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Modificazioni del microbiota nell’adulto vs. adolescente dopo sleeve gastrectomy laparoscopica
Get PDFSono stati arruolati dal 1° Ottobre 2014 in modo prospettico 25 pazienti adulti e 20 adolescenti obesi con indicazione alla chirurgia bariatrica o a trattamento multimodale (dieta ed esercizio fisico). Al fine di ottenere uno studio caso-controllo età -correlato, sono stati arruolati, nello stesso periodo,12 adolescenti e 12 adulti sani volontari normopeso (NP) presso l’Unità di Metagenomica del Microbioma umano dell’Ospedale Pediatrico Bambin Gesù (OPBG) e presso il dipartimento di Medicina Clinica del Policlinico Umberto I rispettivamente.
Applicando il test di Kruskal-Wallis per le abbondanze relative di phylum per i 4 Gruppi/Gruppo CTRL, abbiamo osservato differenze statisticamente significative nella distribuzione di Actinobacteria, Bacteroidetes and Firmicutes (p < 0.05).
Nel confronto di distribuzione Actinobacteria e Bacteroidetes erano statisticamente significativi per le coppie ob_ado/ob_adulti, con livelli di Actinobacteria più elevati per il gruppo ob_ado, mentre i livelli di Bacteroidetes erano predominanti nel gruppo ob_adulti
Dei 20 pazienti adulti obesi (ob_adulti) arruolati, 10 sono stati sottoposti a sleeve gastrectomy . Applicando il test di Kruskal-Wallis per le abbondanze relative di specie pre e post sleeve gastrectomy abbiamo osservato differenze statisticamente significative nella distribuzione di Bacteroides fragilis, Coriobacteriaceae, Veillonella parvula. (p < 0.05)
Venticinque pazienti obesi adolescenti (ob-ado)sono stati arruolati e 21 sottoposti a sleeve gastrectomy. Tredici hanno raggiunto il follow-up di 6 mesi ed hanno eseguito campionatura di feci, pasto misto e prelievi ematici.Applicando il test di Kruskal-Wallis per le abbondanze relative di phylum per i pazienti ob_ado pre e post sleeve gastrectomy abbiamo osservato differenze statisticamente significative nella distribuzione di Actinobacteria (p < 0.05) Applicando il test di Kruskal-Wallis per le abbondanze relative di genere/ specie pre e post sleeve gastrectomy abbiamo osservato differenze statisticamente significative nella distribuzione di Clostridiales, Erysipelotrichaceae, Abiotrophia, Haemophilus parainfluenzae,Propionibacterium acnes, (p < 0.05) E’ in corso l’analisi delle correlazioni tra le caratteristiche cliniche e antropometriche e le abbondanze di batteri. .
Il modello basato sulle OTUs, ci ha consentito di assegnare come markers F. prausnitzii e Actinomyces al gruppo Obesi adolescenti( Ob_ado), mentre Parabacteroides, Rikenellaceae, B. caccae, Barnesiellaceae, e Oscillospira al gruppo di controllo (CTRL_ado).
In conclusione questo studio ha dimostrato caratteristiche uniche nella diversità ecologica, nella composizione e nel modello correlato alle OTU del microbiota intestinale in obesi adolescenti e adulti, e tra questi e gli individui normopeso. I “markers” identificati in questo studio potrebbero essere considerati per lo sviluppo di nuovi probiotici, età-correlati, che possono portare a definire nuove strategie, basate sulla modulazione del microbiota, per la prevenzione e il trattamento dell’obesità
Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy
No full textBACKGROUND:
The aim of this study was to evaluate the long-term effects of laparoscopic sleeve gastrectomy (LSG) on type 2 diabetes mellitus (T2DM) and other related co-morbidities in severely obese patients.
METHODS:
From May 2003 to July 2008, 33 morbidly obese diabetic patients (20 with body mass index [BMI]>50 kg/m(2)) underwent LSG. A total of 23 females and 10 males participated, with a mean age of 49.3±8 years, mean preoperative BMI of 52.1±8.5 kg/m(2), mean fasting plasma glucose (FPG) of 143.2±47.9 mg/dL, mean glycosylated hemoglobin (HbA(1c)) of 7.3%±1.4%, and a mean T2DM duration of 7 years. All patients had a 36-month follow-up, and 13 had a 60-month follow-up.
