Single-Port One Anastomosis Sleeve Gastrectomy with Transit Bipartition: Initial Experience and Technique.

BACKGROUND: Sleeve gastrectomy with transit bipartition (SG-TB) procedure has been gaining traction recently. While being a relatively novel procedure, it shows potentials to improve the standalone SG outcomes, such as diabetes remission and reflux. This article aims to show insights on performing SG-TB in one anastomosis fashion (SG-OATB) and single-port approach. METHODS: Three patients who underwent laparoscopic single-port SG-OATB at our hospital were included. The parameters included in this study comprised of age, gender, height, weight, body mass index (BMI), type 2 diabetes mellitus (T2DM) assessment, gastroesophageal reflux disease (GERD) assessment, length of the small bowel, the duration of the procedure, and 30-day readmission rate. RESULTS: The mean preoperative assessments for the three patients were as follows: two females vs. one male; age 38.7 ± 5.5 years old; weight 105.7 ± 5.4 kg; height 1.64 ± 0.11 m; BMI 39.3 ± 4.7 kg/m2; fasting blood glucose 6.7 ± 1.2 mmol/L; glycosylated hemoglobin level 7.1 ± 1.3%; GERD-Questionnaire score 6.3 ± 1.5; two patients with esophagitis grade A and B following endoscopy. The total duration of the procedure was 170.0 ± 26.5 min; there was no need for conversion to multiple-port in all patients. The 30-day readmission rate for all patients was 0%. CONCLUSION: In our small cases of patients, single-port SG-OATB is feasible and safe. We found the closure of the anastomosis defect to be most technically demanding. To understand better the outcome of single-port SG-OATB, studies with larger sample and longer follow-up will be needed in the future.

Causal relationship of obesity and adiposity distribution on risk of ventral hernia.

PURPOSE: Ventral hernia (VH) is a common surgical disease. Previous studies suggested that obesity is an important risk factor for VH. However, the causal relationship between fat distribution and the risk of VH is still unclear. This study used Mendelian randomization (MR) to evaluate their causal relationship. METHODS: We used the body mass index (BMI), body fat percentage, and body fat mass to represent general obesity and utilized the volume of abdominal subcutaneous adiposity tissue, visceral adiposity tissue, waist circumference, hip circumference, and waist-to-hip ratio to represent abdominal adiposity. The data were extracted from the large-scale genome-wide association study of European ancestry. We used two-sample MR to infer causality, using multivariate MR to correct the effects of confounding factors. RESULTS: Increased BMI, body fat percentage, body fat mass, visceral adiposity tissue, waist circumference, and hip circumference rather than subcutaneous adiposity tissue or waist-to-hip ratio, were causally associated with a higher risk of VH. The results of multivariate MR suggested that body fat percentage was causally associated with a higher risk of VH after adjusting for body mass index, diabetes, and smoking. CONCLUSION: General obesity, increased visceral adiposity tissue, waist circumference, and hip circumference rather than subcutaneous adiposity tissue or the waist-to-hip ratio were causally associated with a higher risk of VH. These findings provided a deeper understanding of the role that the distribution of adiposity plays in the mechanism of VH.

Mid-Term Diabetes Remission Outcome in Patients with BMI ≤ 30 kg/m2 Following Sleeve Gastrectomy.

BACKGROUND: Bariatric and metabolic surgery is recommended for Asian patients with type 2 diabetes mellitus (T2DM) and BMI ≥ 27.5 kg/m2. However, mid to long-term ·evidence is still lacking. METHODS: Patients' data that underwent laparoscopic sleeve gastrectomy (SG) as the primary surgery at the Affiliated Hospital of Xuzhou Medical University were analyzed. Patients with T2DM diagnosed with either fasting blood glucose (FBG) ≥ 7.0 mmol/L or glycosylated hemoglobin (HbA1c) level ≥ 7.0% and 27.5 ≤ BMI ≤ 30 kg/m2 were included. RESULTS: 24 patients (7 male and 17 female) were included in this study. With a mean follow-up duration of 4.5 ± 1.1 years, the mean percentage of total weight loss (%TWL) was 14.4 ± 6.7%. Postoperatively, nine patients (37%) still required oral anti-diabetic medications, while no patients used insulin. FBG and HbA1c levels declined to 6.3 ± 1.5 mmol/L and 6.0 ± 1.0%, respectively. Fifteen patients (63%) were with HbA1c levels < 7% and without medication requirements, five patients (21%) were with HbA1c levels < 7% with the help of oral anti-diabetic medication, and four patients (16%) were with HbA1c levels > 7% with the help of oral anti-diabetic medication. CONCLUSIONS: Our study provides further evidence that SG could result in both T2DM improvement and remission in patients with BMI ≤ 30 kg/m2. Longer follow-up duration and larger sample will be needed in the future.

