Perioperative managment of laparoscopic sleeve gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the surgical technique and perioperative management of laparoscopic sleeve gastrectomy (LSG).</p><p><b>METHODS</b>A total of 57 morbid obesity patients undergoing LSG surgery from May 2010 to December 2012 were enrolled in the study, whose clinical data in perioperative period were analyzed retrospectively. These patients had more than 1 year of follow-up. All the patients received preoperative preparation and postoperative management, and postoperative excess weight loss(EWL%) and improvement of preoperative complications was evaluated.</p><p><b>RESULTS</b>All the cases completed the operation under laparoscopy, except 1 case because of the abdominal extensive adhesion. The average operation time was(102.0±15.2) min and the mean intraoperative blood loss (132.3±45.6) ml. Of 2 postoperative hemorrhage patients, 1 case received conservative treatment, and another one underwent laparoscopic exploration. The EWL% at 3 months, 6 months and 1 year after procedure was (54.9±13.8)%, (79.0±23.6)% and (106.9±25.1)% respectively. The preoperative complications were improved in some degree. There were no operative death, and anastomotic leak, anastomotic stenosis, or surgical site infection occurred.</p><p><b>CONCLUSION</b>LSG is a safe and effective surgical technique, whose safety and efficacy may be increased by improving the perioperative management.</p>

Impacts of laparoscopic bariatric surgery on GLP-1 and Ghrelin level in patients with type 2 diabetes mellitus / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the impacts of laparoscopic bariatric surgery on fasting glucagon-like peptide-1 (GLP-1) and Ghrelin level in patients with type 2 diabetes mellitus (T2DM), and the mechanism in surgical treatment of T2DM.</p><p><b>METHODS</b>From March 2010 to August 2011, 44 patients with T2DM underwent laparoscopic bariatric, including laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 14), laparoscopic mini-gastric bypass (LMGB, n = 11), laparoscopic sleeve gastrectomy (LSG, n = 9) and laparoscopic adjustable gastric banding (LAGB, n = 10). The curative effects, changes of metabolism and gastrointestinal hormones were analyzed respectively.</p><p><b>RESULTS</b>Within 6 months after surgery, the clinical complete remission of T2DM was 11, 8, 6, 3 cases in LRYGB, LMGB, LSG, LAGB group respectively; the clinical partial remission was 3, 3, 2, 4 cases respectively. The inefficacy was 1, 3 patients in LSG and LAGB group respectively. The effects of surgery within 6 months postoperative among 4 groups were different (χ(2) = 8.162, P < 0.05). The levels of body mass index (F = 275.29) and homeostasis model assessment of insulin resistance (F = 40.09) of 4 groups were declined in 6 months postoperatively (P < 0.01). The extents of decrease were no significance among 4 groups. Compared to preoperative level, GLP-1 in LRYGB ((116 ± 33) vs. (66 ± 20) ng/L and LMGB group ((103 ± 22) vs. (65 ± 16) ng/L) was higher in the first month after surgery (F = 21.76 and 139.21, P < 0.05). The changes in LSG and LAGB group were no significance (P > 0.05). The level of Ghrelin in LRYGB, LMGB, LSG group at the first week after surgery were (208 ± 79), (275 ± 102) and (258 ± 91) ng/L respectively, and they were lower than preoperative (there were (398 ± 114), (439 ± 96) and (446 ± 105) ng/L, F = 55.08, 49.96 and 46.47, all P < 0.01). But the level of Ghrelin in LRYGB and LMGB groups rebounded in the first postoperative month. The postoperative level of Ghrelin was higher in LAGB group (F = 29.24, P = 0.001).</p><p><b>CONCLUSIONS</b>There are difference efficacies and impacts on gastrointestinal hormones among different modes of bariatric surgery. The change of gastrointestinal hormones is plausible mechanism of T2DM remission after surgery.</p>