RESULTS:
Twenty-nine patients (87.8%) discontinued antidiabetic medications 3 months after LSG, (mean BMI of 42.8±7.8 kg/m(2); FPG of 104.5±22.1 mg/dL; HbA(1c) of 5.3%±.4%). At 36 months, 22 of 26 LSG patients (84.6%) had normal FPG and HbA(1c) values without antidiabetic therapy. At the 60-month follow-up, 10 of 13 patients (76.9%) had normal FPG and HbA(1c) values without antidiabetic therapy. The Framingham risk score decreased significantly from 9.7% preoperatively to 4.7% postoperatively. No new diabetic retinopathy occurred during the whole period of observation.
CONCLUSIONS:
This study confirms the efficacy of LSG in the treatment of T2DM and indicates that, at both 36- and 60-month follow-ups, LSG can provide a significant percentage of treated patients with a prolonged remission of T2DM, with diminished cardiac risk factors and no development of diabetic retinopathy. These results compare favorably with those reported after standard medical therapy
Laparoscopic sleeve gastrectomy in adolescents with or without syndromic obesity: two years follow-up
Get PDFIntroduction
Childhood obesity is an emerging health problem. Surgical treatment of obese adolescents, particularly those affected by congenital syndrome, represents a controversial issue. The aim of this multicenter study was to retrospectively assess the results of laparoscopic sleeve gastrectomy (LSG) in a cohort of adolescents affected by morbid obesity, with or without congenital syndromes.
Materials and methods
Forty-one obese (BMI 49 ± 6 kg/m2) adolescents with mean age of 16 ± 3 years (58.5% with previous intragastric balloon failure), and subjected to LSG, were retrospectively evaluated for complications rate, % excess weight loss (%EWL), and inhibition of co-morbidities after 2 years of follow-up.
Results
All the operations were completed laparoscopically and no intra-operative complications were recorded. No mortality was recorded while peri- or post-operative complications only occurred in two patients (4.9%). The EWL% at 6, 12, and 24 months were 42.3, 58.3, and 59.4, respectively. %EWL was comparable (p = 0.7) between non-syndromic and syndromic obese adolescents at 24 months. Conversely patients with previous intragastric balloon surgery had a significant lower EWL (%) at 24 month (p < 0.01). Moreover, at the same time point, co-morbidity resolution rate was 78.2% while improvement rate was 57.6%. Specifically, remission rate of type 2 diabetes (T2DM), hypertension and obstructive sleep apnea (OSA) were 71, 75 and 61%, respectively.
Conclusion
LSG is advantageous in the treatment of morbidly obese juveniles concerning safety, weight loss and co-morbidity control and at same time presenting, a possible effective therapeutic option for patients affected by congenital syndrom
Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes
No full textBackground This study aimed to compare the efficacy of laparoscopic sleeve gastrectomy (SG) with that of laparoscopic gastric bypass (GBP) and laparoscopic adjustable gastric banding (AGB) for glucose homeostasis in morbidly obese subjects with type 2 diabetes mellitus (T2DM) at a 3-year follow-up assessment and to elucidate the role of weight loss in the T2DM resolution after SG. Methods For this study, 60 morbidly obese T2DM patients (44 females and 16 males) who underwent AGB (24 patients), GBP (16 patients), or SG (20 patients) between 1996 and 2008 were retrospectively analyzed. Age, sex, body mass index (BMI), estimated weight loss (EWL), fasting glycemia, HbA1c, euglycemic hyperinsulinemic clamp, discontinuation of diabetes treatment, and time until interruption of therapy were evaluated. Results In the study, 54 patients received oral hypoglycemic agents for at least 12 months before surgery, and 6 patients received insulin. The mean follow-up period was 36 months. The resolution rate was 60.8% for the AGB patients, 81.2% for the GBP patients, and 80.9% for the SG patients. The postoperative time until interruption of therapy was 12.6 months for the AGB patients, 3.2 months for the GBP patients, and 3.3 months for the SG patients. The hyperinsulinemic euglycemic clamp test was performed 12 months after surgery for the cured patients. Insulin resistance was restored to normal values in all the patients. The greatest improvement from preoperative values occurred in the SG group. For the not-cured GBP and SG patients, an improvement of 120 mg/dl in fasting plasma glucose was observed 3 months after the surgery, suggesting an enhancement in insulin sensitivity, which determines better medical control. The resolution rate remained constant at the 36-month follow-up evaluation in both the GBP and SG groups. Conclusions All three bariatric procedures are effective in treating diabetes, with a 3-year follow-up evaluation showing an effect that lasts. The AGB procedure was the least effective. The antidiabetic effect was similarly precocious after GBP and SG compared with AGB. This difference may indicate that a hormonal mechanism may be involved, independent of weight loss. © Springer Science+Business Media, LLC 2009
Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia
No full textBackground: Gastroesophageal reflux disease (GERD) with or without hiatal hernia (HH) is now recognized as an obesity-related co-morbidity. Roux-en-Y gastric bypass has been proved to be the most effective bariatric procedure for the treatment of morbidly obese patients with GERD and/or HH. In contrast, the indication for laparoscopic sleeve gastrectomy (SG) in these patients is still debated. Our objective was to report our experience with 97 patients who underwent SG and HH repair (HHR). The setting was a university hospital in Italy.
