ObjectiveTo investigate effects of sleeve gastrectomy (SG)-transit bipartition (SG-TB) and simple SG on bariatric and anti-diabetic and protective effect on esophagus reflux. MethodsA total of 36 male Sprague-Dawley rats were used to successfully induce the obesity with type 2 diabetes mellitus (T2DM) model by dietary feeding and receiving intraperitoneal injection of streptozotocin (35 mg/kg), then were randomly averagely divided into SG, SG-TB, and sham operation (SO) groups according to the surgical methods, and 8 rats from each procedure were randomly selected and included to use for experimental observation. The observation period was 12 weeks. The changes of terminal esophageal mucosa were observed at the 12th week after operation. The body weight and food intake were measured every 2 weeks after operation. The fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) blood glucose levels were measured before operation and at the 4th and 12th week after operation. And the changes of glucagon like peptide-1 (GLP-1) and insulin levels were measured before operation and at the 12th week after operation. ResultsThere were no significant differences in all indexes among the 3 groups before operation (P>0.05). ① No esophageal papillomatosis was observed in the SG-TB group at the 12th week after operation, but more severe esophageal papillomatosis was observed in the SG group, and the mucosal height in the SG-TB group was lower than that in the SG group (P<0.05). ② From the 4th week after operation, the body weight and food intake of the SG-TB group and SG group were lower than the SO group (P<0.05), and their changes of these two groups over time were generally stable. While no significant difference was found in the reduction of body weight between the SG-TB group and the SG group (P>0.05), however the food intakes of the SG-TB group were higher than the SG group at the 10th and 12th week after operation (P<0.05). ③ The levels of FBG, OGTT and ITT blood glucoses in the SG-TB group and SG group were lower than in the SO group at the 4th and 12th week after operation (P<0.05) and remained stable after operation. However, no significant difference was found in the FBG and ITT blood glucose level between the SG-TB group and the SG group (P>0.05), while the level of OGTT blood glucose in the SG-TB group was lower than that in the SG group at the 12th week after operation (P<0.05). ④ The levels of GLP-1 in the SG-TB group and SG group were higher than in the SO group and still higher than before operation (P<0.05), while the insulin levels were lower than in the SO group and lower than before operation (P<0.05). ConclusionsFrom preliminary results of this study, change of terminal esophageal mucosa after SG-TB is weaker than that of SG operation, and it is found that SG-TB surgery shows a better trend in blood glucose control as compared with SG operation. However, due to the limitations of sample size, further research and anti-reflux effect of SG-TB operation still need to be verified.
ObjectiveTo compare effectiveness of single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) and single anastomosis sleeve ileal (SASI) bypass on weight loss and glucose regulating as well as difference in micronutrient deficiency in obese rats with type 2 diabetes mellitus. MethodsThirty-six Spraque-Dawley rats fed with high fat diet combined with intraperitoneal injection of low-dose streptozotocin (35 mg/kg) for 1 month were used to induce obese rats with type 2 diabetes mellitus, then were randomly averagely divided into 3 groups: SADI-S group, SASI group, and sham operation (SO) group. Eight rats from numbered rats of each group were randomly selected to carry out experimental observation. The rats’ body weight, food intake, and fasting blood glucose (FBG) were measured from before operation to postoperative 1–6 months. Meanwhile blood was collected before surgery, as well as at month 1 and 6 after surgery for oral glucose tolerance testing (OGTT) and insulin resistance testing (ITT). Serum glucagon-like peptide (GLP-1), hemoglobin, and albumin levels, as well as vitamin B12, calcium, and ferrum concentrations were measured before surgery as well as at month 1 and 6 after surgery. Results① The body weight, food intake (except 5–6 months), and FBG level in the SADI-S group and SASI group were lower than the SO group (P<0.05) from 1- to6-month after operation, and all obviously decreased at month 1 after operation (P<0.05), but there was no statistical differences between the SADI-S group and SASI group (P>0.05). ② The postoperative OGTT and ITT blood glucose levels in the SADI-S group and SASI group