PMID- 26240621
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20150805
LR  - 20220321
IS  - 1895-4588 (Print)
IS  - 2299-0054 (Electronic)
IS  - 1895-4588 (Linking)
VI  - 10
IP  - 2
DP  - 2015 Jul
TI  - A prospective evaluation of the influence of three bariatric procedures on 
      insulin resistance improvement. Should the extent of undiluted bile transit be 
      considered a key postoperative factor altering glucose metabolism?
PG  - 213-28
LID - 10.5114/wiitm.2015.52062 [doi]
AB  - INTRODUCTION: Insulin resistance (IR), the essential step in development of type 
      2 diabetes mellitus (T2DM), resolves quickly after bariatric surgery, but the 
      effectiveness depends on the type of the procedure. Although the long-term 
      influence on IR improvement is well documented, the mechanisms of the ultra-fast 
      response after restrictive and bypass procedures require explanation. AIM: To 
      determine IR evolution from the initial preparative period to 6 months after the 
      operation, exposing the rapid postoperative response while comparing the 3 
      bariatric methods, with the belief that the metabolic effect may be correlated 
      with anatomical combinations. MATERIAL AND METHODS: From January to December, 
      2013, a cohort of severely obese, insulin resistant individuals recruited to the 
      prospective study underwent laparoscopic sleeve gastrectomy (SG-30), Roux-en-Y 
      gastric bypass (RYGB-30) and one-anastomosis gastric bypass (OAGB-30). Main 
      laboratory parameters of glucose metabolism were evaluated in fasting patients 
      preoperatively, 4 days and 1, 3 and 6 months after surgery. RESULTS: Within the 
      whole observation period the most significant improvement in homeostasis model 
      assessment for IR (HOMA-IR) was observed in the first 4 days after each 
      operation. The decrease of HOMA-IR was higher (p < 0.0001) in gastric bypass 
      groups than in patients after SG (-41%). The difference between bypass groups 
      favors OAGB over RYGB (63 vs. -56%, p = 0.0489). CONCLUSIONS: Among all bariatric 
      management factors, operation type is the most important in IR improvement. The 
      significant difference in response after SG vs. RYGB and OAGB supports the 
      concept of metabolic competence of duodeno-jejunal exclusion. Altered bile flow 
      after duodeno-jejunal exclusion may be responsible for enhanced glucose 
      metabolism improvement.
FAU - Kaska, Lukasz
AU  - Kaska L
AD  - Department of General, Endocrine and Transplant Surgery, Medical University of 
      Gdansk, Gdansk, Poland.
FAU - Proczko, Monika
AU  - Proczko M
AD  - Department of General, Endocrine and Transplant Surgery, Medical University of 
      Gdansk, Gdansk, Poland.
FAU - Wisniewski, Piotr
AU  - Wisniewski P
AD  - Department of General, Endocrine and Transplant Surgery, Medical University of 
      Gdansk, Gdansk, Poland.
FAU - Stankiewicz, Marta
AU  - Stankiewicz M
AD  - Department of Clinical Nutrition, Medical University of Gdansk, Gdansk, Poland.
FAU - Gill, Derek
AU  - Gill D
AD  - Department of General, Endocrine and Transplant Surgery, Medical University of 
      Gdansk, Gdansk, Poland.
FAU - Sledzinski, Zbigniew
AU  - Sledzinski Z
AD  - Department of General, Endocrine and Transplant Surgery, Medical University of 
      Gdansk, Gdansk, Poland.
LA  - eng
PT  - Journal Article
DEP - 20150608
PL  - Poland
TA  - Wideochir Inne Tech Maloinwazyjne
JT  - Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other 
      miniinvasive techniques
JID - 101283175
PMC - PMC4520841
OTO - NOTNLM
OT  - Roux-en-Y gastric bypass
OT  - homeostasis model assessment for insulin resistance
OT  - insulin resistance
OT  - one-anastomosis gastric bypass
OT  - role of bile
OT  - sleeve gastrectomy
OT  - type 2 diabetes mellitus
EDAT- 2015/08/05 06:00
MHDA- 2015/08/05 06:01
PMCR- 2015/07/01
CRDT- 2015/08/05 06:00
PHST- 2015/01/25 00:00 [received]
PHST- 2015/02/27 00:00 [revised]
PHST- 2015/03/16 00:00 [accepted]
PHST- 2015/08/05 06:00 [entrez]
PHST- 2015/08/05 06:00 [pubmed]
PHST- 2015/08/05 06:01 [medline]
PHST- 2015/07/01 00:00 [pmc-release]
AID - 25212 [pii]
AID - 10.5114/wiitm.2015.52062 [doi]
PST - ppublish
SO  - Wideochir Inne Tech Maloinwazyjne. 2015 Jul;10(2):213-28. doi: 
      10.5114/wiitm.2015.52062. Epub 2015 Jun 8.