Methods: From July 2009 to December 2011, 378 patients underwent a preoperative workup for SG. In 97 patients, SG was performed with HHR. The clinical outcome was evaluated considering GERD symptom resolution or improvement, interruption of antireflux medications, and radiographic evidence of HH recurrence.
Results: Before surgery, symptomatic GERD was present in 60 patients (15.8%), and HH was diagnosed in 42 patients (11.1%). In 55 patients (14.5%), HH was diagnosed intraoperatively. The mean follow-up was 18 months. GERD remission occurred in 44 patients (73.3%). In the remaining 16 patients, antireflux medications were diminished, with complete control of symptoms in 5 patients. No HH recurrences developed. "De novo" GERD symptoms developed in 22.9% of the patients undergoing SG alone compared with 0% of patients undergoing SG plus HHR.
Conclusion: SG with HHR is feasible and safe, providing good management of GERD in obese patients with reflux symptoms. Small hiatal defects could be underdiagnosed at preoperative endoscopy and/or upper gastrointestinal contrast study. Thus, a careful examination of the crura is always recommended intraoperatively. (C) 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved
Early postoperative insulin-resistance changes after sleeve gastrectomy
No full textIntroduction: Biliopancreatic diversion and Gastric bypass are associated with a rapid improvement in insulin resistance few days after surgery. The purpose of this study was to evaluate the short-term effects in insulin resistance following sleeve gastrectomy (SG). Materials and methods: Between December 2007 and September 2008, 17 consecutive obese type 2 diabetes mellitus patients (three men, mean age 51.1 years, mean BMI 44.7 kg/m2) were submitted to laparoscopic SG. Fasting serum glucose, insulin concentration, and homeostatic model assessment for insulin resistance (HOMA IR) were drawn preoperatively and at 5, 15, 30, and 60 postoperative days. In seven of these patients insulin sensitivity was evaluated on postoperative days 1, 2, 3, and 4. Moreover a control group of three overweight and diabetic patients (one man, mean age 52.1 years and mean BMI 26.8 kg/m2) submitted to laparoscopic cholecystectomy and undergoing the same diet protocol was studied. Results: In all obese patients, a sharp (5 days) and significant reduction of serum glucose and insulin concentration and HOMA IR values was observed after SG. In seven patients, serum glucose and insulin concentration and HOMA IR values were significantly lower at third postoperative day. At the 15th postoperative day both serum glucose and insulin concentration and HOMA IR remained significantly lower in the absence of significant weight modifications. At 30 and 60 postoperative days, these values remained substantially unchanged in spite of a greater weight loss. In the cholecystectomy patients group, at postoperative day 5, only the serum glucose concentrations were significantly reduced although with the higher values than normal in respect to the preoperative values. Conclusions: After SG the improvement of insulin action occurred rapidly and independently of EWL. The results of the present study confirm that a hormonal mechanism may contribute to changes in insulin resistance following SG. © 2009 Springer Science + Business Media, LLC
Obesity, type 2 diabetes mellitus, and other comorbidities: A prospective cohort study of laparoscopic sleeve gastrectomy vs medical treatment
No full textOBJECTIVE:
To compare the effect of sleeve gastrectomy vs medical therapy on type 2 diabetes mellitus and other obesity-related comorbidities (obstructive sleep apnea syndrome, hypertension, and dyslipidemia) in prospectively enrolled and matched obese patients with type 2 diabetes.
