Jejunal wall triglyceride concentration of morbidly obese persons is lower in those with type 2 diabetes mellitus.

The overproduction of intestinal lipoproteins may contribute to the dyslipidemia found in diabetes. We studied the influence of diabetes on the fasting jejunal lipid content and its association with plasma lipids and the expression of genes involved in the synthesis and secretion of these lipoproteins. The study was undertaken in 27 morbidly obese persons, 12 of whom had type 2 diabetes mellitus (T2DM). The morbidly obese persons with diabetes had higher levels of chylomicron (CM) triglycerides (P < 0.001) and apolipoprotein (apo)B48 (P = 0.012). The jejunum samples obtained from the subjects with diabetes had a lower jejunal triglyceride content (P = 0.012) and angiopoietin-like protein 4 (ANGPTL4) mRNA expression (P = 0.043). However, the apoA-IV mRNA expression was significantly greater (P = 0.036). The jejunal triglyceride content correlated negatively with apoA-IV mRNA expression (r = -0.587, P = 0.027). The variables that explained the jejunal triglyceride content in a multiple linear regression model were the insulin resistance state and the apoA-IV mRNA expression. Our results show that the morbidly obese subjects with diabetes had lower jejunal lipid content and that this correlated negatively with apoA-IV mRNA expression. These findings show that the jejunum appears to play an active role in lipid homeostasis in the fasting state.

Different effect of laparoscopic Roux-en-Y gastric bypass and open biliopancreatic diversion of Scopinaro on serum PYY and ghrelin levels.

BACKGROUND: The impact of bariatric surgery on levels of peptide YY (PYY) and ghrelin is still under discussion. We undertook a simultaneous evaluation of the serum changes in PYY and ghrelin depending on the specific type of bariatric surgery. METHODS: Total PYY and ghrelin were analyzed in 29 healthy persons and in morbidly obese persons undergoing open biliopancreatic diversion (BPD) of Scopinaro (n = 38) or laparoscopic Roux-en-Y gastric bypass (RYGB; n = 13). RESULTS: RYGB resulted in a significantly greater loss of weight and body mass index than BPD. Both RYGB and BPD were associated with a significant increase in PYY, significantly greater for BDP (p = 0.001). Ghrelin rose significantly after RYGB (p = 0.022) but not after BPD. After surgery, PYY correlated positively with weight (r = 0.416, p = 0.009). Ghrelin did not correlate significantly with any of the variables studied. Analysis of variance showed that only the type of surgery contributed significantly to explain the variances in the PYY (p = 0.002) and ghrelin (p = 0.018). CONCLUSIONS: BPD results in a greater increase in PYY and a lower weight loss than RYGB. However, only RYGB was associated with a significant increase in ghrelin. The differing weight loss according to the type of bariatric surgery does not seem to be explained by changes arising in PYY and ghrelin.

Laparoscopic cystectomy and ileal conduit: case report.

A completely new combined laparoscopic cystectomy and ileal conduit technique for removal of an infiltrating bladder cancer was carried out on a 64-year-old woman. The bladder was dissected free and extracted whole through the right flank. The right ureter and a loop of intestine were withdrawn through the same incision. An ileal segment was isolated and intestinal continuity restored. The right ureter was anastomosed to one extreme of the segment that was then reintroduced into the abdomen, taken across to the left side, withdrawn with the left ureter, anastomosed extracorporeally, and reintroduced. The stoma was constructed in the left flank at the patient's request. Recuperation was unusually fast and painless, and little postoperative analgesia was required. Further experience and a two-team approach could reduce the operation time to 3 or 4 hours. We are now convinced that combining the two procedures was better for the patient, even though it prolonged the time in the operating room.

[Radical cystectomy and laparoscopic ileal conduit]. / Cistectomía radical y conducto ileal laparoscópico.

Herein we describe for the first time a laparoscopic cystectomy procedure and an ileal conduit that were performed in a single session in a patient with a tumor infiltrating the right wall. The procedure starts by releasing the ureters from the iliac junction up to a point close to the bladder. The peritoneum is incised superiorly at the level of the urachus and we proceed until the space of Retzius and the lateral walls are released. The vesicouterine plica is then incised and the bladder wings are dissected with the Endo-GIA. With a straight dissector, the urethra is released and cut until the bladder is completely free within the abdominal cavity. The trocar is removed from the right flank, the incision is extended up to about 4 cms and the bladder is removed. The right ureter and an ileal loop are then brought out through the incision on the right flank. A segment of intestine is isolated and intestinal continuity is reestablished using mechanical sutures. Then the ureter is implanted at one end of the isolated intestinal segment. The other end of the segment of intestine is taken to the left flank and anastomosed extracorporeally in a similar manner to the ureter of that side. The ileal conduit is positioned transversely so it is unnecessary to take the ureter to the opposite side. Finally, a stoma is created, which the patient desired done in the left side, and the procedure is completed. Although the operating time is long, the surgical insult is minimal because the McBurney type flank incisions cause little injury to the abdominal wall.