were lower than those in the SO group (P<0.05) and were lower than those in the preoperative levels (P<0.05), and the SADI-S group had a lower OGTT blood glucose level than the SASI group at month 6 after operation (P<0.05). ③ The GLP-1 levels of the SADI-S group and SASI group were higher than that of the SO group (P<0.05), and higher than before operation at month 6 after operation (P<0.05) , but there was no statistical difference was found between the SADI-S group and SASI group after operation (P>0.05). ④ The postoperative albumin levels of the SADI-S group and SASI groups= were lower than of the SO group (P<0.05) and were lower than before operation, and albumin level of the SADI-S group was lower than of the SASI group at postoperative month 6 (P<0.05); while the hemoglobin had no statistical differences among the 3 groups (P>0.05). ⑤ The ferrum concentration of the SADI-S group was lower than that of the SASI group and SO group at 1 month after operation (all P<0.05), while it increased slightly at month 6 after operation and had no statistical difference between the SADI-S group and SASI group (P>0.05); the calcium concentrations of the SADI-S group and SASI group only at 6 month after operation were lower than those of the SO group (P<0.05), and were lower as compared with before operation (P<0.05) , but no statistical difference was found between the SADI-S group and SASI group (P>0.05); the vitamin B12 had no statistical differences among the 3 groups (P>0.05). ConclusionsFor obese rats with type 2 diabetes mellitus, SADI-S and SASI have similar weight loss effect. Long-term glucose reduction of SADI-S shows a advantage than SASI, but influence of postoperative micronutrients of SASI is inferior to SASI.
ObjectiveTo investigate the effect of the remnant stomach after gastric bypass (GB) surgery on the weight loss and glucose metabolism in rats with obese and type 2 diabetes mellitus (T2DM).MethodsHigh fat feeding for one month combined with intraperitoneal injection of low-dose streptozotocin was used to induce obese rats with T2DM. Twenty-four rats with obese and type T2DM successfully established were randomly divided into resectional gastric bypass (R-GB) group, GB surgery (GB group), and sham operation (SO) group, eight rats in each group. The weight loss and anti-diabetic effect of the R-GB and GB were compared. Body weight, food intake, and fasting blood glucose (FBG) were measured at week 1 before operation and week 1–8 after the operation. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed using tail venous blood at week 1 before operation and on week 8 after operation (at 0, 30, 60, 90, and 120 min). The levels of serum glucagon like peptide-1 (GLP-1), gastrin, insulin, and glucagon at week 1 before operation and at week 8 after operation were detected, meanwhile the homeostasis model assessment insulin resistance (HOMA-IR) index was calculated.Results① The body weight and food intake of the rats in the R-GB group and GB group were lower than those in the SO group after operation (P<0.05) and which were lower than before operation (P<0.05), but the differences were not significant between the R-GB group and GB group after operation (P>0.05). ② The levels of FBG in the R-GB group only at week 1–4 after operation were lower than those before operation (P<0.05), while which in the GB group at week 1–8 after operation were lower than those before operation and were lower than in the SO group (P<0.05), but which in the R-GB group only at week 2–4 after operation were lower than in the SO group and which were higher than that in the GB group from 3 to 8 weeks after operation (P<0.05). ③ The area under receiver operating characteristic curves (AUCs) of blood glucoses of OGTT and ITT and HOMA-IR index at week 8 after operation were lower than those before operation (P<0.05) in the GB group and which were lower than those the other two groups (P<0.05). ④ The AUC of gastrin level at week 8 after operation was lower than that before operation in the R-GB group and which lower than that in the other two groups (P<0.05). The AUC values of insulin and glucagon levels at week 8 after operation were lower than those before operation in the GB group and which lower than those in the other two groups (P<0.05). The AUC of GLP-1 level at week 8 after operation was higher than that before operation in the GB group and which higher than that in the other two groups (P<0.05).ConclusionsGB could remarkably improve glucose metabolism and weight loss in obese rat with T2DM. Gastric remnant gastrectomy following GB has a remarkable anti-diabetic effect, but it doesn’t effect on weight loss.
