title: Long-term Outcome after Robotic-assisted Gastroplication in Adolescents: Hunger Hormone and Food Preference Changes Two Case Reports.
abstract: Weight loss surgery (WLS) is efficacious for long-term weight reduction and decreases overall mortality in severely obese patients. The mechanisms implicated in long-term weight loss are not fully understood. Proposed mechanisms include changes in gut hormones and brain regulation of appetite and satiety. We aimed to investigate the long-term ghrelin and leptin profiles and changes in food preference and eating behavior after WLS in adolescent patients. Two obese females aged 15 years and 14 4/12 years, who did not respond to lifestyle changes, including dietary intervention and physical exercise in combination with medical therapy, underwent robotic-assisted gastroplication. Anthropometric measurements, food habits and eating behavior, as well as metabolic and hormonal changes during long-term post-surgical follow-up were monitored. Long-term weight reduction was obtained in both patients, with a significant decrease in waist circumference. Resting energy expenditure showed a decrease over time, with a respiratory quotient that increased showing a shift from oxidation of a high-fat diet before surgery to oxidation of a mixed diet two and three years later. Both subjects improved their eating habits and lifestyle. Co-morbidity resolution was also noted. Increased pre-prandial ghrelin levels as well as higher post-prandial ghrelin and a leptin drop compared with pre-surgery values were observed in both patients. Persistent weight loss after gastroplication is associated with a favorable change in gut hormones and food preferences. The role of hormonal and sensory components in long-term results seems crucial. Particularly in adolescent patients, a multidisciplinary approach and continuous nutritional care is mandatory for weight maintenance and consolidation of changes.
authors.forename: Valeria
authors.initials: V
authors.lastname: Calcaterra
authors.forename: Hellas
authors.initials: H
authors.lastname: Cena
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Fonte
authors.forename: Mara
authors.initials: M
authors.lastname: De Amici
authors.forename: Matteo
authors.initials: M
authors.lastname: Vandoni
authors.forename: Michela
authors.initials: M
authors.lastname: Albanesi
authors.affiliation: Fondazione IRCCS Policlinico San Matteo and University of Pavia, Department of Maternal and Children's Health, Pediatric Surgery Unit, Pavia, Italy, Phone: +39 038 250 29 30 E-mail: g.pelizzo@smatteo.pv.it.
authors.forename: Gloria
authors.initials: G
authors.lastname: Pelizzo
mesh_terms: D000293:Adolescent; D005247:Feeding Behavior / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005518:Food Preferences / Q000502:physiology*; D015391:Gastroplasty / Q000379:methods*; D054439:Ghrelin / Q000097:blood; D006801:Humans; D020738:Leptin / Q000097:blood; D009765:Obesity / Q000601:surgery*; D065287:Robotic Surgical Procedures; D013995:Time
chemical_list: D054439:Ghrelin; D020738:Leptin