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Background: Laparoscopic Sleeve Gastrectomy (LSG) is an effective and relatively safe bariatric procedure, but long-term results are still rare. Our aim was to evaluate the efficacy of LSG on weight loss, gastroesophageal reflux symptoms and Type 2 Diabetes. Methods: Medical records of all 105 patients undergoing SG at our Institution between 2006 and 2009 were retrospectively examined. Long-term outcomes were analyzed in terms of BMI, %TWL, %EWL, comorbidities resolution and revisional surgery. According to the preoperative BMI, patients were divided in two groups: Group 1 (n=61) BMI

La chirurgia bariatrica rappresenta una valida opzione terapeutica nel trattamento dell'obesità, essendo in grado di indurre una significativa e stabile perdita di peso con miglioramento o scomparsa delle co-morbidità associate all'obesità. In particolare, numerose evidenze scientifiche documentano un drammatico miglioramento dell'omeostasi glicemica dopo interventi di chirurgia bariatrica, sebbene sia difficile stabilire se si tratti di risoluzione o remissione del diabete. Inoltre restano ancora da chiarire i precisi meccanismi fisiopatologici alla base del miglioramento del diabete. Durante il triennio del Corso di Dottorato in "Fisiopatologia Clinica e Medicina Sperimentale" la mia attività di ricerca ha riguardato gli effetti di differenti interventi di chirurgia bariatrica sui meccanismi fisiopatologici alla base del miglioramento dell'omeostasi glico-lipidica, con particolare riguardo allo studio degli ormoni entero-insulari e dell'andamento glicemico in condizioni di vita reale in soggetti in risoluzione clinica del diabete dopo chirurgia bariatrica allo scopo di definire criteri più appropriati di remissione. A tal fine sono stati condotti quattro studi: Studio 1. Obiettivo. Valutare la sensibilità insulinica, la secrezione insulinica e la risposta postprandiale degli ormoni entero-insulari in pazienti con diabete mellito di tipo 2 (DM2) ed obesità sottoposti a bypass gastrico (BPG) o gastrectomia verticale (SG). Materiali e Metodi. In 33 pazienti obesi con DM2 [14 sottoposti a BPG; 6M, età: 49±7 anni, BMI: 42±6 Kg/m2 ed HbA1C: 8.1±2.2 %, (M±DS) e 19 sottoposti a SG; 8M, età: 44±10 anni, BMI: 46±9 Kg/m2 ed HbA1C: 7.6±2 %] sono state valutate sensibilità e secrezione insulinica e la risposta degli ormoni gastrointestinali (GIP, GLP-1 e grelina) ad un pasto misto liquido (305 kcal) prima ed 1 anno dopo chirurgia bariatrica. Risultati. Ad 1 anno dall'intervento chirurgico si è osservato un decremento ponderale di circa 40 kg dopo entrambe le procedure. La remissione del DM2, valutata come glicemia a digiuno < 126 mg/dl ed HbA1C < 6.5%, si verificava nel 86% dei pazienti dopo BPG e nel 74% dei soggetti dopo SG. La sensibilità insulinica, espressa come indice OGIS (Oral Glucose Insulin Sensitivity), aumentava significativamente a 12 mesi, senza differenze tra le due procedure chirurgiche. La secrezione insulinica, sia precoce ed espressa come IGI30 (Indice insulinogenico), che totale (IGI180) aumentava significativamente in entrambi i gruppi (p 200 mg/dl a 120'. Al CGM, la glicemia media era simile in entrambi i gruppi (117 e 106 mg/dl, rispettivamente nel gruppo bariatrico e di controllo, p=0.07); tuttavia entrambi i gruppi chirurgici avevano valori di IG massimo significativamente maggiori rispetto al gruppo di controllo (p

