Background
Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure that has several
advantages over Roux-en-Y gastric bypass, but data on the effectiveness of this procedure
on metabolic syndrome have rarely been reported.
Methods
This case control study compared the incidence of low grade systemic inflammation,
insulin resistance, anthropometrics, lipid disturbances, and metabolic syndrome in
12 patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP) and 10 patients
undergoing LSG, matched for age, sex, body mass index (BMI), and HbA1c.
Results
At 6 months after surgery, there was no significant difference in any of the parameters
investigated. Metabolic syndrome improved in all five patients undergoing LRYGBP and
in 4 out of 6 patients undergoing LSG (ns). At 1 year after surgery, patients in the
LRYGBP group had a significantly lower BMI (32.6 ± 5.1 vs 36.5 ± 2.5 kg/m2; P < .05) and percent of excess BMI lost (70.1 ± 20.5 vs 55.3 ± 12.8; P < .05), and had significantly lower plasma levels of C-reactive protein (2.3 ± 1.5
vs 5.1 ± 4.6 mg/L; P < .05), total cholesterol (4.7 ± 1 vs 5.6 ± 0.3 mmol/L; P < .001) and LDL cholesterol (2.7 ± 0.7 vs 3.7 ± 0.3 mmol/L; P < .001). Remission of metabolic syndrome was significantly less common after LSG
at 1 year than LRYGBP (3 vs 0 patients; P < .05).
Conclusion
In this limited study patients undergoing LRYGBP demonstrated significantly lower
BMIs, improved lipid profiles, decreased systemic low-grade inflammation and less
metabolic syndrome than those with LSG at 1-year follow-up.
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References
- A potential decline in life expectancy in the United States in the 21st Century.N Engl J Med. 2005; 352: 1138-1145
- Obesity.Lancet. 2005; 366: 1197-1209
- Health ramifications of the obesity epidemic.Surg Clin North Am. 2005; 85: 681-701
- Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.JAMA. 2003; 289: 76-79
- Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey.JAMA. 2002; 287: 356-359
- Metabolic syndrome–a new world-wide definition. A Consensus Statement from the International Diabetes Federation.Diabet Med. 2006; 23: 469-480
- C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14719 initially healthy American women.Circulation. 2003; 107: 391-397
- Elevated C-reactive protein levels in overweight and obese adults.JAMA. 1999; 282: 2131-2135
- C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue?.Arterioscler Thromb Vasc Biol. 1999; 19: 972-978
- Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures.Am J Med. 2008; 121: 885-893
- Impact of laparoscopic Roux-en-Y gastric bypass on metabolic syndrome, inflammation, and insulin resistance in super versus morbidly obese women.Obes Surg. 2009; 19: 577-582
- Laparoscopic sleeve gastrectomy for morbid obesity.World J Gastroenterol. 2008; 14: 821-827
- Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure.Obes Surg. 2010; 20: 271-275
- Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel.Ann Intern Med. 1991; 115: 956-961
- The assessment of insulin resistance in man.Diabet Med. 2002; 19: 527-534
- Two-step laparoscopic duodenal switch for superobesity: a feasibility study.Surg Endosc. 2009; 23: 2385-2389
- Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects.Obes Surg. 2008; 18: 1077-1082
- Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity.Surg Endosc. 2006; 20: 859-863
- Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients.Obes Surg. 2006; 16: 1138-1144
- Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion.Surgery. 2010; 147: 664-669
- Early postoperative insulin-resistance changes after sleeve gastrectomy.Obes Surg. 2010; 20: 50-55
- Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial.Ann Surg. 2009; 250: 234-241
- Surgery as an effective early intervention for diabesity: why the reluctance?.Diabetes Care. 2005; 28: 472-474
- Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.N Engl J Med. 2004; 351: 2683-2693
- Inflammation and metabolic disorders.Nature. 2006; 444: 860-867
- Inhibition of C-reactive protein in morbidly obese patients after laparoscopic sleeve gastrectomy.Obes Surg. 2009; 19: 456-460
Article info
Publication history
Published online: October 08, 2010
Accepted:
August 24,
2010
Footnotes
A.I. and R.A. contributed equally to this manuscript.
Supported by grants from the Institut National de la Santé et de la Recherche Médicale (France); the University of Nice, the Programme Hospitalier de Recherche Clinique (CHU of Nice), and charities (AFEF/Schering-Plough/ROCHE and SNFGE to AT).
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.