ABSTRACT
Objective To investigate the effect of duodenal-jejunal bypass(DJB) on glucose metabolism and the expression of ileum proglucagon mRNA in Goto-Kakizaki (GK) type 2 diabetic rats.Methods 18 male GK rats and 1 8 male Wistar rats were randomly divided into 4 groups:GK operation group(group A),GK sham operation group(group B),Wistar operation group (group C),Wistar sham operation group (group D).There were 9 rats in each group.The fasting blood glucose and GLP-1 levels were measured before and at the 8th weekafter surgery.Oral glucose tolerance test was measured,and the area under blood glucose concentration curve wascalculated.Ileum tissues were obtained 8 weeks postoperatively and reverse transcriptase polymerase chain reac-tion was used to detect ileum PG mRNA expression after the operation.Results At the 8th week after surgery,the fasting blood glucose of group A decreased from(8.73 ± 1.30) mmol/L to(5.86 ±0.57) mmol/L(P ＜0.05).Area under blood glucose concentration curve decreased from preoperative(60.23 ± 5.14)mmol · h/L to (47.80 ±1.79) mmol· h/L(P ＜ 0.05).Fasting serum GLP-1 in group A increased from (7.69 ± 0.74) pmol/L to (29.00 ±4.85) pmol/L while postprandial GLP-1 increased from(15.74 ± 5.71) pmol/L to (45.78 ± 7.26) pmol/L (P ＜0.05).At the 8th week after surgery,the ileum PG mRNA level in group A was significantly higher than that in group B(P ＜ 0.05).Conclusions DJB can directly improve glucose metabolism in non-obese type 2 diabetic rats,and the operation has no hypoglycemic effect on normal blood glucose.The increased expression of ileum PG mRNA might contribute to the hypoglycemic effect of the surgery.
ABSTRACT
Objective To compare the difficult degree,differences in gastric pouch volume,the complications,and postoperative weight loss effect of two gastric pouch practices in laparoscopic gastric bypass for bariatrics.Methods We retrospectively analyzed laparoscopic gastric bypass surgery in 76 bariatrics cases from May 2010 to May 2012.Two methods were used to create gastric pouch,among which 39 cases were operated with the dissection landmark method (called dissection),and 37 cases with bougie airbags 30 ml (called the bougie).Parameters were compared between the 2 groups including operation time for gastric pouch,the amount of staple cartridges,intraoperative complications,blood loss,and postoperative excess weight loss percentage (EWL ％),the postoperative bleeding,obstruction,fistula and other complications.Results All patients were followed up for more than one month.The dissection group used longer time in creating gastric pouch than that in the bougie group [(58 ± 27) min,(42 ±21) min,P ＜ 0.01].The number of staple cartridges used were significantly different between the two groups [(6.2 ±3.0),(4.3 ± 2.0),P ＜ 0.01].There were 10 cases of complications in the dissection group (26％),and 3 cases in the bougie group (8％) (P ＜0.05).One month after the surgery,one each patient had transient hematochezia.There was no gastric pouch-related complications in the two groups postoperation.There was no difference in excess weight loss (P ＞ 0.05).Conclusions The two methods can achieve the same effect on excess weight loss.The bougie method used less time in creating the gastric pouch,less consumable materials,and less complications occurred in creating gastric pouch.