Bariatric surgery induces pancreatic cell transdifferentiation as indicated by single-cell transcriptomics in Zucker diabetic rats.

AIMS: Bariatric surgery results in rapid recovery of glucose control in subjects with type 2 diabetes mellitus. However, the underlying mechanisms are still largely unknown. The present study aims to clarify how bariatric surgery modifies pancreatic cell subgroup differentiation and transformation in the single-cell RNA level. METHODS: Male, 8-week-old Zucker diabetic fatty (ZDF) rats with obesity and diabetes phenotypes were randomized into sleeve gastrectomy (Sleeve, n = 9), Roux-en-Y gastric bypass (RYGB, n = 9), and Sham (n = 7) groups. Two weeks after surgery, the pancreas specimen was further analyzed using single-cell RNA-sequencing technique. RESULTS: Two weeks after surgery, compared to the Sham group, the metabolic parameters including fasting plasma glucose, plasma insulin, and oral glucose tolerance test values were dramatically improved after RYGB and Sleeve procedures (p < .05) as predicted. In addition, RYGB and Sleeve groups increased the proportion of pancreatic ß cells and reduced the ratio of α cells. Two multiple hormone-expressing cells were identified, the Gcg+/Ppy + and Ins+/Gcg+/Ppy + cells. The pancreatic Ins+/Gcg+/Ppy + cells were defined for the first time, and further investigation indicates similarities with α and ß cells, with unique gene expression patterns, which implies that pancreatic cell transdifferentiation occurs following bariatric surgery. CONCLUSIONS: For the first time, using the single-cell transcriptome map of ZDF rats, we reported a comprehensive characterization of the heterogeneity and differentiation of pancreatic endocrinal cells after bariatric surgery, which may contribute to the underlying mechanisms. Further studies will be needed to elucidate these results.

Comparison of three different anastomotic methods of sleeve gastrectomy with transit bipartition using an obese rodent model.

The long-term effects and safety of single-anastomosis sleeve ileal (SASI) bypass have not been confirmed. The one anastomosis procedure carries the risk of bile reflux, and Braun anastomosis has the capacity to reduce bile reflux. This study was designed to compare the influences of bile reflux and histological changes in the esogastric sections of rats. Obese Sprague-Dawley rats underwent sleeve gastrectomy with transit bipartition (RYTB) (n = 12), SASI (n = 12), SASI bypass with Braun anastomosis (BTB) (n = 12), esojejunostomy (EJ) (n = 12), and SHAM (n = 8) surgery. During the 12-week follow-up period, weight changes, glucose improvement, and changes in serum nutrition were evaluated. Histological expression and bile acid concentration in the rats in all groups were also evaluated. No significant differences in weight loss and glucose improvements were observed in the RYTB, SASI, and BTB groups. The RYTB and BTB groups had significantly lower bile acid concentration and albumin levels than the SASI group. In addition, mucosal height in the RYTB and BTB groups was significantly lower than in the SASI group. Braun anastomosis had a significant effect on anti-reflux. BTB may be a superior primary procedure due to its potential for parallel bariatric and metabolic improvements, effective anti-reflux effects, simplified operations, and avoidance of severe malnutrition. Further clinical studies are needed to confirm these findings.

Routine gastric suspension technique in single-port sleeve gastrectomy procedure.

