoperative videos from representative sleeve gastrectomies performed on 6915 patients with morbid obesity. These videos were reviewed by blinded peer surgeons on key technical elements, and 605 reviews were linked to sleeve gastrectomy outcomes of all of the surgeons' patients from January 1, 2015, to December 31, 2016.EXPOSURES Surgeons' technical approaches to 5 controversial aspects of laparoscopic sleeve gastrectomy: dissection of the proximal stomach, sleeve caliber, sleeve anatomy, staple line reinforcement, and leak testing. MAIN OUTCOMES AND MEASURESThe 30-day outcomes were rate of postoperative hemorrhage and staple line leak. The 1-year outcomes were percentage of total weight lost and reflux severity (Gastroesophageal Reflux Disease Health-Related Quality of Life instrument). RESULTS A total of 30 surgeons submitted 46 videos of operations performed on 6915 patients (mean [SD] age, 45.4 [11.7] years; 5494 [79.5%] female; 4706 [68.1%] White).Complete dissection of the proximal stomach was associated with reduced hemorrhage rates (higher ratings for complete mobilization of fundus were associated with a decrease in hemorrhage rate from 2.1% [25th percentile] to 1.0% [75th percentile], P = .01; higher ratings for visualization of the left crus were associated with a decrease in hemorrhage rate from 1.5% to 0.94%, P = .006; and higher ratings for complete division of the short gastrics were associated with a decrease in hemorrhage rate from 2.8% to 1.2%, P = .03). The reduction in hemorrhage rates came at the expense of higher leak rates (higher ratings for complete mobilization of fundus were associated with an increase in leak rate from 0.05% [25th percentile] to 0.16% [75th percentile], P < .001; higher ratings for visualization of the left crus were associated with an increase in leak rate from 0.1% to 0.2%, P = .003; and higher ratings for complete division of the short gastrics were associated with an increase in leak rate from 0.02% to 0.1%, P = .01). Surgeons who stapled more tightly to the bougie had smaller decreases in reflux than those who stapled less tightly (−2.0 to −1.3 on a 50-point scale, P = .002). Staple line reinforcement (buttressing and oversewing) was associated with a small (2 of 1000 cases) decrease in hemorrhage rates. Staple line buttressing was also associated with a similarly small increase in leak rates (1 of 1000 cases). Leak testing was associated with a statistically insignificant change in the staple line leak rate (0.16%-0.22%, P = .47).CONCLUSIONS AND RELEVANCE Variations in su...

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Section: Discussionmentioning

confidence: 99%

Associations Between Video Evaluations of Surgical Technique and Outcomes of Laparoscopic Sleeve Gastrectomy

et al. 2021

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“…The greater fat mass losses observed following RYGB relative to gastric banding might be related to the greater increases in glucagon‐like peptide‐1 (GLP‐1) that occur following RYGB compared with gastric banding 43 . GLP‐1 is known to increase post‐prandial insulin secretion and induce a sensation of satiety, thus making it a key factor for the regulation of glucose and appetite control 44 . This is supported by the 1‐year post‐surgery outcomes of Holter et al, 45 which demonstrated that patients affected by obesity and T2DM who undergo RYGB have a higher insulin secretion rate within the first 60 min and lower glucose levels 120 min after ingesting glucose, compared with those who undergo gastric banding.…”

Section: Discussionmentioning

confidence: 99%

Body composition changes at 12 months following different surgical weight loss interventions in adults with obesity: A systematic review and meta‐analysis of randomized control trials

et al. 2022

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Summary To determine relative lean mass and fat mass changes in adults with obesity following surgical weight loss interventions, a systematic review and meta‐analysis was conducted. The Cochrane Central Register of Controlled Trials, PubMed, Web of Science, EMBASE, and Scopus were screened for eligible studies. Inclusion criteria included randomized controlled trials (RCTs) performed in populations with obesity (body mass index ≥30 kg/m2) aged over 18 years, who underwent any type of bariatric surgery and reported body composition measures via dual‐energy X‐ray absorptiometry or bio‐electrical impedance analysis. Authors conducted full text screening and determined that there were six RCTs eligible for inclusion, with data extracted at 12 months post‐surgery. Meta‐analysis revealed that, relative to gastric banding, Roux‐en‐Y gastric bypass (RYGB) led to greater total body mass loss (mean difference [MD]: −9.33 kg [95% CI: −12.10, −6.56]) and greater fat mass loss (MD: −8.86 kg [95% CI: −11.80, −5.93], but similar lean mass loss (MD: −0.55 kg [95% CI: −3.82, 2.71]. RYGB also led to similar changes in total body mass, fat mass, and lean mass compared with sleeve gastrectomy. RYGB results in greater 12‐month weight and fat loss, but similar changes in lean mass, compared with gastric banding. Further RCTs comparing body composition changes following different bariatric surgery procedures are required.

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“…Further studies are required to determine whether these changes in hormone levels are in fact causal to weight loss. Studies regarding other factors that contribute to bariatric surgeries ( Madsbad et al, 2014 ; Wang et al, 2019 ) such as vagal and hypothalamic activity, role of bile acids, and gut flora alterations are lacking. More studies are encouraged to elucidate the detailed mechanisms of weight and energy regulation and glucose metabolism after use of gastric bariatric devices.…”

Section: Discussionmentioning

confidence: 99%

“…This study suggests that additional factors beyond restriction exist. It seems that gastric motility, neural activity, ghrelin level, concentrations of gut hormones, energy expenditure, bile acids metabolism, and gut microbial diversity play important roles; however, the conclusions varied significantly ( Wang et al, 2019 ). For example, Aron-Wisnewsky et al (2019) observed that gut microbial gene abundance increased after AGB whereas Lee et al (2019) reported an opposite result.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Mechanisms of Gastric Volume-Restriction Bariatric Devices

Wang

Kassab

2021

Front. Physiol.

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Obesity is a chronic disease that affects over 795 million people worldwide. Bariatric surgery is an effective therapy to combat the epidemic of clinically severe obesity, but it is only performed in a very small proportion of patients because of the limited surgical indications, the irreversibility of the procedure, and the potential postoperative complications. As an alternative to bariatric surgery, numerous medical devices have been developed for the treatment of morbid obesity and obesity-related disorders. Most devices target restriction of the stomach, but the mechanism of action is likely more than just mechanical restriction. The objective of this review is to integrate the underlying mechanisms of gastric restrictive bariatric devices in obesity and comorbidities. We call attention to the need for future studies on potential mechanisms to shed light on how current gastric volume-restriction bariatric devices function and how future devices and treatments can be further improved to combat the epidemic of obesity.

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Mechanisms of Weight Loss After Sleeve Gastrectomy and Adjustable Gastric Banding: Far More Than Just Restriction

Cited by 23 publications

References 99 publications

Associations Between Video Evaluations of Surgical Technique and Outcomes of Laparoscopic Sleeve Gastrectomy

Associations Between Video Evaluations of Surgical Technique and Outcomes of Laparoscopic Sleeve Gastrectomy

Body composition changes at 12 months following different surgical weight loss interventions in adults with obesity: A systematic review and meta‐analysis of randomized control trials

Efficacy and Mechanisms of Gastric Volume-Restriction Bariatric Devices

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