Enterohormonal changes after digestive adaptation: five-year results of a surgical proposal to treat obesity and associated diseases.
BACKGROUND
Recent physiological knowledge allows the design of bariatric procedures that aim at neuroendocrine changes instead of at restriction and malabsorption. Digestive adaptation is a surgical technique for obesity based in this rationale.


METHODS
The technique includes a sleeve gastrectomy, an omentectomy and a jejunectomy that leaves initial jejunum and small bowel totaling at least 3 m (still within normal variation of adult human bowel length). Fasting ghrelin and resistin and fasting and postprandial GLP-1 and PYY were measured pre- and postoperatively.


RESULTS



METHODS
228 patients with initial body mass index (BMI) varying from 35 to 51 kg/m(2); follow-up: 1 to 5 years; average EBMIL% was 79.7% in the first year; 77.7% in the second year; 71.6% in the third year; 68.9% in the fourth year. PATIENTS present early satiety and major improvement in presurgical comorbidities, especially diabetes. Fasting ghrelin and resistin were significantly reduced (P < 0.05); GLP-1 and PYY response to food ingestion was enhanced (P < 0.05). Surgical complications (4.4%) were resolved without sequela and without mortality. There was neither diarrhea nor detected malabsorption.


CONCLUSIONS
Based on physiological and supported by evolutionary data, this procedure creates a proportionally reduced gastrointestinal (GI) tract that amplifies postprandial neuroendocrine responses. It leaves basic GI functions unharmed. It reduces production of ghrelin and resistin and takes more nutrients to be absorbed distally enhancing GLP-1 and PYY secretion. Diabetes was improved significantly without duodenal exclusion. The patients do not present symptoms nor need nutritional support or drug medication because of the procedure, which is safe to perform.
Santoro
Sérgio
S
Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil. sergio@santoro.med.br
Milleo
Fábio Quirilo
FQ
Malzoni
Carlos Eduardo
CE
Klajner
Sidney
S
Borges
Pedro C M
PC
Santo
Marco Aurélio
MA
Campos
Fábio Guilherme
FG
Artoni
Roberto Ferreira
RF
D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D005743:Gastrectomy; D054439:Ghrelin / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000503:physiopathology* / Q000601:surgery*; D009852:Omentum / Q000601:surgery; D019894:Peptide YY / Q000097:blood; D052243:Resistin / Q000097:blood
D054439:Ghrelin; D052243:Resistin; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1