ABSTRACT
Objective@#To explore the application value of laparoscopic gastric plication (LGP) combined with duodeno-jejunal omega switch (DJOS) in modified adjustable gastric banding.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of a female 46-year-old patient who had failure to undergo the adjustable gastric banding in the Hospital of Ludwig Maximilian University from December 2016 to December 2018 were collected. LGP and DJOS were performed in two-stages after completion of preoperative examinations. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examiantion and telephone interview was performed to collect the information of body mass index (BMI), insulin therapy, and long-term complications until December 2018. Count data were represented as absolute numbers.@*Results@#(1) Surgical and postoperative situations: the patient underwent LGP in the first stage and DJOS in the second stage successfully. For the LGP, the operation time, time of intestinal reconstruction, volume of intraoperative blood loss, time to first flatus, time to drainage tube removal, time to resume to normal diet, and duration of postoperative hospital stay were 96 minutes, 58 minutes, 210 mL, 32 hours, 48 hours, 42 days, and 3 days, respectively. For the DJOS, the above indicators were 148 minutes, 117 minutes, 260 mL, 47 hours, 72 hours, 21 days, and 7 days, respectively. There was no complication occurred in either LGP or DJOS. (2) Follow-up: the patient was followed up for 24 months after LGP. The BMI of this patient decreased to 45.3 kg/m2 at 6 months after LGP, and decreased to 37.2 kg/m2 at 18 months after DJOS. Insulin therapy was discontinued. There was no long-term complication such as malnutrition, dumping syndrome, or biliary reflux.@*Conclusion@#LGP combined with DJOS can enrich treatment methods of obese patient with BMI >50 kg/m2, which offers a safer surgical procedure option for patients after gastric binding.
ABSTRACT
BACKGROUND: Ileal transposition surgery is an increasingly used procedure in combination with sleeve gastrectomy to control obesity and type 2 diabetes mellitus (T2DM). A short-term effect on glycemia amelioration after the ileal transposition (IT) procedure is observed; however, it appears that the effect is time dependent, and it remains uncertain if this effect is also linked with an adipose tissue hormonal activity. METHODS: Twenty male Zucker rats underwent IT or sham surgery. Six months after surgery, serum levels of adiponectin, vaspin, resistin, chemerin RBP4 were analyzed using ELISA kits. Tissue concentrations of glycogen sythase kinase alfa (GSK-3α), glucose 6-phosphatase (G6PC), glycogen phosphorylase (PYGM), and phosphofructokinase (PFK) in muscle and GLUT4 in visceral fat, white adipose tissue, and muscle were assessed in duplicate by an enzyme-linked immunosorbent assay (ELISA) kit. Additionally, the transposed ileum and analogical ileal segment of sham-operated rats were processed for histomorphometry analysis. RESULTS: The animals which underwent IT showed significantly a higher adiponectin and vaspin serum level. Concentrations of resistin decreased after IT surgery but were not significantly different between the groups. The plasma level of chemerin decreased significantly after IT and correlated negatively with adiponectin serum level in the IT group. The effects of IT on RBP4 serum level appeared to be significantly lower than those in the sham group and correlated with GLUT4 concentration in IT white adipose tissue negatively, but positively with the sham group. CONCLUSIONS: The data suggest that ileum transposition leads to a stimulatory effect on important adipokines involved in glucose metabolism. The adipokine serum level could be a useful biomarker of postoperative physiological state.