BACKGROUND: Due to limited technical demand, single-port sleeve gastrectomy (SPSG) is a feasible laparoscopic technique for sleeve gastrectomy (SG). Nonetheless, difficulties exist when performing the single-port technique, and in this study, we aim to describe a slight maneuver that can improve the SPSG procedure. METHODS: Patients who underwent laparoscopic SG between January 2022 and May 2023 at our hospital were included. The patients were classified into two groups: (1) SPSG and (2) multiple-port SG (MPSG). The parameters for this analysis were the patients' age, gender, weight, body mass index (BMI), conversion rate, drainage placement, 30-day readmission rate, and postoperative complications. Postoperative one-month and three-month percentages of total weight loss (%TWL) were calculated and compared. RESULTS: 171 patients were included in this study: (1) the SPSG group (n = 96) and (2) the MPSG group (n = 75). No statistically significant difference was observed within the preoperative (age, gender, height, weight, and BMI) and the perioperative parameters between SPSG and MPSG (operation time, drainage placement, 30-day readmission) (p > 0.05). Per Clavien-Dindo's grading, two patients in the SPSG group suffered grade 1 complications; for the MPSG group, one patient sustained grade 2 and another suffered grade 3b complication. No statistical significance was observed on the %TWL between the two groups (p > 0.05). CONCLUSION: Our study found that performing SPSG in specific patient is feasible and non-inferior when compared to the MPSG. Further studies will be needed to elucidate better the efficacy and safety of performing SPSG.

Regulation of Pancreatic TXNIP-Insulin Expression Levels after Bariatric Surgery Using Diabetic Rodent Model.

Purpose: The purpose of this study was to investigate the effect of bariatric surgery on pancreatic thioredoxin-interacting protein (TXNIP) and insulin expression levels. The research question is does bariatric surgery induce changes in the pancreatic TXNIP level, given that TXNIP has been proposed as a key glucose control factor? Methods: Using nondiabetic and diabetic rats, we investigated whether our streptozotocin-induced diabetic rat models exhibited changes in pancreatic TXNIP regulation. Following this confirmation, we randomly divided the diabetic rats into the following three groups: the gastric bypass group (n = 16), pair-fed group (n = 10), and sham group (n = 10). Preoperatively and 3 weeks postoperatively, all the rats underwent an oral glucose tolerance test, insulin tolerance test, and blood sampling procedures for hormonal analysis. Results: The TXNIP messenger ribonucleic acid (mRNA) and protein expression levels were significantly lower in the gastric bypass group than in the other groups. Regarding the gastric bypass group, the pancreatic mRNA expression levels of microRNA-204 (miR-204) and MafA were significantly lower and higher, respectively, than in the other groups. Furthermore, the levels of pancreatic insulin expression at the mRNA and protein levels were also significantly higher in the gastric bypass group than in the other groups. Conclusion: Bariatric surgery significantly improved glucose control and regulated the pancreatic insulin production pathways of TXNIP, miR-204, and MafA. The regulation of TXNIP, miR-204, and MafA might play an important role in the mechanism of diabetes remission following bariatric surgery.

Can we abandon foregut exclusion for an ideal and safe metabolic surgery?

Foregut (foregut exclusions) and hindgut (rapid transit of nutrients to the distal intestine) theories are the most commonly used explanations for the metabolic improvements observed after metabolic surgeries. However, several procedures that do not comprise duodenal exclusions, such as sleeve with jejunojejunal bypass, ileal interposition, and transit bipartition and sleeve gastrectomy were found to have similar diabetes remission rates when compared with duodenal exclusion procedures, such as gastric bypass, biliopancreatic diversion with duodenal switch, and diverted sleeve with ileal interposition. Moreover, the complete exclusion of the proximal intestine could result in the malabsorption of several important micronutrients. This article reviews commonly performed procedures, with and without foregut exclusion, to better comprehend whether there is a critical need to include foregut exclusion in metabolic surgery.

The Protective Effect of Transit Bipartition and Its Modification Against Sleeve Gastrectomy-Related Esophagitis in a Rodent Model.

