title: A modified laparoscopic sleeve gastrectomy for the treatment of diabetes mellitus type 2 and metabolic syndrome in obesity.
abstract: BACKGROUND
  Ghrelin is a gastrointestinal peptide hormone (a 28-amino acid peptide) produced primarily by X/A cells in the oxyntic glands of the stomach fundus and cells lining the duodenum cavern. It suppresses insulin secretion and action and commands a significant role in regulating food intake. The aim of the present study was to show that modified laparoscopic sleeve gastrectomy (MLSG), in which a significant part of the gastric fundus and body of the stomach is removed up to 1 inch from the pylorus vein, may contribute to decreasing circulating ghrelin levels.
  
  
  METHODS
  A study population consisting of 150 individuals was monitored after undergoing a MLSG, with individuals chosen based on a documented history of diabetes mellitus type 2 and metabolic syndrome, clinical results determining a body mass index (BMI) of 35 to 60 kg/m(2), peptide C level greater than 1, negative anti-glutamic acid decarboxylase, negative anti-insulin, and confirmed stability of drug/insulin treatment and glycosylated hemoglobin greater than 6.5% for at least 24 and 3 months, respectively, before enrollment.
  
  
  RESULTS
  Twenty-four months after surgery, 150 patients (86.6%) presented with normal glycemic levels between 77 and 99 mg/dL. All patients improved average serum insulin levels by 9 mU/L and average glycosylated hemoglobin levels by 5.1% (normal range, 4%-6%). All patients tested negative for Helicobacter pylori and stopped using insulin, with 3 patients prescribed twice-daily use of an oral hypoglycemiant. In 14% of cases, patients experienced partial hair loss with low serum zinc levels and were prescribed oral zinc reposition and topical hair stimulants. The average weight loss recorded was 44.6% for patients with a BMI less than 45 kg/m(2) and 58% for patients with a BMI greater than 50 kg/m(2).
  
  
  CONCLUSIONS
  The MLSG is a safe procedure with a low morbidity rate (2.7%) (4 cases of fistula and 2 of bleeding) and no surgical mortality in this study. This surgery can promote control of diabetes mellitus type 2 and aid the treatment of exogenous overweight and morbidly obese individuals. The results of this study show that only through resection of the ghrelin-producing gastric area can most obesity cases and diabetes type II conditions be reverted to nonobese and controlled diabetes.
authors.affiliation: Sirio Libanes Hospital, Institute of Orthopedics and Traumatology, Clinical Hospital, University of São Paulo, 74 Adma Jafet St., 16th Floor, 01308050 São Paulo, Brazil. epirolla@terra.com.br
authors.forename: Eduardo H
authors.initials: EH
authors.lastname: Pirolla
authors.forename: Ricardo
authors.initials: R
authors.lastname: Jureidini
authors.forename: Mario L
authors.initials: ML
authors.lastname: Barbosa
authors.forename: Luis C
authors.initials: LC
authors.lastname: Ishikawa
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Camargo
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D054439:Ghrelin / Q000097:blood; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D010535:Laparoscopy; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D054439:Ghrelin; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human