Long-term outcomes and cause of high rate of loss to follow-up after laparoscopic adjustable gastric banding in obese patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term outcomes of weight loss and the cause of high rate of loss to follow-up after laparoscopic adjustable gastric banding (LAGB) in obese patients.</p><p><b>METHODS</b>Clinical and follow-up data of 226 obese patients undergoing LAGB operation in the Changhai Hospital from June 2003 to June 2007 were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 125 patients were followed up for 3-7 years. Among these 125 cases, 115 (92.0%) presented weight loss after LAGB, 60 (48.0%) presented extra weight loss after LAGB. Another 105 cases (44.7%) were lost to follow-up. Most of patients who were loss to follow-up were younger (P<0.05). Gender, weight and BMI were not associated with the rate of loss to follow-up (all P>0.05).</p><p><b>CONCLUSIONS</b>Laparoscopic adjustable gastric band surgery is a relatively simple and safe procedure among the bariatric surgery, but the follow-up protocol is complex and the rate of loss to follow-up is high. Postoperative follow-up should be emphasized.</p>

Efficacy comparison between 2 methods of laparoscopic gastric bypass surgery in the treatment of type 2 diabetes mellitus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the outcomes after 2 methods of laparoscopic gastric bypass surgery for patients with type 2 diabetes mellitus(T2DM).</p><p><b>METHODS</b>From December 2009 to June 2011, 21 patients with T2DM underwent laparoscopic gastric bypass surgery, including laparoscopic Roux-en-Y gastric bypass (LRYGB, n=11), and laparoscopic mini-gastric bypass (LMGB, n=10). Clinical data were analyzed retrospectively.</p><p><b>RESULTS</b>The clinical complete remission rate of T2DM was 64%(7/11) in LRYGB group, and 60%(6/10) in LMGB group. The clinical partial remission rate of T2DM was 36%(4/11) in LRYGB group, and 40%(4/10) in the LMGB group. There was no significant difference between the two groups(both P>0.05). The levels of BMI, waist circumference, HOMA-IR and HbA1c within the postoperative 6 months were improved in each group (all P<0.05), but there was no significant difference between the two groups(all P>0.05). There were no conversion or perioperative deaths in both groups. Compared to LMGB, the LRYGB group had longer operative time[(147.0±35.9) min vs. (110.5±39.7) min, P=0.038] and postoperative hospital stay [(8.9±2.3) d vs. (7.1±1.4) d, P=0.046). One patient suffered from ileus in LRYGB group, one patient suffered from reflux esophagitis and one suffered chronic diarrhea in LMGB group. The incidence of postoperative complication was similar between the two groups(P>0.05).</p><p><b>CONCLUSION</b>LRYGB and LMGB may result in satisfactory and safe effects for the treatment of T2DM, while the LMGB is simpler and associates with quicker recovery.</p>

Understanding of International Sleeve Gastroectomy Expert Panel Consensus Statement and our experience / 中华胃肠外科杂志

An international symposium on the standard surgical treatment of morbid obesity and type 2 diabetes mellitus was held in Florida, USA in March 2011. An expert panel from all over the world attended the meeting. The expert panelists discussed and established International Sleeve Gastroectomy Expert Panel Consensus Statement : best practice guidelines based on experience of more than 12,000 cases, which made a very commendable attempt in standardized surgical pathway of sleeve gastroectomy. Based on clinical experience over 10 years and the understanding of the consensus , this paper discusses the learning curve, preoperative preparation, indications/contraindications, surgical technique, management and prevention of complications, and post operative management.

Outcomes after laparoscopic surgery for 219 patients with obesity / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the outcomes after laparoscopic gastrointestinal surgery for patients with obesity and type 2 diabetes mellitus(T2DM).</p><p><b>METHODS</b>From June 2003 to June 2010, 219 patients underwent laparoscopic gastrointestinal surgery for obesity and T2DM, including laparoscopic adjustable gastric banding(LAGB, n=201), laparoscopic mini gastric bypass(LMGB, n=13), and laparoscopic sleeve gastrectomy(LSG, n=5). Clinical data were analyzed retrospectively.</p><p><b>RESULTS</b>The mean body mass index(BMI) of patients who received LAGB was 37.9 kg/m(2), and decreased to 32.4 kg/m(2) at 6 months and to 29.7 kg/m(2) at 12 months. In 43 patients who had concurrent T2DM, 11(25.6%) showed clinical partial remission(CPR) and 16(37.2%) clinical complete remission (CCR). Postoperative complications occurred in 26 patients(12.9%). The mean BMI of patients undergoing LMGB was 34.7 kg/m(2), and decreased to 31.6 kg/m(2) at 6 months and 26.9 kg/m(2) at 12 months after surgery. Ten patients had T2DM before operation, of whom 2(20.0%) had CPR and 7(70.0%) CCR postoperatively. Postoperative complications occurred in 2 patients(15.4%). The mean BMI of patients who underwent LSG was 43.8 kg/m(2), and was reduced to 38.1 kg/m(2) at 6 months and 34.3 kg/m(2) at 12 months after operation. Three patients were diagnosed with T2DM before operation. One patient (33.3%) had CPR and 1(33.3%) reached CCR after operation. There was 1(20.0%) patient who developed complication. No perioperative death occurred.</p><p><b>CONCLUSION</b>Laparoscopic gastrointestinal surgery may result in satisfactory weight loss and clinical remission of T2DM with few complications.</p>