BACKGROUND: The protective effect of transit bipartition against esophagitis has not yet been proven. Thus, we investigate and compare the bariatric outcomes and esophagus' histological changes of sleeve gastrectomy (SG), SG with transit bipartition (SG-TB), and the proximal SG-TB (SG-PTB) in a rodent model. METHODS: This study included 45 diabetic Sprague-Dawley rats assigned to one of the four groups, SG-PTB (n = 15), SG-TB (n = 12), SG (n = 10), and SHAM (n = 8). Eight surviving rats from each group were included for further investigation. Histological analysis of the gastroesophageal junction was performed. Body weight, food intake, glucose control, and hormonal changes (glucagon-like peptide-1 and insulin) were assessed before and after surgery in all groups. RESULTS: Preoperatively, no significant differences were observed in food intake, body weight, and fasting blood glucose levels among the groups. Postoperatively, the SG-PTB and SG-TB groups showed significantly superior glucose control compared to the SG group following the gavage of glucose (p < 0.05). Postoperatively, the SG-PTB and SG-TB groups had higher postoperative GLP-1 levels than postoperative SG and SHAM groups. More severe esophageal hyperpapillomatosis (EHP) of the esophageal section was observed in the SG group. The mucosal height of the SG group was significantly higher than that of the SG-PTB, SG-TB, and SHAM groups (p < 0.05). CONCLUSION: The transit bipartition procedure may protect the distal esophagus from histological changes associated with esophagitis. Clinical studies are needed to confirm the anti-reflux effects of transit bipartition.

The effect of bariatric surgery on the expression of Growth Differentiation Factor-15/Macrophage-Inhibitory Cytokine-1 (GDF-15/MIC-1) in rat.

BACKGROUND: Reduced appetite and loss of preference to nutrition dense high-fat diet are present after bariatric surgery. But the mechanism responsible for these changes in biological activities remains unclear. Similar changes in biological activities have been observed with growth/differentiation factor-15/macrophage-inhibitory cytokine-1 (GDF-15/MIC-1) treatment alone. AIM OF STUDY: To assess the effect of bariatric surgery on GDF-15/MIC-1expression and circulating level in rodent model. SETTING: The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu 221,006, P. R. China. METHODS: Among 40 fatty Sprague-dawley (SD) rats, 30 randomly receive low-dose STZ to induced diabetes and were randomly assigned to Roux en Y gastric bypass (RYGB, n = 10), Sleeve gastrectomy (SG, n = 10), and SHAM (n = 10). The remaining fatty SD rats were assigned to Normal control (NC, n = 10). Rats were followed for 8 weeks postoperatively. Circulating levels of GDF15 and tissue (gastrointestinal and liver) expression were assessed after surgery. Preoperative oral glucose tolerance test (OGTT), and Insulin tolerance test (ITT) were reassessed postoperatively. Changes in bodyweight and food intake were also recorded. RESULTS: Bariatric surgery significantly increased circulating plasma level of GDF15 (p < 0.05). Postoperatively, tissue expression of GDF15 was significantly higher in the stomach pouch, jejunum, and ileum of rats in the RYGB group as well as ileum of rats in the SG group compared to Sham and NC (p < 0.05). Higher Expression of GDF15 in the stomach pouch of the SG group was not statistically significant compared to the stomach of Sham and NC group. GDF15 expression in the liver was significantly less in the RYGB group (p < 0.05). CONCLUSION: Bariatric surgery significantly increases circulating levels and gastrointestinal tissue expression of GDF15. Given that GDF15 is an important regulator of energy homeostasis, further studies are needed to ascertain the relevance in bariatric surgery.

Association Between the Parental Weight Status and the Weight Loss Outcome in Patients After Sleeve Gastrectomy.

PURPOSE: Obesity is a complex multifactorial disease. Parents with obesity could have an impact on the weight loss outcome of their children following bariatric-metabolic surgery. Therefore, we aimed to investigate the association between the weight status of the parents and the weight loss outcome in patients undergoing sleeve gastrectomy (SG). METHODS: Patients undergoing SG with ≥ 3 years of follow-up between January 2016 and June 2018 were included in this study. The patients were categorized into three groups: (1) both parents did not have obesity (non-obesity parents, NOP); (2) one parent had obesity (single-parent obesity, SPO); (3) both parents had obesity (both parents' obesity, BPO). The main parameters for this study were the patients' preoperative and postoperative weight and the weight of the parents. RESULTS: A total of 218 SG patients were included in this study (NOP, n = 116; SPO, n = 64; BPO, n = 38). There was no statistically significant difference in the preoperative assessments. The main results for the NOP vs. SPO vs. BPO were as follows; parents' body mass index (BMI) 23.6 ± 2.5 vs. 27.9 ± 5.0 vs. 30.2 ± 3.3 kg/m2, percentage of total weight loss (%TWL) 30.2 ± 9.0 vs. 30.8 ± 10.4 vs. 23.8 ± 10.9%. The %TWL for the BPO group was significantly lower than the NOP and SPO groups (p < 0.05). CONCLUSION: The patient's weight loss outcome was significantly lower when both parents had obesity. Further controlled or prospective studies are needed to determine the best means to improve weight loss outcomes in such patients.

