Omentectomy in addition to gastric bypass surgery and influence on insulin sensitivity: a randomized double blind controlled trial.
OBJECTIVE
Accumulation of visceral adipose tissue is associated with insulin resistance and cardio-vascular disease. The aim of this study was to elucidate whether removal of a large amount of visceral fat by omentectomy in conjunction with Roux en-Y gastric bypass operation (RYGB) results in enhanced improvement of insulin sensitivity compared to gastric bypass surgery alone.


METHODS
Eighty-one obese women scheduled for RYGB were included in the study. They were randomized to RYGB or RYGB in conjunction with omentectomy. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp before operation and sixty-two women were also reexamined 2 years post-operatively. The primary outcome measure was insulin sensitivity and secondary outcome measures included cardio-metabolic risk factors.


RESULTS
Two-year weight loss was profound but unaffected by omentectomy. Before intervention, there were no clinical or metabolic differences between the two groups. The difference in primary outcome measure, insulin sensitivity, was not significant between the non-omentectomy (6.7 ± 1.6 mg/kg body weight/minute) and omentectomy groups (6.6 ± 1.5 mg/kg body weight/minute) after 2 years. Nor did any of the cardio-metabolic risk factors that were secondary outcome measures differ significantly.


CONCLUSIONS
Addition of omentectomy to gastric bypass operation does not give an incremental effect on long term insulin sensitivity or cardio-metabolic risk factors. The clinical usefulness of omentectomy in addition to gastric bypass operation is highly questionable.


BACKGROUND
NCT01785134.
Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
Daniel P
DP
Andersson
Karolinska Institutet, Department of Surgery, Ersta Hospital, 116 91 Stockholm, Sweden.
Anders
A
Thorell
Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
Patrik
P
Löfgren
Department of Clinical Science, Intervention and Technology (CLINTEC) (H9), Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
Mikael
M
Wirén
Department of Medicine, Karolinska Institutet, Ersta Hospital, 116 91 Stockholm, Sweden.
Eva
E
Toft
Department of Medicine, Karolinska Institutet, Ersta Hospital, 116 91 Stockholm, Sweden.
Veronica
V
Qvisth
Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism Uppsala University, Uppsala Science Park, 751 85 Uppsala, Sweden.
Ulf
U
Riserus
Uppsala Clinical Research Center, Uppsala University, Uppsala Science Park, 751 85 Uppsala, Sweden.
Lars
L
Berglund
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden.
Erik
E
Näslund
CLINTEC and Department of Surgery, Södertälje Hospital, 152 86 Södertälje, Sweden.
Sven
S
Bringman
CLINTEC and Department of Surgery, Södertälje Hospital, 152 86 Södertälje, Sweden.
Anders
A
Thörne
Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
Peter
P
Arner
Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden. Electronic address: johan.hoffstedt@ki.se.
Johan
J
Hoffstedt
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D004311:Double-Blind Method; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D015309:Glucose Clamp Technique / Q000379:methods; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000601:surgery*; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D009852:Omentum / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
D001786:Blood Glucose
Bariatric surgery; Hyperinsulinemic euglycemic clamp; Insulin sensitivity; Omentectomy; Weight loss