A new technique for esophagojejunostomy or esophagogastrostomy after laparoscopic gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To report the newly developed reconstruction technique after laparoscopic total gastrectomy: intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil; Covidien), and evaluate its feasibility, safety, and clinical outcomes.</p><p><b>METHODS</b>After LTG (3 patients with gastric carcinoma in the body) or LPG (2 patients with gastric carcinoma in the cardiac and fundus, respectively, and 1 with cardiac stromal tumor), the anvil was then inserted transorally into the esophagus by using the OrVil system. Double-stapling esophagojejunostomy or esophagogastrostomy with a circular stapler was performed intracorporeally.</p><p><b>RESULTS</b>The operations were uneventful. The operative time was (183.3+/-25.8) min, and blood loss was (128.3+/-90.2) ml. Postoperative fluorography revealed no anastomotic leakage or stenosis. Patients resumed an oral liquid diet on postoperative day (4.0+/-1.1), and were discharged on day (9.0+/-2.6). Patients were followed at 28 days and no complications were reported.</p><p><b>CONCLUSIONS</b>LTG with Roux-en-Y reconstruction or LPG with esophagogastrostomy using the OrVil system appear to be safe and reliable with satisfactory short-term outcomes.</p>

Effects of Gastric bypass surgery on the apoptosis of islet β-cells in type 2 nonobese diabetic (NOD) rats and its mechanism / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of Gastric bypass surgery on the apoptosis of islet β-cells in type 2 nonobese diabetic (NOD) rats and its mechanisms.</p><p><b>METHODS</b>Seventy-two 8-week-old GK rats were randomly divided into four groups:operation group (group O, n = 18), sham operation group (group S, n = 18), diet control group (group F, n = 18) and control group (group C, n = 18). The levels of fasting, postprandial blood glucose, insulin and glucagon-like peptide-1 (GLP-1) were measured and compared among the 4 groups before the operation and at 1, 2, 4 and 8 weeks following the operation. The blood samples were collected at 2, 4 and 8 weeks after the operation for the measurement of postprandial blood glucose, and then the rats in batches (6 rats in each group) were decapitated to retrieve the pancreas. The apoptosis of the islet β-cells was detected by using TUNEL assay, and the expression of apoptosis-related proteins Bcl-2, Bax was measured with immunohistochemistry.</p><p><b>RESULTS</b>As for group O, the fasting blood glucose level decreased from (16.2 ± 0.8) mmol/L before the operation to respectively (9.2 ± 0.6) mmol/L and (9.7 ± 0.7) mmol/L at 4 and 8 weeks after the operation; postprandial blood glucose decreased from (31.1 ± 1.1) mmol/L before the operation to respectively (13.1 ± 0.7) mmol/L and (12.3 ± 0.7) mmol/L at 4 and 8 weeks after the operation. Fasting insulin level increased from (28.0 ± 1.2) mU/L before the operation to respectively (62.8 ± 1.9) mU/L and (61.7 ± 1.4) mU/L at 4 and 8 weeks after the operation; and at 4 and 8 weeks after the operation postprandial insulin level was (77.4 ± 1.1) mU/L and (77.1 ± 1.0) mU/L. At 2 weeks from the operation, the fasting GLP-1 in group O increased from (10.7 ± 1.0) pmol/L to (13.5 ± 0.8) pmol/L, and respectively to (26.1 ± 0.9) pmol/L and (25.3 ± 1.2) pmol/L at 4 and 8 weeks after the operation. The differences in the above-mentioned items before and after the operation were all significant in group O (P < 0.05), and the differences in the items among group O and the other three groups (P < 0.05) were all significant as well. In group O, the apoptosis rate of pancreatic islet cell decreased to (5.9 ± 0.7)% at 4 weeks from the operation, and (6.3 ± 1.1)% at 8 weeks from the operation (P < 0.05). The expression of Bcl-2 protein in group O was 31.3 ± 1.5, 35.7 ± 1.0 and 35.8 ± 0.8 at 2, 4 and 8 weeks post operation, which was significantly higher in statistics than those of the same time point in the other three groups (P < 0.05). The expression of Bax protein in group O was 13.3 ± 0.9, 10.8 ± 0.9 and 10.9 ± 1.1 at 2, 4 and 8 weeks from the operation, which was significantly lower in statistics than those of the same time point in the other three groups (P < 0.05).</p><p><b>CONCLUSIONS</b>Gastric bypass surgery can significantly reduce the blood glucose level and promote the secretion of GLP-1, and therefore inhibit the apoptosis of the islet β cells in diabetic rats through the Bcl-2 pathway.</p>