Comparison of the Outcomes of Single Anastomosis Duodeno-Ileostomy with Sleeve Gastrectomy (SADI-S), Single Anastomosis Sleeve Ileal (SASI) Bypass with Sleeve Gastrectomy, and Sleeve Gastrectomy Using a Rodent Model with Diabetes.

OBJECTIVE: Single anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) is a powerful form of bariatric surgery; however, it has a high risk of malnutrition. Single anastomosis sleeve ileal (SASI) bypass with sleeve gastrectomy may be used as an alternative procedure to avoid malnutrition associated with SADI-S; however, no comparison between the two procedures has been performed. METHODS: Sprague-Dawley rats with diabetes (n = 32) were divided into four groups: SADI-S (n = 8), SASI (n = 8), SG (n = 8), and SHAM (n = 8). Body weight, food intake, and fasting blood glucose were measured, and the oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed before and after surgery. Blood samples were collected before and after the surgery to assess the levels of glucagon-like peptide-1 (GLP-1), hemoglobin, albumin, vitamin B12, calcium, and iron. RESULTS: The SADI-S and SASI groups showed significantly greater weight loss and better glucose control than the SG group postoperatively. The SADI-S and SASI groups showed similar improvements in glucose control throughout the study. The SADI-S and SASI groups had significantly higher GLP-1 levels than the SG group at 6 months. The SADI-S and SASI groups presented with various degrees of deficiencies, with the SADI-S group showing a higher risk for hypoalbuminemia and iron deficiency than the SASI group. CONCLUSIONS: The SASI procedure may be a better alternative as it has excellent bariatric and metabolic results with lower risk for hypoalbuminemia and can be easily converted into either SADI-S or SG procedures. Nevertheless, further clinical results are needed.

Safety of peripheral gastric vessel coagulation during laparoscopic sleeve gastrectomy.

INTRODUCTION: Staple-line bleeding (SLB) is a common issue during laparoscopic sleeve gastrectomy (SG). Identifying a method or technique intraoperatively to manage or reduce the prevalence of SLB is crucial. MATERIALS AND METHODS: Patients' data who had undergone primary laparoscopic SG from January 2018 to December 2019 at our hospital were retrospectively analysed. The patients in this study received peripheral gastric vessel coagulation intervention in addition to the standard SG procedure. Preoperative parameters included age, gender, body mass index (BMI), the prevalence of diabetes and hypertension. Intra- and postoperative parameters were prevalence of SLB, operative time, total postoperative stay, the prevalence of leakage and bleeding. Intraoperative SLB was identified and analysed through video recordings. RESULTS: 217 cases of laparoscopic SG were included in the study. The mean preoperative assessments were as follows: age, 34.2 ± 10.7 years; male/female, 98/119; BMI, 39.9 ± 7.6 kg/m2; prevalence of diabetes, 52 (24.0%) and hypertension, 90 (41.5%). Of 217 patients, 35 (16%) were found to have SLB following the new interventional procedure. The mean operative time was 93.2 ± 13.6 min. The mean total postoperative stay was 3.3 ± 1.3 days. The postoperative prevalence of leakage and bleeding were 0% and 0%, respectively. CONCLUSION: The technique of coagulating the peripheral gastric vessels to prevent SLB is safe and appears promising. A prospective study comparing with and without peripheral gastric vessel coagulation will be needed in the future.

Sleeve Gastrectomy with Braun Anastomosis Transit Bipartition (B-TB): a Potential Midway Between Single Anastomosis and Roux-en-Y Transit Bipartition.

