Omentectomy added to Roux-en-Y gastric bypass surgery: a randomized, controlled trial

Dillard, Troy H.; Purnell, Jonathan Q.; Smith, Mark D.; Raum, William J.; Hong, Dennis; Laut, Jamie; Patterson, Emma

doi:10.1016/j.soard.2011.09.027

Cited by 47 publications

(24 citation statements)

References 32 publications

(49 reference statements)

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“…There are some reports of surgical removal of visceral fat thorough omentectomy [25,26]. There was no significant difference between RY gastric bypass without omentectomy and with omentectomy in fat mass 12 months after surgery [25]; this is compatible with our result.…”

Section: Discussionsupporting

confidence: 91%

Visceral fat changes after distal gastrectomy according to type of reconstruction procedure for gastric cancer

et al. 2013

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BackgroundNoncancerous causes of death, such as cerebrovascular or cardiac disease, are not rare in patients with gastric cancer who had undergone curative gastrectomy. Metabolic syndrome, characterized by visceral fat accumulation, is a risk factor for cerebrovascular and cardiac diseases. However, there is limited information on the effects of reconstruction procedures on changes in visceral fat after distal gastrectomy. The aim of this study was to analyze the impact of the reconstruction procedure (Roux-en-Y reconstruction (RY) and Billroth I reconstruction (BI)) on changes in visceral fat, as determined using computed tomography.MethodsThe study subjects were 152 patients with gastric cancer who underwent distal gastrectomy with lymphadenectomy between 2002 and 2007. The visceral fat area was measured for one cross-sectional computed tomogram obtained at the level of the umbilicus.ResultsAdjuvant chemotherapy (yes vs. no, P = 0.0006), type of reconstruction (BI vs. RY, P = 0.0146), field of lymph node dissection (

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Section: Discussionsupporting

confidence: 91%

Visceral fat changes after distal gastrectomy according to type of reconstruction procedure for gastric cancer

et al. 2013

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“…Furthermore, a study of weight loss induced by diet/lifestyle intervention showed that a reduction in visceral but not subcutaneous fat mass correlated with metabolic improvement (6). On the other hand, several studies have shown that removal of a subset of visceral adipose tissue (the greater omentum) in connection with bariatric surgery does not cause additional improvements in the metabolic profile (7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

Changes in Subcutaneous Fat Cell Volume and Insulin Sensitivity After Weight Loss

et al. 2014

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OBJECTIVELarge subcutaneous fat cells associate with insulin resistance and high risk of developing type 2 diabetes. We investigated if changes in fat cell volume and fat mass correlate with improvements in the metabolic risk profile after bariatric surgery in obese patients. RESEARCH DESIGN AND METHODSFat cell volume and number were measured in abdominal subcutaneous adipose tissue in 62 obese women before and 2 years after Roux-en-Y gastric bypass (RYGB). Regional body fat mass by dual-energy X-ray absorptiometry; insulin sensitivity by hyperinsulinemic-euglycemic clamp; and plasma glucose, insulin, and lipid profile were assessed. RESULTSRYGB decreased body weight by 33%, which was accompanied by decreased adipocyte volume but not number. Fat mass in the measured regions decreased and all metabolic parameters were improved after RYGB (P < 0.0001). Whereas reduced subcutaneous fat cell size correlated strongly with improved insulin sensitivity (P = 0.0057), regional changes in fat mass did not, except for a weak correlation between changes in visceral fat mass and insulin sensitivity and triglycerides. The curve-linear relationship between fat cell size and fat mass was altered after weight loss (P = 0.03). CONCLUSIONSAfter bariatric surgery in obese women, a reduction in subcutaneous fat cell volume associates more strongly with improvement of insulin sensitivity than fat mass reduction per se. An altered relationship between adipocyte size and fat mass may be important for improving insulin sensitivity after weight loss. Fat cell size reduction could constitute a target to improve insulin sensitivity.Obesity is associated with insulin resistance and dyslipidemia and also with a very high risk of developing type 2 diabetes. Interestingly, studies of bariatric surgery (i.e., techniques that reduce or bypass the stomach in order to achieve weight reduction) show, first, that there is no clear quantitative relationship between the weight loss induced by various surgical procedures and the degree of normalization in insulin sensitivity and other metabolic parameters and, second, that metabolism is markedly improved before any significant weight loss is achieved (1,2). In a hallmark study by Klein et al. (3), a large amount of subcutaneous abdominal adipose tissue was removed from obese subjects by liposuction. This was not accompanied by

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“…When changes in body composition were compared after malabsorptive biliointestinal bypass (BIBP) and restrictive LAGB during a 4-year follow-up, the effects of BIBP were greater on total fat loss and trunk fat 49 . When omentectomy accompanies a laparoscopic Roux-en-Y gastric bypass (RYGB) procedure, changes in glucose homeostasis, lipid levels, and adipokine profile at 90 days postoperatively have been variably reported 50,51 .…”

Section: Expected Benefit On Cvd Risk Factorsmentioning

confidence: 99%

Treatment of Obesity

Wolfe

Kvach

Eckel

2016

Circulation Research

485

192

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This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD) as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by non-surgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the co-morbidities, quality of life and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes, inflammation, obstructive sleep apnea and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors following weight loss, it is reasonable to expect a reduction of CVD events and related mortality following weight loss in populations with obesity. The quality of the current evidence is reviewed and future research opportunities and summaries are stated.

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Omentectomy added to Roux-en-Y gastric bypass surgery: a randomized, controlled trial

Cited by 47 publications

References 32 publications

Visceral fat changes after distal gastrectomy according to type of reconstruction procedure for gastric cancer

Visceral fat changes after distal gastrectomy according to type of reconstruction procedure for gastric cancer

Changes in Subcutaneous Fat Cell Volume and Insulin Sensitivity After Weight Loss

Treatment of Obesity

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