Laparoscopic adjustable gastric banding in the treatment of obesity: analysis of 172 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the outcome of weight loss by laparoscopic adjustable gastric banding (LAGB) on obesity patients and the improvement of comorbidity.</p><p><b>METHODS</b>From June 2003 to June 2009, the data 172 obesity patients(119 women, 53 men, mean age 28.5 years, mean body mass index 38.5 kg/m(2)) were analyzed. Comorbidities included 28 cases with diabetes, 36 with hypertension, 85 with dyslipidemia, 56 with sleep apnea and 138 with fatty liver.</p><p><b>RESULTS</b>Mean body mass index(BMI) at 1,3,6,12, 24, 36 and 48 months was 37.2 kg/m(2),35.9 kg/m(2), 34.5 kg/m(2), 32.9 kg/m(2), 30.7 kg/m(2), 29.2 kg/m(2) and 28.1 kg/m(2), respectively. The percentage of excess weight loss(% EWL) at 1, 3, 6, 12, 24, 36, and 48 months was 10.1%, 16.2%, 25.1%, 37.4%, 51.3%, 59.0% and 62.1%, respectively. At 24, 36 and 48 months, respectively, 50.7%, 63.6% and 70.0% of patients had more than 50% excess weight loss. Complications included 6 cases of port infection, 3 of other port problem, 7 of gastric pouch dilatations, 4 of slippage and 1 of chronic intestinal obstruction. Bands of 5 patients were explanted. No death occurred. Blood glucose of 60.7% patients with diabetes was controlled well without any drug. The blood pressure of 22 hypertensive patients became normal. The blood fat of 49 hyperlipidemia cases returned to normal. The symptom of 29 patients with sleep apnea disappeared. All the patients with fatty liver were improved in different degree.</p><p><b>CONCLUSION</b>Gastric banding provides good weight loss and significant reduction in comorbidities with few and minor complications.</p>

Short-term outcome of laparoscopic gastric bypass and minigastric bypass on obesity patients with type 2 diabetes mellitus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the short-term outcome of laparoscopic gastric bypass on obesity patients with type 2 diabetes mellitus.</p><p><b>METHODS</b>Seven obesity patients with type 2 diabetes mellitus received laparoscopic gastric bypass(n=1) or laparoscopic minigastric bypass(n=6), and their data of treatment outcomes were analyzed.</p><p><b>RESULTS</b>The operations were all successfully performed without any complications. The average operation time was 125 minutes(range: 100 to 170 minutes). The patients underwent 1-18 months follow-up after operation. Diabetic indicators returned to normal without any medication and body weight reduced by on average of 24.3 kg.</p><p><b>CONCLUSION</b>Laparoscopic gastric bypass and minigastric bypass have good short-term outcome in the treatment of obesity patients with type 2 diabetes mellitus.</p>

