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Nice, France

Ritz P.,Toulouse University Hospital Center | Ritz P.,University Paul Sabatier | Topart P.,Clinique de lAnjou | Benchetrit S.,Center Pericaud | And 7 more authors.
Surgery for Obesity and Related Diseases | Year: 2014

Background: The benefits and risks of bariatric surgery are debated in older patients. The objective of this study was to compare the weight changes and adverse outcomes in patients>60 years and in younger ones. Methods: The French SOFFCO registry was screened for gastric bypass (RYGB), gastric banding (LAGB), or sleeve gastrectomy (SG) performed between 2007 and 2010. Adverse outcomes and weight changes (%) over 12 months were compared between patients<40 years (N = 1379), between 40-59 years (N = 1065), and>60 years (N = 164). Results: After a RYGB surgical (12.3 versus 3.8%; P = .03) and nonsurgical (7.0% versus .8%; P = .01) complications were more prevalent in patients above 60 years than in those below 40. No increased prevalence of surgical and nonsurgical complications was seen after a LAGB or a SG. Weight loss (% of initial weight) was lower after a LAGB than after a RYGB or a SG. After LAGB weight loss (%) did not differ between patients above 60 years and those aged<40 (difference 1.7±1.5%, P = .26). After a RYGB weight loss (%) was lower in patients aged>60 years (-5.6±1.7%, P = .001) than in those aged<40 years. After a SG, weight loss (%) was lower in patients aged>60 years (-7.0±2.6%, P = .01) than in those aged<40 years. Conclusion: Bariatric surgery can be a short-term effective and safe therapeutic option in elderly patients. LAGB or SG appears to be an alternative strategy to RYGB, with lower adverse outcome rate. © 2014 American Society for Bariatric Surgery. Source

Eickhoff H.,Obesity Center | Eickhoff H.,University of Coimbra | Louro T.M.,University of Coimbra | Matafome P.N.,University of Coimbra | And 3 more authors.
Obesity Surgery | Year: 2015

Background: In obese diabetic patients, bariatric surgery has been shown to induce remission of type 2 diabetes. Along with weight loss itself, changes in gut hormone profiles after surgery play an important role in the amelioration of glycemic control. However, the potential of gastrointestinal surgery regarding diabetes remission in non-severely obese diabetic patients has yet to be defined. In the present experimental study, we explored the effect of established bariatric procedures with and without duodenal exclusion on glycemic control and gut hormone profile in a lean animal model of type 2 diabetes. Methods: Forty 12- to 14-week-old non-obese diabetic Goto-Kakizaki (GK) rats were randomly assigned to four groups: control group (GKC), sham surgery (GKSS), sleeve gastrectomy (GKSG), and gastric bypass (GKGB). Age-matched Wistar rats served as a non-diabetic control group (WIC). Glycemic control and plasma lipids were assessed at the beginning of the observation period and 4 weeks after surgery. Fasting and mixed meal-induced plasma levels of ghrelin, glucagon-like peptide-17-36 (GLP-1), and peptide tyrosine-tyrosine (PYY) were measured. Results: In GK rats, glycemic control improved after sleeve gastrectomy (SG) and gastric bypass (GB). Mixed meal-induced gut hormone profiles in Wistar rats (WIC) were significantly different from those of sham-operated or control group GK rats. After SG and GB, GK rats showed a similar postprandial decrease in ghrelin as observed in non-diabetic WIC. Following both surgical procedures, a significant meal-induced increase in PYY and GLP-1 could be demonstrated. Conclusions: SG and GB induce a similar improvement in overall glycemic control in lean diabetic rodents. Meal-induced profiles of ghrelin, GLP-1, and PYY in GK rats are significantly modified by SG and GB and become similar to those of non-diabetic Wistar rats. Our data do not support the hypothesis that duodenal exclusion and early contact of food with the ileal mucosa alone explain changes in gut hormone profile in GK rats after gastrointestinal surgery. © 2014, Springer Science+Business Media New York. Source

Abramo A.,Anestesia e Rianimazione Universitaria | Di Salvo C.,Anestesia e Rianimazione Universitaria | Baldi G.,Anestesia e Rianimazione Universitaria | Marini E.,Anestesia e Rianimazione Universitaria | And 4 more authors.
Obesity Surgery | Year: 2012