PURPOSE: The single anastomosis sleeve ileal bypass (SASI) procedure is a simple modification of the Roux-en-Y transit bipartition (RYTB) procedure; however, SASI risks patients with possible biliary reflux. Braun anastomosis has been proposed to fix the biliary reflux of single anastomosis procedures. This study presented our early "sleeve gastrectomy with Braun anastomosis Transit Bipartition" (B-TB) outcomes. MATERIALS AND METHODS: Patients who underwent B-TB or RYTB between June 2020 and April 2021 at our hospital and have completed three months follow-up were included in this study. RESULTS: Ten patients with B-TB and forty patients with RYTB were included. No significant differences were observed between the B-TB and RYTB patients regarding the preoperative conditions. The B-TB procedure had significantly shorter operation time and postoperative hospitalization time than the RYTB procedure. There was no significant difference between the two groups regarding the 3-month percentage of total weight loss (B-TB vs RYTB: 19.7 ± 2.7% vs 22.2 ± 5.4%) and the postoperative complications before discharge. Preoperatively, two patients and eight patients achieved GERD-Q score ≥8 for the B-TB and RYTB group, respectively. At postoperative 3 months, those with GERD-Q score ≥8 was reduced to one patient and two patients for the B-TB and RYTB group, respectively. No patients have reported symptoms of greenish-yellow vomiting in both groups postoperatively. CONCLUSION: B-TB is an exciting procedure with potential benefits. However, as it is an investigational procedure, extra care should be maintained. Larger samples and more extended follow-up data are needed in the future.

The effect of sleeve ablation of gastric mucosa on body weight and glucose homeostasis in Sprague-Dawley rat model.

BACKGROUND: The gastric mucosa is an important endocrine organ, most of which is resected in sleeve gastrectomy (SG). The effect of removing most of the gastric mucosa has not been studied. OBJECTIVE: To assess the effect of ablating the gastric mucosa (an area proportional to that in SG), on obesity and diabetes in a rat model. SETTING: The Affiliated Hospital of Xuzhou Medical University in Xuzhou Jiangsu, P. R. China. METHODS: Among 34 fatty Sprague-Dawley rats, 26 randomly received low-dose streptozotocin (STZ) to induce diabetes and then were randomly assigned to gastric mucosa ablation (GMA, n = 10), sleeve gastrectomy (SG, n = 8), and sham (n = 8) groups. The remaining normal fatty rats were assigned to the non-diabetic gastric mucosa ablation (nGMA, n = 8) group. In the GMA groups, the gastric mucosa was thermally ablated using electrocautery. Rats were followed for 8 weeks postoperatively. Preoperative oral glucose tolerance test (OGTT), insulin tolerance test (ITT), and mixed meal tolerance test (MMTT) were repeated at designated time points postoperatively. Changes in body weight, food intake, and fasting blood glucose were also recorded. RESULTS: Fasting ghrelin concentration and area under curve (AUC) decreased significantly (P < .05) in the GMA groups and the SG group after surgery. Gastrin concentration remained unchanged in SG but decreased significantly in the GMA groups after surgery. Significantly increased GLP-1 AUC was found in the GMA groups and the SG group postoperatively. The decrease in fasting blood glucose did not differ significantly between the diabetic GMA and SG groups after surgery. Glucose AUC during OGTT in both SG and diabetic GMA groups was decreased significantly from the preoperative level, but the decreased glucose AUC in the SG group was significantly greater (P < .05). The decrease in body weight and food intake in the SG group was significantly greater than in the GMA groups. CONCLUSION: Ablation of most of the gastric mucosa along the greater curvature is effective in weight loss and glycemic control in a rodent model.

Effect of Sleeve Gastrectomy on Plasma Thioredoxin-Interacting Protein (TXNIP).

PURPOSE: The mechanism in which bariatric surgery induces diabetes remission is still poorly understood. This study proposes Thioredoxin-interacting protein (TXNIP) as a possible factor for the anti-diabetic mechanism after sleeve gastrectomy (SG). MATERIALS AND METHODS: Plasma TXNIP level in obesity patients with diabetes (T2D, N = 20), obesity patients without diabetes (NDO, N = 20), and patients without obesity and diabetes (lean, N = 10) were assessed before surgery and at 1 and 12 months after SG. RESULTS: Preoperative TXNIP level was significantly higher in T2D (196.4 ± 76.0 pg/ml) and NDO (149.7 ± 94.1 pg/ml) patients when compared with lean patients (98.7 ± 22.7 pg/ml) (p-value < 0.05). At 1 month and 12 months postoperatively, the TXNIP levels were reduced significantly from the preoperative levels in the T2D and NDO patients (p-value < 0.05). Before surgery, a correlation between TXNIP and fasting blood glucose (FBG) (r2 = 0.1585, p-value = 0.0109), HbA1C (r2 = 0.2120, p-value = 0.0028), and insulin (r2 = 0.1217, p-value = 0.0274) was observed. At 12 months after surgery, the reduction of TXNIP was also correlated with the degree of FBG (r2 = 0.1038, p-value = 0.0426), HbA1C (r2 = 0.2459, p-value = 0.0011), and insulin (r2 = 0.1365, p-value = 0.0190) reduction. CONCLUSION: Plasma TXNIP level is elevated in obesity patients with/without diabetes. SG resulted in a significant reduction of plasma TXNIP level which is correlated with the degree of FBG, HbA1C, and insulin reduction. Regulation of TXNIP could be part of the mechanism of diabetes remission after bariatric surgery.

