Effects of weight loss after bariatric surgery for morbid obesity on vascular endothelial growth factor-A, adipocytokines, and insulin.

BACKGROUND: Adipocytes regulate blood vessel formation, and in turn endothelial cells promote preadipocyte differentiation through the expression of proangiogenic factors, such as vascular endothelial growth factor (VEGF)-A. Some adipocytokines and hormones also have an effect on vascular development. OBJECTIVES: Our objectives were to analyze the relationship between weight and circulating VEGF-A in morbidly obese subjects before and after bariatric surgery, and investigate the relationship between circulating VEGF-A and certain adipocytokines and hormones regulating adipocytes. METHODS: A total of 45 morbidly obese women and nine lean females were included in the study. Patients underwent bariatric surgery: vertical banded gastroplasty (n=17), gastric bypass (n=17), and biliopancreatic diversion (n=11). Serum samples for VEGF-A, adiponectin, leptin, ghrelin, and insulin were obtained preoperatively and 9-12 months after surgery. RESULTS: Obese patients showed significantly higher VEGF-A levels than controls (306.3+/-170.3 vs. 187.6+/-91.9 pg/ml; P=0.04), decreasing to 246.1+/-160.4 after surgery (P<0.001), with no differences among surgical procedures. In controls there was an inverse correlation between VEGF-A and ghrelin (r=-0.85; P<.01), but not in obese patients. Leptin and insulin concentrations were increased in obese patients, with a significant decrease shown after weight loss with surgery. Conversely, adiponectin concentrations were lower in obese patients, with a significant increase shown after weight loss with surgery. Ghrelin was higher in controls than obese patients, decreasing after gastric bypass and biliopancreatic diversion, but not after vertical banded gastroplasty. CONCLUSION: Serum VEGF-A levels are significantly higher in obese patients than in lean controls, decreasing after weight loss with bariatric surgery, behaving similarly to other hormones related to adipose mass like leptin and insulin.

Cirugía de reconversión en la obesidad mórbida / Revision surgery in morbid obesity

Introducción. Ante el fracaso de una determinada técnica quirúrgica bariátrica se plantea la necesidad de una nueva intervención. Analizamos en este trabajo las causas del fracaso, las opciones terapéuticas y sus consecuencias. Métodos. Hemos llevado a cabo un análisis retrospectivo revisando las historias clínicas de los pacientes intervenidos en el Servicio de Cirugía I durante el período comprendido entre enero de 1990 y diciembre de 2002 (403 sujetos).Resultados. La tasa global de reintervenciones es del 19,88 por ciento (100 pacientes), con un total de 503 intervenciones en los 403 pacientes de la serie. La técnica que más reintervenciones presenta es la gastroplastia vertical anillada, y la causa más frecuente de fracaso es la aparición de una fístula reservorio-gástrica. Conclusiones. Tras el análisis que hemos llevado a cabo se desprende que la cirugía de la reintervención obedece a distintas causas, la mayor parte de las veces a un fracaso de la técnica (fístula reservorio-gástrica) o bien a una inadecuada selección de los pacientes. Aunque es una cirugía compleja, en nuestra serie no hemos tenido mortalidad, y los resultados en cuanto a disminución de la comorbilidad y datos antropométricos han sido favorables (AU)

Peptide YY secretion in morbidly obese patients before and after vertical banded gastroplasty.

BACKGROUND: The Peptide YY (PYY) secretion pattern was assessed in morbidly obese (MO) patients before and after vertical banded gastroplasty (VBG). METHODS: 12 MO patients (10 women, 2 men) age 29-62 years, BMI 50.7 +/- 9.6 kg/m2, treated with a VBG were studied. Before surgery, blood samples were taken in basal conditions of fasting and 10, 15, 20, 30 and 60 min after the ingestion of a semiliquid test meal. This was repeated in the same patients 6 and 12 months after VBG. Blood samples were also taken from 6 healthy non-obese subjects as controls. PYY plasma concentration was measured by radioimmunoassay with I125. RESULTS: There were statistically significant differences between the preoperative PYY concentration in MO patients compared to controls. After a VBG, PYY concentration varied significantly compared to the preoperative levels. There was no significant difference between the PYY concentrations in the MO patients after VBG and the controls. CONCLUSION: PYY concentration is lower in MO patients compared with non-obese. After VBG, PYY concentration gradually rises to the control levels.