The aim of the work was to compare the hormonal and the metabolic mechanisms involved in weight loss and remission of T2DM one year after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) in morbidly obese type 2 diabetic (T2DM) patients. Insulin sensitivity, insulin secretion, and the gastrointestinal (GI)hormone response to a mixed meal test (MMT) were evaluated before and one year after BS (14 RYGB and 19 VSG). RYGB and VSG groups had similar characteristics at baseline. Weight loss at one year was similar in the 2 groups (ΔBMI %: − 32 ± 10 and − 30 ± 7 %, p = 0.546). Insulin sensitivity and insulin secretion improved similarly after either procedures with a similar rate in T2DM remission (86 % in RYGB and 76 % in VSG). Meal-stimulated GLP-1 levels increased after both procedures reaching significantly higher levels after RYGB (p = 0.0001). GIP response to MMT decreased to a similar extent after the 2 interventions (p = 0.977). Both fasting and postmeal ghrelin concentrations were markedly suppressed after VSG and significantly lower than RYGB (p = 0.013 to p = 0.035). The improvement of insulin sensitivity and beta-cell function was significantly associated with weight loss (p = 0.014 to p = 0.035), while no relation was found with the changes in GI hormones. In conclusion, in morbidly obese T2DM patients, RYGB and VSG result in similar improvements of the glucose status in the face of different GI hormonal pattern. Weight loss is the key determinant of diabetes remission one year after surgery.

Idiopathic reactive hypoglycemia (IRH) is characterized by recurrent episodes of symptomatic hypoglycemia occurring within 4 hours after meals. The underlying mechanisms remain obscure.This study aimed to investigate the response of the glucoregulatory and gastrointestinal hormones to an oral glucose load (OGTT) in individuals with documented IRH.This was a cross-sectional study composed of outpatients referred to "Federico II" University of Naples.We enrolled subjects with IRH documented by a mixed meal under ordinary life conditions and healthy subjects as controls.We measured plasma glucose, insulin, glucagon-like peptide 1 (GLP-1), GIP, and glucagon response to a 75-g OGTT in cases and controls.Ten IRH and eight control subjects were enrolled. During the OGTT, mean plasma glucose tended to be lower in IRH than in control subjects, reaching a statistically significant difference at 240 minutes (T240) (43 ± 1.6 vs 72 ± 0.3 mg/dL; P = .001). Accordingly, the insulin response was higher in IRH than in control subjects (P.019) with a statistically significant difference (46%) at T90 (P = .045) and was associated with significantly lower glucagon levels in the late phase of the OGTT: at T120 (P = .031) and T180 (P = .048) in IRH than in control subjects. A greater GLP-1 response was found among IRH compared with control subjects (P = .005); GLP-1 peak was 2-fold higher in IRH individuals (9.77 ± 2.52 pmol/L) than in the control group (4.19 ± 0.53 pmol/L; P = .041). In the IRH group, GLP-1 peak inversely correlated with the nadir of plasma glucose (r = -0.66; P = .039). A multivariate analysis confirmed that GLP-1 peak independently predicted the plasma glucose nadir (β = -0.593; P = .026).GLP-1 may play a significant role in the pathogenesis of idiopathic IRH.

To evaluate the clinical efficacy of bariatric surgery vs medical therapy with liraglutide on weight loss, glycemic control and cardiovascular risk profile in patients with type 2 diabetes and severe obesity. A retrospective evaluation was conducted in 31 patients with type 2 diabetes and severe obesity who had undergone bariatric surgery and in 31 patients with type 2 diabetes and comparable body weight who had added liraglutide to their background medical treatment in the period 2009–2013. Anthropometric parameters, glycemic control, treatment of diabetes and other comorbidities, safety and side effects before and 12 months after treatment were assessed. Age was 47 ± 8 years (mean ± SD) in bariatric surgery and 56 ± 9 years in medical treatment group (p

BACKGROUND: There are few studies of long-term outcomes for either laparoscopic adjustable gastric banding (LAGB) or laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of this study was to compare outcomes of patients randomly assigned to undergo LAGB or LRYGB at 10 years. METHODS: LAGB, using the pars flaccida technique, and standard LRYGB were performed. From January 2000 to November 2000, 51 patients (mean age 34.0 ± 8.9 years; range 20-49) were randomly allocated to undergo either LAGB (n = 27, 5 men and 22 women; mean age 33.3 years; mean weight 120 kg; mean body mass index [BMI] 43.4 kg/m(2)) or LRYGB (n = 24, 4 men and 20 women; mean age 34.7; mean weight 120 kg; mean BMI 43.8 kg/m(2)). Data on complications, reoperations, weight, BMI, percentage of excess weight loss, and co-morbidities were collected yearly. The data were analyzed using Student's t test and Fisher's exact test, with P