Comparing the Anti-diabetic Effect of Sleeve Gastrectomy with Transit Bipartition Against Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Using a Diabetic Rodent Model.

PURPOSE: Roux-en-Y gastric bypass (RYGB) has superior long-term diabetes remission outcomes to sleeve gastrectomy (SG). However, in regions with a high prevalence of gastric cancer, RYGB may not be the best option. This study aimed to investigate the anti-diabetic effect of SG with transit bipartition (SG-TB) compared with SG and RYGB. MATERIALS AND METHODS: A total of 32 diabetic Sprague-Dawley rat models were assigned to one of four groups: SG (n = 8), RYGB (n = 8), SG-TB (n = 8), and SHAM (n = 8). Body weight, food intake, blood glucose, and hormonal changes (glucagon-like peptide-1 (GLP-1), insulin, and glucagon) were measured to investigate the effect of surgery in all groups. Oral glucose tolerance test and insulin tolerance test were performed before and 8 weeks after surgery. RESULTS: There were no significant differences in the postoperative changes in body weight and food intake among the SG, RYGB, and SG-TB groups. Postoperatively, the RYGB and SG-TB groups had significantly higher GLP-1 levels and lower insulin levels than the SG group. Further, RYGB and SG-TB had significantly better glucose control improvements than SG. There were no significant differences in GLP-1, insulin, glucagon, and homeostasis model assessment of insulin resistance levels between RYGB and SG-TB. The preoperative and postoperative values of all variables in the SHAM group did not show significant differences. CONCLUSION: In this study using a diabetes-induced rodent model, we found that the anti-diabetic effect of SG-TB is superior to that of SG and non-inferior to that of RYGB.

Short-Term Results Suggest That Sleeved Stomach without Resection Is as Effective as Sleeve Gastrectomy in Improving Glucose Control in Type 2 Diabetes Mellitus Sprague-Dawley Rat Model.

BACKGROUND: Although sleeve gastrectomy results in good weight loss and metabolic improvements, it is an irreversible procedure. Therefore, we attempted to assess the possibility of creating a sleeved stomach without resection. Material and Methods. A total of 22 male Sprague-Dawley rats with type 2 diabetes were randomly assigned into 3 different groups: (1) sleeve gastroplasty with gastric remnant-jejunal anastomosis (SGP, n = 8); (2) sleeve gastrectomy (SG, n = 8); and (3) SHAM (n = 6). Body weight, food intake, fasting blood glucose (FBG), hormonal analysis, and oral glucose tolerance test (OGTT) were performed and measured preoperatively and postoperatively. RESULTS: During the postoperative period, SGP and SG showed significantly lower food intake and body weight when compared with the preoperative levels, respectively (p value < 0.05). Postoperatively, SGP and SG showed improvements in FBG and glucose tolerance levels compared to their respective preoperative levels (p < 0.05). FBG and glucose tolerance levels did not differ between SGP and SG postoperatively. SG resulted in a reduction in fasting ghrelin levels when compared with the preoperative level (p < 0.05). Fasting insulin levels did not differ preoperatively and postoperatively among all groups. Postoperatively, fasting GLP-1 levels were higher in SGP and SG when compared with the preoperative levels, but no statistical significance was observed. Compared preoperatively, the SGP and SG procedures resulted in a decline in HOMA-IR at postoperative 6th week (p < 0.05). CONCLUSION: Our animal experiment suggested that at least in the short term, sleeved stomach without resection resulted in similar weight loss and improved glucose control effects compared to sleeve gastrectomy.