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ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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vol. 7
Original paper

Impact of laparoscopic sleeve gastrectomy on body mass index, ghrelin, insulin and lipid levels in 100 obese patients

Hady Razak Hady, Jacek Dadan, Paweł Gołaszewski, Kamil Safiejko

Videosurgery Miniinv 2012; 7 (4): 251-259
Online publish date: 2012/06/06
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Introduction: A high percentage of patients benefit from bariatric procedures in terms of metabolic effect and substantial body mass reduction. These procedures improve glucose metabolism leading to the amelioration or complete resolution of type 2 diabetes, reduction of insulin resistance and alleviation of metabolic syndrome effects.

Aim: To assess the impact of laparoscopic sleeve gastrectomy (LSG) on the plasma levels of ghrelin, insulin, glucose, triglycerides, total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) fractions as well as aspartate and alanine transaminases in patients with obesity.

Material and methods: One hundred patients who underwent laparoscopic sleeve gastrectomy in our centre between 2005 and 2009 were included in the study. Among them were 48 males with an average age of 47.93 ±9.24 years and 52 females with an average age of 44.19 ±9.33 years. Percentage excess weight loss (%EWL), percentage excess body mass index (BMI) loss (%EBL), ghrelin, insulin, glucose, triglycerides, cholesterol, HDL, LDL, alanine transferase (ALT), and asparagine transferase (AST) were measured preoperatively and on the 7th day then 1, 3 and 6 months after the surgery.

Results: Statistically significant reduction in postoperative BMI, plasma levels of glucose and insulin as well as the homeostatic model assessment insulin resistance (HOMA IR) score was noted in comparison to the preoperative values. The ghrelin levels decreased. Lipid profile, AST and ALT levels varied depending on the particular time points.

Conclusions: Laparoscopic sleeve gastrectomy reduces body mass and leads to the decrease of concentration of ghrelin in plasma as well as to the improvement of metabolism of insulin, glucose, cholesterol and triglycerides. The above changes alleviated symptoms of metabolic syndrome and obesity related co-morbidities.

obesity, sleeve gastrectomy, ghrelin, insulin, glucose and lipid homeostasis, metabolic syndrome


Grundy SM. Multifactorial causation of obesity: implications for prevention. Am J Clin Nutr 1998; 67 (Suppl): 563S-72S.

Hill JO, Peters JC. Environmental contributions to the obesity epidemic. Science 1998; 280: 1371-4.
. Wyleżoł M, Paśnik K, Dąbrowiecki S, et al. Polish recommendations for bariatric surgery. Videosurgery Miniinv 2009; 4 (Suppl 1): S5-8.
Rigamonti AE, Pincelli AI, Corra B, et al. Plasma ghrelin concentrations in elderly subjects: comparison with anorexic and obese patients. J Endocrinol 2002; 175: 1-5.
World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO Consultation. Part 1: diagnosis and classification of diabetes mellitus. Geneva, Switzerland: World Health Organization; 1999.
Available at: http://whqlibdoc.who.int/hq/1999/WHO_NCD_NCS_ 99.2.pdf.
Grundy SM, Brewer HB, Cleeman JI, et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004; 109: 433-8.
Iannelli A, Dainese R, Piche T, et al. Laparoscopic sleeve gastrectomy for morbid obesity. World J Gastroenterol 2008; 14: 821-7.
. Marceau P, Hould FS, Simard S, et al. Biliopancreatic diversion with duodenal switch. World J Surg 1998; 22: 947-54.

Johnston D, Dachtler J, Sue-Ling HM, et al. The Magenstrasse and Mill operation for morbid obesity. Obes Surg 2003; 13: 10-6.

Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg 2007; 17: 565-8.

Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care 2004; 27: 1487-95.

Hady RH, Zbucki R, Łuba M, et al. Otyłość jako choroba społeczna i wpływ czynników środowiskowych na wartość BMI w materiale własnym. Adv Clin Exp Med 2010; 19: 369-78.

Steinbrook R. Surgery for severe obesity. N Eng J Med 2004; 350: 1075-9.

Stanowski E, Paśnik K. Bariatric surgery – the current state of knowledge. Videosurgery Miniinv 2008; 3: 71-86.

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292: 1724-37.

Nocca D. Laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy: which has a place in the treatment of diabetes in morbidly obese patients? Diabetes Metab 2009; 35: 524-7.

Armstrong J, O’Malley SP. Outcomes of sleeve gastrectomy for morbid obesity: a safe and effective procedure? Int J Surg 2010; 8: 69-71.

Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy. Ann Surg 2008; 247: 401-7.

Himpens J, Dapri G, Cadie`re GB. A Prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 2006; 16: 1450-6.