Effects of duodenal-jejunal bypass and sleeve gastrectomy on the expression of liver glucokinase in diabetic rats / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of duodenal-jejunal bypass(DJB) and sleeve gastrectomy(SG) on the expression of liver glucokinase(GCK) in diabetic rats.</p><p><b>METHODS</b>Animal models of Goto-Kakizaki rats and Sprague-Dawley rats were established by DJB and SG. Results of fasting glycemia and insulin were compared. Liver tissue was harvested 8 weeks postoperatively.Quantitative real-time PCR and Western blot were used to detect liver GCK mRNA and protein expression after operation.</p><p><b>RESULTS</b>Fasting plasma glucose levels of DJB group and SG group in GK rats were markedly declined 3 day and 1, 2, 4, 6, 8 weeks postoperatively(all P <0.01), while Sham group only dropped 3 day and 1 week postoperatively, and there were no significant differences 2 weeks postoperatively(P >0.05). Fasting plasma glucose levels of each group in SD rats did not change after operation. In GK rats, GCK mRNA level (1.45 +/-0.29) and protein expression (494.25 +/-30.25) after DJB were higher than Sham group (1.05 +/-0.19 and 409.13 +/-26.86) and control group (1.04 +/-0.17 and 404.75 +/-30.90). GCK mRNA level and protein expression after SG were 0.65 +/-0.25 and 345.25 +/-28.13 respectively, which were significantly lower than those in control group(all P <0.01). All the groups in SD rats experienced similar GCK expression change.</p><p><b>CONCLUSION</b>Both DJB and SG can decrease the plasma glucose levels of GK rats, while there are different effects on the expression of liver GCK.</p>

Application of neoadjuvant chemotherapy in laparoscopic gastrectomy for advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the benefit of neoadjuvant chemotherapy in advanced gastric cancer patients treated by laparoscopy.</p><p><b>METHODS</b>Fifteen patients with histologically proved gastric adenocarcinomas (stages II(, III(, IIII(M(0)) were treated with FOLFOX7 neoadjuvant chemotherapy followed by laparoscopy between June 2005 and March 2007( trial group). Thirty patients were assigned to the control group with only laparoscopic treatment in the same period. The clinicopathological data were compared between two groups.</p><p><b>RESULTS</b>All the patients in trial group accepted four cycles of preoperative chemotherapy and the toxicity was less than grade 3. Two of them achieved complete response, 10 achieved partial response and 3 kept stable disease. Ten patients of trial group underwent laparoscopic-assisted radical gastrectomy. The rates of R(0)-resection(80.0%) and pN(0) (60.0%) in trial group were significantly higher than those in control group(46.7% and 20.0%), while the rate of positive lymph node 11.0%(34/309) was significantly lower than that of control group 23.8%(142/596). The operation time and postoperative complication were similar in two groups.</p><p><b>CONCLUSIONS</b>Advanced gastric cancer after neoadjuvant chemotherapy can be down-regulated in the stage, increase the rate of R(0)-resection, diminish the infiltration extent of tumor, decrease the metastasis of lymph node, and increase the possibility of laparoscopic radical gastrectomy.</p>

Efficacy of laparoscopic sleeve gastrectomy on morbidly obese patients with type 2 diabetes mellitus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of laparoscopic sleeve gastrectomy(LSG) on improving glycemic control of morbidly obese patients with type 2 diabetes mellitus.</p><p><b>METHODS</b>Prospective study of 30 type 2 diabetes mellitus(T2DM) patients with BMI > or = 35 undergone LSG was carried out. Pre- and post-operative clinical parameters associated with diabetes mellitus 6 months after operation were evaluated. Data collected included demographics, weight loss(BMI, EWL%), diabetes control (FPG, HbA1C) and ghrelin.</p><p><b>RESULTS</b>Fasting plasma glucose and glycosylated hemoglobin concentration tests and clinical outcomes suggested LSG resulted in significant improvement or resolution of T2DM in all the 30 patients with CR 63%(19/30) and PR 37%(11/30).</p><p><b>CONCLUSIONS</b>LSG can lead to significant changes in controlling glycemia on morbidly obese patients with T2DM in 6 months. Long-term efficacy needs further follow-up.</p>