ObjectiveTo compare the curative effect of biliopancreatic diversion with duodenal switch (BPD/DS) with different gastrointestinal anastomotic position in the rat with obese diabetes. MethodsThe obese diabetic rat models were induced by high-fat feeding for 1 month combined with intraperitoneal injection of low-dose streptozotocin (35 mg/kg), then which were divided into modified BPD/DS (M-BPD/DS), BPD/DS, sleeve gastrectomy (SG), and sham operation (SO) groups according to the operation performed. Eight rats in each group were randomly selected for following experimental observation. The situation of weight loss, glucose reduction, nutrition, and esophagitis were compared among 4 groups, especially between the M-BPD/DS and BPD/DS groups. Results① The body mass and food intake of rats in the M-BPD/DS and BPD/DS groups at 1–4 month(s) after operation (except food intake at the 4th month) were lower than those in the SO group (P<0.05), but it was found that the food intake of the M-BPD/DS group was higher than that of the BPD/DS group at the first month after operation (P<0.05). ② The fasting blood glucose levels of the M-BPD/DS and BPD/DS groups were lower than those of the SO group (P<0.05) and were lower than those before the operation (P<0.05), but which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). ③ The area under receiver operating characteristic curve (AUC) of blood glucose level by oral glucose tolerance test, insulin tolerancetest (ITT), and the homeostasis model assessment-insulin resistance index at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were lower of the SO group (P<0.05) and before operation (P<0.05), but which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). It was also found that the AUCs of ITT values at the 4th month after operation of the M-BPD/DS and BPD/DS groups were higher than those of the 1st month after operation (P<0.05). ④ The AUCs of the glucagon like peptide-1 (GLP-1) levels at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were higher than those of the SO group (P<0.05), while the AUCs of the insulin index were lower than those of the SO group (P<0.05) at 1 and 4 months after operation. At the 1st and 4th month after operation, the AUCs of the GLP-1 were higher and the insulin were lower than those before operation (P<0.05) in the M-BPD/DS and BPD/DS groups, which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). ⑤ The albumin, calcium, and ferrum at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were statistically lower than those of the SO group (P<0.05) and lower than those before operation (P<0.05). ⑥ The thickness of esophageal squamous epithelium and rate of nipple elongation of the M-BPD/DS group were lower than those of the BPD/DS group (P<0.05). ConclusionThe results of this experiment suggest that moving the gastrointestinal anastomosis above the pylorus simplifies the operationof BPD/DS without affecting its weight loss and glucose lowering effect , and may have a protective effect on the esophagus.
ObjectiveTo evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity with different degrees of obesity.MethodsThe clinicopathologic data of patients received LSG in this hospital from October 2016 to October 2018 were analyzed retrospectively. The effect of LSG on postoperative weight loss in patients with different degrees of obesity were analyzed too.Results① A total of 161 patients with simple obesity were included in this study, including 40 cases of degree Ⅰ obesity, 41 cases of degree Ⅱ obesity, 61 cases of degree Ⅲ obesity, and 19 cases of super obesity. All operations were successfully completed, there was no conversion to laparotomy or mortality. The postoperative bleeding occurred in 4 (2.5%) cases, nausea and vomiting occurred in 97 (60.2%) cases during hospitalization, and 143, 130, and 122 cases were followed up in 1-, 2-, and 3-year after operation. The body mass indexes (BMIs) were decreased significantly in postoperative 1-, 2-, and 3-year (P<0.05) as compared with their preoperative values, respectively. The excess BMI loss percentage(EBMIL%) in postoperative 1-, 2-, and 3-year were (87.4±25.7)%, (84.6±30.5)%, and (88.8±20.4)%, respectively. The rates of weight regaining were 3.8% (5/130) and 4.9% (6/122) in 2- and 3-year following-up, respectively. ② There were no remarkable changes in the trend of BMI in patients with degree Ⅰ and Ⅱ obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–2.3±1.1)% and (3.3±1.5)%, respectively]. Conversely, there were remarkable changes in the trend of BMI in patients with degree Ⅲ obesity and super obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–7.1±1.9)% and (–11.6±5.3)%, respectively].ConclusionsFrom the results of this study, LSG has a good effect on weight loss in the treatment of patients withdegree Ⅰ and Ⅱ obesity. The long-term efficacy of LSG in patients with degree Ⅲ and super obesity, whether to take other bariatric procedures, whether to perform the second operation, and the timing of the second operation need to be further explored.