title: The impact of the repair of staple line dehiscence in post-RYGB patients on glucose homeostasis and gut hormones--a preliminary study.
abstract: BACKGROUND
  Staple-line disruption (SLD) following Roux-en-Y gastric bypass (RYGB) results in weight regain. This study evaluated glucose homeostasis and gut hormonal changes following surgical repair of gastrogastric fistula.
  
  
  METHODS
  Three patients with SLD underwent an oral 75 g glucose tolerance test (OGTT) before (baseline) and one week after gastric pouch restoration. Plasma glucose, insulin and glucagon glucose-dependent insulinotropic polypeptide (GIP) and glucagonlike peptide-1 (GLP-1) were measured in the OGTT samples. Fasting plasma levels of ghrelin and leptin were assessed.
  
  
  RESULTS
  Restoration of gastric pouch provided moderate amelioration of glucose metabolism and gut hormones, yet without complete normalisation of glucose homeostasis at one week after surgery. Duodenal passage exclusion resulted in early improvement of control fasting plasma glucose with decrease of glucagon from 18.5 to 15 (ng/mL, by 19%), relatively stable insulin and decline of incretin hormones (GIP and GLP-1). Post-challenge measurements confirmed amelioration of glycaemic control with decrease of plasma glucose from 182 to 158 mg/dL at 60 minutes. Surgical re-intervention resulted in exacerbation of GIP response with brisk rise in plasma level, accompanied by considerable increase of peak insulin concentration. The overall post-challenge glucagon and GLP-1 responses were decreased. Marked decrease in fasting plasma ghrelin and leptin were observed.
  
  
  CONCLUSIONS
  Our report gives further insight into the hormonal mechanisms underlying the effects of surgically altered anatomy of different parts of the small intestine on glucose homeostasis that is highly important, since it may facilitate novel conservative therapies of diabetes without the need for surgery.
authors: Department of General and Transplant Surgery, Medical University of Lodz, Barlicki University Hospital,Kopcinskiego St. 22, Lodz, Poland. A.Durczynski@interia.pl
authors: Adam
authors: A
authors: Durczynski
authors: Dariusz
authors: D
authors: Szymanski
authors: Michal
authors: M
authors: Nowicki
authors: Piotr
authors: P
authors: Hogendorf
authors: Katarzyna
authors: K
authors: Wojciechowska-Durczyńska
authors: Leszek
authors: L
authors: Czupryniak
authors: Janusz
authors: J
authors: Strzelczyk
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism* / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D005768:Gastrointestinal Hormones / Q000378:metabolism*; D054439:Ghrelin / Q000097:blood; D005934:Glucagon / Q000097:blood; D005951:Glucose Tolerance Test; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood; D020738:Leptin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D055502:Secondary Prevention; D017792:Surgical Stapling / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery*
chemical_list: D001786:Blood Glucose; D005768:Gastrointestinal Hormones; D054439:Ghrelin; D007328:Insulin; D020738:Leptin; D005934:Glucagon