Application of laparoscopic compression anastomosis clip for laparoscopic gastrointestinal anastomosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of laparoscopic compression anastomosis clip (LapCAC) for laparoscopic gastrointestinal anastomosis.</p><p><b>METHODS</b>In March, 2007, three gastric cancer patients undergone total gastrectomy (1 case) and distal gastrectomy (2 cases) received laparoscopic gastrointestinal anastomosis with LapCAC. The gastrointestinal anastomotic complications, first post-operational flatus, bowel movement and extrusion of clip device were observed.</p><p><b>RESULTS</b>No anastomotic complications such as leakage or obstruction were found. The clip was expelled with stool within 12-18 days. All the patients had good results in recovery of bowel function.</p><p><b>CONCLUSION</b>LapCAC is safe and simple for laparoscopic gastrointestinal anastomosis.</p>

Efficacy of sleeve gastrectomy plus gastric remnant banding on weight reduction and remnant gastric dilatation: an animal experimental study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of sleeve gastrectomy plus gastric remnant banding on weight reduction and remnant gastric dilatation in SD rat model.</p><p><b>METHODS</b>Sleeve gastrectomy plus gastric remnant banding was performed in 20 male SD rats as the study group; sleeve gastrectomy was performed in 20 SD male rats as the control group, and laparotomy was performed in 10 SD male rats as the blank control group. Body weight was measured before the experiment, at day 1 and at 2-week intervals within 16 weeks after operation.</p><p><b>RESULTS</b>The number of survival rats was 15 in the study group (15/20), 13 in the control group (13/20), and 10 in the blank control group (10/10). Postoperative body weight increased markedly in the blank control group, returned to the pre-operative level two weeks after operation in the control group, and four weeks after operation in the study group. Weight increase of the study group was significantly slower than that of the other two groups (P<0.01). Postoperative gastric dilation of the control group was more obvious as compared to the study group.</p><p><b>CONCLUSION</b>Sleeve gastrectomy plus gastric remnant banding is safe and effective because of the restriction of postoperative gastric dilation.</p>

Diagnosis and treatment of postoperative complications after laparoscopic adjustable gastric banding procedure / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnosis and treatment of the complications in patients after laparoscopic adjustable gastric banding (LAGB) procedure.</p><p><b>METHODS</b>Retrospectively analyze the data of the 23 patients who received the LAGB procedure from June 2003 to November 2004.</p><p><b>RESULTS</b>Of the 23 LAGB operations, 3 (13%) cases of vomiting and nausea, 1 (4.3%) case of access-port infection and 5 (21.4%) cases of food intolerance occurred. One band (4.3%) and one injection reservoir (4.3%) displaced and were removed by laparoscopy. No death and thrombo-embolism occurred.</p><p><b>CONCLUSIONS</b>The diagnosis and treatment of complications after LAGB in morbid obesity was special, if managed properly, the result would be satisfactory.</p>

Effect of weight loss induced by laparoscopic adjustable gastric banding on immunity of morbid obesity / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the immunity of morbid obesity (MO) before and after laparoscopic adjustable gastric banding (LAGB).</p><p><b>METHODS</b>15 cases, with a mean body mass index (BMI) of 35.8 kg/m(2), were treated by LAGB from Jun. 2003 to Oct. 2003 in our department. Patients' immune parameters were determined preoperatively and 1, 3 and 6 months postoperatively. 15 cases with a normal BMI (23.6 kg/m(2)) were set as controls.</p><p><b>RESULTS</b>Before surgery, the MO had a significant lower level of CD(4)(+), CD(4)(+)/CD(8)(+) and a higher level of serum interleukin-2 (IL-2), Interleukin-6 (IL-6) than the controls (P < 0.01). There was a significant reduction of weight and BMI 6 months postoperatively (P < 0.01). At the same time, CD(4)(+) increased and serum IL-2 decreased significantly. But CD(4)(+)/CD(8)(+)and serum IL-2, IL-6 were still abnormal compare to the controls.</p><p><b>CONCLUSIONS</b>MO may combined with an abnormal immunity. But after enough weight loss induced by LAGB, it can be partly reversed.</p>