DESIGN:
A prospective cohort study. Morbidly obese patients with type 2 diabetes who either underwent sleeve gastrectomy or conventional therapy were followed up and assessed for their diabetic state and other comorbidities every 3 months for 18 months.
SETTING:
Centre for the Surgical-Medical Treatment of Morbid Obesity, Policlinico “Umberto I,” University of Rome “Sapienza,” Italy.
PATIENTS:
A total of 30 morbidly obese patients with type 2 diabetes who underwent sleeve gastrectomy (group A) and a total of 30 morbidly obese patients with type 2 diabetes who underwent conventional therapy (group B).
RESULTS:
In group A, the preoperative mean (SD) body mass index, fasting plasma glucose level, and hemoglobin A1c level were 41.3 (6.0), 166.6 (68.1) mg/dL, and 7.9% (2.1%), respectively, and, at 18 months, these values were 28.3 (5.4), 96.2 (29.4) mg/dL, and 6.0% (1.5%), respectively. For 80% of patients, diabetes was resolved. With regard to other comorbidities, the prevalence of obstructive sleep apnea syndrome dropped from 50% to 10%, and patients reduced significantly their use of medication for hypertension and dyslipidemia. In group B, the preoperative mean (SD) body mass index, fasting plasma glucose level, and hemoglobin A1c level were 39.0 (5.5), 183.7 (63.5) mg/dL, and 8.1% (1.7%), respectively, and, at 18 months, these values were 39.8 (5.0), 150 (48) mg/dL, and 7.1% (1.3%), respectively. All patients remained diabetic and continued or increased their level of hypoglycemic therapy. With regard to other comorbidities, we observed an increase in the use of medication for hypertension and dyslipidemia, and the prevalence of obstructive sleep apnea syndrome did not change.
CONCLUSIONS:
This study confirms the efficacy of sleeve gastrectomy in the treatment of morbidly obese type 2 diabetic patients when compared with conventional medical treatment
Type 2 diabetes in obese patients with body mass index of 30-35 kg/m2: sleeve gastrectomy versus medical treatment.
No full textBACKGROUND:
Type 2 diabetes mellitus (T2DM) and obesity are diseases of epidemic proportions. Long-term realistic weight loss by nonsurgical methods has a variable effect on glycemic control, and only a proportion of patients with T2DM have a worthwhile response. Laparoscopic sleeve gastrectomy (LSG) has been proposed as an advantageous bariatric procedure for patients with a lower body mass index (BMI). Our objective was to compare the effects of LSG and medical therapy on patients with T2DM and a BMI of <35 kg/m(2).
METHODS:
A total of 18 nonmorbidly obese patients with T2DM, diagnosed according to the American Diabetes Association guidelines, were consecutively enrolled. Of these patients, 9 underwent LSG (group A) and 9 underwent conventional medical therapy (group B). The 2 groups were matched for BMI, glycated hemoglobin (HbA1c) and C-peptide levels, pretrial therapy type, and number of patients with a T2DM duration of >10 years.
RESULTS:
In group A, T2DM resolution was achieved in 8 (88.8%) of the 9 patients (T2DM duration 5.2 yr). Hypertension was controlled in all 8 of 9 patients. Dyslipidemia was corrected. In 1 patient, obstructive sleep apnea syndrome improved. In group B, all 9 patients continued to have T2DM and required hypertensive and hypolipemic therapies throughout the observation period. At baseline, 3 patients were affected by obstructive sleep apnea syndrome and remained affected 1 year later.
CONCLUSION:
The results of the present study have confirmed the efficacy of LSG in the treatment of nonmorbidly obese T2DM patients, with a remission rate of 88.8% without undesirable excessive weight loss. The results in this group of patients add to those obtained by us in patients with a BMI >35 kg/m(2)
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