Effect of Nutritional Deprivation after Sleeve Gastrectomy on Bone Mass, Periostin, Sclerostin and Semaphorin 4D: A Two-Year Longitudinal Study.

Bariatric surgery induces bone loss, but the exact mechanisms by which this process occurs are not fully known. The aims of this 2-year longitudinal study were to (i) investigate the changes in areal bone mineral density (aBMD) and bone turnover markers following sleeve gastrectomy (SG) and (ii) determine the parameters associated with the aBMD variations. Bone turnover markers, sclerostin, periostin and semaphorin 4D were assessed before and 1, 12 and 24 months after SG, and aBMD was determined by DXA at baseline and after 12 and 24 months in 83 patients with obesity. Bone turnover increased from 1 month, peaked at 12 months and remained elevated at 24 months. Periostin and sclerostin presented only modest increases at 1 month, whereas semaphorin 4D showed increases only at 12 and 24 months. A significant aBMD decrease was observed only at total hip regions at 12 and 24 months. This demineralisation was mainly related to body weight loss. In summary, reduced aBMD was observed after SG in the hip region (mechanical-loading bone sites) due to an increase in bone turnover in favour of bone resorption. Periostin, sclerostin and semaphorin 4D levels varied after SG, showing different time lags, but contrary to weight loss, these biological parameters did not seem to be directly implicated in the skeletal deterioration.

Changes in Lean Tissue Mass, Fat Mass, Biological Parameters and Resting Energy Expenditure over 24 Months Following Sleeve Gastrectomy.

Sleeve gastrectomy (SG) induces weight loss but its effects on body composition (BC) are less well known. The aims of this longitudinal study were to analyse the BC changes from the acute phase up to weight stabilization following SG. Variations in the biological parameters related to glucose, lipids, inflammation, and resting energy expenditure (REE) were concomitantly analysed. Fat mass (FM), lean tissue mass (LTM), and visceral adipose tissue (VAT) were determined by dual-energy X-ray absorptiometry in 83 obese patients (75.9% women) before SG and 1, 12 and 24 months later. After 1 month, LTM and FM losses were comparable, whereas at 12 months the loss of FM exceeded that of LTM. Over this period, VAT also decreased significantly, biological parameters became normalized, and REE was reduced. For most of the BC, biological and metabolic parameters, no substantial variation was demonstrated beyond 12 months. In summary, SG induced a modification in BC changes during the first 12 months following SG. Although the significant LTM loss was not associated with an increase in sarcopenia prevalence, the preservation of LTM might have limited the reduction in REE, which is a longer-term weight-regain criterion.

Laparoscopic sleeve gastrectomy: Effect on long-term remission for morbidly obese patients with type 2 diabetes at 5-year follow up.

BACKGROUND: In the short-term, laparoscopic sleeve gastrectomy has been shown to be effective for the treatment of the type 2 diabetes in patients with severe obesity. There are few data with greater follow-up. Our aim was to evaluate the results of laparoscopic sleeve gastrectomy on the control of type 2 diabetes in patients with severe obesity at 5 years at the University Hospital, France. METHODS: From a total of 355 patients with severe obesity operated between January 2006 and June 2010, 52 (15%) had a diagnosis of type 2 diabetes before undergoing laparoscopic sleeve gastrectomy. RESULTS: There were 31 females (60%) and 21 males (40%), with a mean age of 51 ± 10 years (range 27-67) with a mean body mass index of 48 ± 10 kg/m2 (range 35-82). The mean duration of type 2 diabetes was 10.8 ± 10.8 years before bariatric operation. The preoperative glycated hemoglobin was 8 ± 2% (range 5.9-12.8) in 45 patients; 17 patients (38%) had levels of glycated hemoglobin ≥9%. Three patients (6%) required insulin alone, 4 (8%) were taking oral antidiabetic medicine and insulin, and the remaining 45 patients (87%) were taking only oral antidiabetic medicines. The complete data regarding weight loss at 5-year follow-up were obtained for 46 patients, yielding an overall follow-up rate of 89%. The prolonged remission of type 2 diabetes achieved at 1 year that persisted at 5 years of follow-up was present in 9 patients (17%). No patient with complete remission of their type 2 diabetes required insulin preoperatively. Improvement of type 2 diabetes was observed in 30 patients (58%) at 1 year, which was maintained for 27 patients (52%) at 5-year follow-up. CONCLUSION: Laparoscopic sleeve gastrectomy has demonstrated a moderate efficacy in the treatment morbidly obese patients with type 2 diabetes. Markedly increased preoperative glycated hemoglobin levels, older age, and preoperative need for insulin treatment may be the factors predicting failure of complete remission of type 2 diabetes after laparoscopic sleeve gastrectomy.

Five-year results of laparoscopic sleeve gastrectomy for the treatment of severe obesity.

BACKGROUND: Since 2011, the most used bariatric technique in France has been the sleeve gastrectomy. There are still few studies exploring the medium and long-term results of this technique. OBJECTIVE: To describe medium-long-term (5 years) results of a cohort of CHU Montpellier experience in sleeve gastrectomy for morbid obesity. METHODS: All patients that underwent laparoscopic sleeve gastrectomy (LSG) from January 2005 to June 2013 were included in this study. RESULTS: A total of 1050 patients were operated. 72.86% were women. The mean preoperative BMI was 44.58 kg/m2 (±7.71). A total of 183 patients (18.5%) were super-obese (BMI > 50 kg/m2). LSG was proposed as primary procedure, and also after failure of adjustable gastric banding in 169 patients (16.9%) or after vertical banded gastroplasty in 7 cases (0.7%). There were 38 postoperative gastric fistulas (3.8%) and 3 of them required some kind of bypass to be definitively treated. There were also 34 hemorrhages (3.4%) of which 21 were reoperated for hemostasis. Two gastric stenoses at the angulus (0.2%) were managed with dilation or RYGB. Overall reoperative rate was 6.8%. One patient died of pulmonary embolism. Most common late complication was GERD (39.1%). After 3, 4 and 5 years of LSG, the average of %EBL was, respectively, 75.95% (±29.16) (382 patients), 73.23% (±31.08) (222 patients) and 69.26% (±30.86) (144 patients). The success rate at 5 years was 65.97% (95 patients). The improvement or remission of comorbidities was found, respectively, in 88.4 and 57.2% of diabetic patients; 76.9 and 19.2% for hypertensive patients and 98 and 85% for patients with sleep apnea syndrome. CONCLUSION: LSG is a bariatric surgery technique that presents a very good risk/benefit ratio. Five-year results are very convincing. GERD is the main long-term complication.