Background: Anesthesia is able to modulate the balance between proinflammatory and anti-inflammatory cytokine production during surgery. The aim of this study is to assess the effect of three anesthesia approaches, total intravenous anesthesia (TIVA), inhalation anesthesia, and xenon anesthesia, on sieric levels of nitric oxide (NO), IL6, IL10, and TNFα in obese patients undergoing Roux-en-Y laparoscopic gastric bypass. Methods: Thirty adult morbidly obese patients (BMI > 35) scheduled for Roux-en-Y laparoscopic gastric bypass were randomly recruited and allocated to TIVA (N = 10), inhalation anesthesia (SEV, N = 10), and xenon anesthesia (XE, N = 10). Exclusion criteria were ASA IV, age <18 or >60 years, and Mallampati IV. Opioid dosage and ventilation parameters were standardized. Sieric levels of NO, IL6, IL10, and TNFα were assessed at T0 (before induction of anesthesia), T1 (end of surgery), and T2 (12 h after the end of surgery). We compared the relative cytokine level variations (delta) at T1 and T2 and the cytokine exposure levels calculated as the area under the curve (AUC) between T0 and T2 in the XE and non-XE (SEV + TIVA) groups. Results: At T1, we found a significant ΔIL10 (reduction) and ΔTNFα (reduction) between XE and SEV (p < 0.05) and XE and TIVA (p < 0.05) groups. At T2, ΔIL10 was still significant. Furthermore, we found a reduced AUC value for TNFα in the XE group. Conclusions: Xenon anesthesia seems able to inhibit postoperative proinflammatory cytokine imbalance in morbidly obese patients undergoing Roux-en-Y laparoscopic gastric bypass; the reduced ΔTNFα at T1 and the reduced global exposition to TNFα in the XE group may explain the reduced ΔIL10 at T1 and T2. © 2011 Springer Science + Business Media, LLC. Source

Eickhoff H.,Obesity Center | Eickhoff H.,Institutes of Physiology | Louro T.,Institutes of Physiology | Louro T.,University of Coimbra | And 5 more authors.
Journal of Endocrinology | Year: 2014

Excessive or inadequate glucagon secretion promoting hepatic gluconeogenesis and glycogenolysis is believed to contribute to hyperglycemia in patients with type 2 diabetes. Currently, metabolic surgery is an accepted treatment for obese patients with type 2 diabetes and has been shown to improve glycemic control inGoto-Kakizaki (GK) rats, a lean animalmodel for type 2 diabetes. However, the effects of surgery on glucagon secretion are not yet well established. In this study,we randomly assigned forty 12- to 14-week-old GK rats to four groups: control group (GKC), sham surgery (GKSS), sleeve gastrectomy (GKSG), and gastric bypass (GKGB). Ten age-matchedWistar rats served as a non-diabetic control group (WIC). Glycemic controlwas assessed before and 4weeks after surgery. Fasting- andmixed-meal-induced plasma levels of insulin and glucagon were measured. Overall glycemic control improved in GKSG and GKGB rats. Fasting insulin levels in WIC rats were similar to those for GKC or GKSS rats. Fasting glucagon levels were highest in GKGB rats. Whereas WIC, GKC, and GKSS rats showed similar glucagon levels, without any significant meal-induced variation, a significant rise occurred in GKSG and GKGB rats, 30 min after a mixed meal, which was maintained at 60 min. Both GKSG and GKGB rats showed an elevated glucagon:insulin ratio at 60 min in comparisonwith all other groups. Surprisingly, the augmented post-procedural glucagon secretion was accompanied by an improved overall glucose metabolism in GKSG and GKGB rats. Understanding the role of glucagon in the pathophysiology of type 2 diabetes requires further research. © 2014 Society for Endocrinology. Source

Wilms B.,Obesity Center | Ernst B.,The Interdisciplinary Center | Schmid S.M.,University of Lubeck | Thurnheer M.,The Interdisciplinary Center | And 2 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2013

Context: The mechanisms of weight loss after Roux-en-Y gastric bypass (RYGB) surgery are incompletely understood. Objective: Our objective was to investigate changes in metabolic processing of ingested food that may contribute to the weight-reducing effect of RYGB surgery. Design and Setting: This was a cross-sectional case-control study at the Interdisciplinary Obesity Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. Patients: Ten formerly obese women (mean±SEM body mass index [BMI] ±26.6±0.9 kg/m2) who had undergone RYGB surgery 41.9 ± 9.7 months before, 8 severely obese women (BMI ± 40.8 ± 2.0 kg/m2), and 10 lean women (BMI ± 20.9 ± 0.6 kg/m2). Intervention: Intervention was a standardized liquid meal test. Main Outcome: The thermic effect of food (TEF), respiratory quotient, and circulating levels of glucose, insulin, and C-peptide were assessed before and repeatedly during the first 90 minutes after the ingestion of a standardized liquid mixed meal containing 39.2 g carbohydrates, 15.4 g protein, and 2.8 g fat. Results: TEF area under curve (0-90 minutes) was significantly greater in RYGB patients than in severely obese and lean women (both P ± .01). After ingestion of the mixed meal, the respiratory quotient increased to significantly greater values in the RYGB patients than in the severely obese and lean group (P ± .001 for ANOVA time ± group interaction). Also, the postprandial rise in circulating glucose, insulin, and C-peptide levels was remarkably higher in the RYGB patients than in the other 2 groups (all P ± .001 for ANOVA time ± group interaction). Conclusion: Data demonstrate an enhanced TEF after RYGB surgery. Although this observation likely contributes to the weight-reducing effects of the surgery, data also point to an altered metabolic processing of food in RYGB patients characterized by an enhanced glucose absorption and postprandial carbohydrate oxidation. Copyright © 2013 by The Endocrine Society. Source

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