Bariatric surgery (BS) is known to favorably impact fasting lipid profile. Fasting and postprandial lipids were evaluated before and 2 years after BS in obese type 2 diabetic (T2DM) patients. A prospective study was conducted in 19 obese T2DM patients: ten undergoing sleeve gastrectomy (SG) and nine undergoing Roux-en-Y gastric bypass (RYGB). Before and 2 years after BS, clinical parameters and the response of lipid and incretin hormones to a mixed meal (MM) were assessed. The two groups had similar characteristics at baseline. After BS, weight loss was similar in the two groups (p ≤ 0.01). Fasting glucose, insulin, and triglycerides decreased while HDL cholesterol increased in a similar way (p

Bariatric surgery (BS) is able to positively influence fasting lipid profile in obese type 2 diabetic patients (T2DM), but no data is available on the impact of BS on postprandial lipid metabolism neither on its relation with incretin hormones. We evaluated the short-term (2 weeks) effects of BS on fasting and postprandial lipid metabolism in obese T2DM patients and the contribution of changes in active GLP-1. We studied 25 obese T2DM patients (age = 46 ± 8 years, BMI = 44 ± 7 kg/m2), of which 15 underwent sleeve gastrectomy and 10 underwent gastric bypass. Lipid and incretin hormone concentrations were evaluated for 3 h after ingestion of a liquid meal before and 2 weeks after BS. After BS, there was a significant reduction in body weight (p

Overweight and obesity independently increase cardiovascular risk, while even modest weight loss can result in clinically significant improvements in cardiovascular risk and reduce long-term mortality. Lowering the body mass index (BMI) threshold for bariatric surgery to those with moderate obesity might be one way to lower the burden of this disease. The aim of this study was to evaluate the efficacy and safety of laparoscopic adjustable silicone gastric banding (LAGB) in moderately obese subjects with or without obesity-related co-morbidities.Thirty-four patients with BMI between 30 and 35 kg/m(2) (5 males/29 females, mean age 36 ± 10 years, mean preoperative weight 87.9 ± 7.1 kg, mean BMI 32.6 ± 1.6 kg/m(2) and mean percentage excess weight 48.7 ± 9 %) who underwent LAGB via pars flaccida between June 1, 2002 and August 31, 2010 were included. Good response was defined as BMI30 kg/m(2) or percentage estimated weight loss (%EWL)50. Poor response was defined as BMI30 kg/m(2) or %EWL less than 50 after a minimum of 1 year.Mean weight, BMI and %EWL were recorded at 1, 3, 5 and 7 years and were 77.4 ± 7.6, 69.9 ± 10.8, 70.9 ± 9.3 and 73.3 ± 12.0 kg; 28.8 ± 2.9, 26.4 ± 3.2, 26.5 ± 3.4 and 27.4 ± 5.0 kg/m(2); and 36 ± 23, 46.1 ± 33.8, 58.6 ± 31.5 and 45 ± 57, respectively (p0.01). Co-morbidities were diagnosed in 17/34 (50 %) patients at baseline and underwent remission or improvement in all cases after 1 year.LAGB in a safe and effective procedure in patients with a BMI35 kg/m(2).

This study was undertaken to assess medium-term effects of laparoscopic sleeve gastrectomy (LSG) on body weight and glucose homeostasis in severely obese type 2 diabetic (T2DM) subjects. Twenty-five obese T2DM subjects (10 M/15 F, age45±9years, BMI48±8 kg/m2, M ± SD) underwent evaluation of anthropometric/clinical parameters and glucose homeostasis before, 3 and 9–15 months after LSG. Mean BMI decreased from48±8 kg/m2to40±9 kg/m2(P<.001) at 3 months and34±6 kg/m2(P<.001) at 9–15 months after surgery. Remission of T2DM (fasting plasma glucose < 126 mg/dL andHbA1c<6.5% in the absence of hypoglycemic treatment) occurred in all patients but one. There was a remarkable reduction in the percentage of patients requiring antihypertensive and hypolipidemic drugs. Our study shows that LSG is effective in producing a significant and sustained weight loss and improving glucose homeostasis in severely obese T2DM patients.