Shi X, Karmali S, Sharma AM, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 2010; 20: 1171-7.

. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in swedish obese subjects. N Engl J Med 2007; 357: 741-52.

Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 2010; 252: 319-24.

Gagner M, Deitel M, Kalberer TL, et al. The second international consensus summit for sleeve gastrectomy, March 19-21, 2009. Surg Obes Relat Dis 2009; 5: 476-85.

. Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg 2010; 20: 535-40.

Fruhbeck G, Diez Caballero A, Gil MJ. Fundus functionality and ghrelin concentrations after bariatric surgery. N Eng J Med 2004; 350: 308-9.

Castańeda TR, Tong J, Datta R, et al. Ghrelin in the regulation of body weight and metabolism. Front Neuroendocrinol 2010; 31: 44-60.

. De Vriese C, Delporte C. Ghrelin: a new peptide regulating growth hormone release and food intake. Int J Biochem Cell Biol 2008; 40: 1420-4.

Silecchia G, Boru C, Pecchia A, et al. 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: 1138-44.

Rosenthal R, Li X, Samuel S, et al. Effect of sleeve gastrectomy on patients with diabetes mellitus. Obes Relat Dis 2009; 5: 429-34.

Rizzello M, Abbatini F, Casella G, et al. Early postoperative insulin-resistance changes after sleeve gastrectomy. Obes Surg 2010; 20: 50-5.
31. Frezza EE, Wozniak SE, Gee L, et al. Is there any role of resecting the stomach to ameliorate weight loss and sugar control in morbidly obese diabetic patients? Obes Surg 2009; 19: 1139-42.

Vidal J, Ibarzabal A, Nicolau J, et al. Short-term effects of sleeve gastrectomy on type 2 diabetes mellitus in severely obese subjects. Obes Surg 2007; 17: 1069-74.

Fried M, Ribaric G, Buchwald JN, et al. Metabolic surgery for the treatment of type 2 diabetes in patients with BMI < 35 kg/m2: an integrative review of early studies. Obes Surg 2010; 20: 776-90.

Peterli R, Wölnerhanssen B, Peters T, et al. 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: 234-41.

Lee WJ, Lee YC, Ser KH. Improvement of insulin resistance after obesity surgery: a comparison of gastric banding and bypass procedures. Obes Surg 2008; 18: 1119-25.

Lee WJ, Lee YC, Ser KH. Improvement of insulin resistance after obesity surgery: a comparison of gastric banding and bypass procedures. Obes Surg 2008; 18: 1119-25.

Iannelli A, Anty R, Schneck AS, et al. Inflammation, insulin resistance, lipid disturbances, anthropometrics, and metabolic syndrome in morbidly obese patients: a case control study comparing laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. Surgery 2010; 149: 364-70.

Batsis JA, Romero-Corral A, Collazo-Clavell M, et al. The effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc 2008; 83: 897-907.

Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683-93.

Chen PH, Chen JD, Lin YC. A better parameter in predicting insulin resistance: obesity plus elevated alanine aminotransferase. World J Gastroenterol 2009; 28: 5598-603.

. Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology 2007; 132: 2253-71.

Hady RH, Dadan J, Iwacewicz P, et al. Our experience in laparoscopic bariatric procedure. Obes Surg 2010; 20: P-046.

Dadan J, Iwacewicz P, Hady RH. New approaches in bariatric surgery. Videosurgery Miniinv 2008; 3: 66-70.

Hady RH, Dadan J, Iwacewicz P, et al. Quality of life after surgical treatment of morbid obesity. Obes Surg 2010; 20: P-59.

Sammour T, Hill AG, Singh P, et al. Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Obes Surg 2010; 20: 271-5.

. Dadan J, Iwacewicz P, Hady RH. Quality of life evaluation after selected bariatric procedures using the Bariatric Analysis and Reporting Outcome System. Videosurgery Miniinv 2010; 5: 93-9.

Bobowicz M, Lehmann A, Orłowski M, et al. Preliminary outcomes 1 year after laparoscopic sleeve gastrectomy based on bariatric analysis and reporting outcome system (BAROS). Obes Surg 2011 doi: 10.1007/s11695-011-0103-4.

Agrawal S, Dessel E, Akin F, et al. Laparoscopic adjustable banded sleeve gastrectomy as a primary procedure for the super-super obese (body mass index > 60 kg/m2). Obes Surg 2010; 20: 1161-3.

Miguel G, Azevedo J, Neto C, et al. Glucose homeostasis and weight loss in morbidly obese patients undergoing banded sleeve gastrectomy: a prospective clinical study. Clinics 2009; 64: 1093-9.
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