BACKGROUND: Laparoscopic greater curvature plication (LGCP) is an innovative restrictive technique designed to reduce gastric volume by plication at the region of greater curvature. The long-term efficacy, safety, and the metabolic effects of this procedure are the subject of this study. METHODS: One hundred twenty-seven patients were enrolled; 84 underwent laparoscopic sleeve gastrectomy (LSG) and 43, LGCP. LSG and LGCP were then compared during long-term follow-ups in terms of glycemic control, hormone and lipid secretion, and changes in body composition. Measured parameters included serum glucose, triglycerides, high- and low-density lipoprotein cholesterol, testosterone, estradiol, leptin, adiponectin, ghrelin, fatmass, and lean body mass. RESULTS: Significant weight-loss and a reduced body composition resulted from either procedure vs. baseline (i.e., pre-surgery), with levels of fasting glucose and glycated hemoglobin also showing statistically significant reductions (at 3 and 18 months for either surgery). Intergroup comparisons for glycemic parameters yielded no statistically significant differences. However, a dramatic reduction in ghrelin was detected following LSG, falling from pre-surgery levels of 140.7 to 69.6 ng/L by 6 months (P < 0.001). Subsequently, ghrelin levels increased, reaching 107.8 ng/L by month 12. Conversely, after LGCP, a statistically significant increase in ghrelin was seen, rising from 130.0 ng/L before surgery to 169.0 ng/L by month 12, followed by a slow decline. CONCLUSIONS: Good metabolic outcomes were obtained following LGCP, which might be mediated via altered glucose metabolism and GI hormones. Nevertheless, this method is less effective than LSG, possibly due to its preservation of the entire stomach, including secretory regions.

• Klíčová slova
• Ghrelin, Hormonal changes, Laparoscopic greater curvature plication, Metabolic surgery, Sleeve gastrectomy,
• MeSH
• dospělí MeSH
• gastrektomie metody   rehabilitace   MeSH
• gastroplastika metody   rehabilitace   MeSH
• ghrelin metabolismus   MeSH
• glykovaný hemoglobin metabolismus   MeSH
• hmotnostní úbytek fyziologie   MeSH
• krevní glukóza metabolismus   MeSH
• laparoskopie metody   rehabilitace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metabolom * MeSH
• morbidní obezita metabolismus   chirurgie   MeSH
• následné studie MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• ghrelin MeSH
• glykovaný hemoglobin MeSH
• krevní glukóza MeSH

INTRODUCTION: Surgical intervention in obesity is today the most effective treatment method in high level obesity management. Bariatric interventions not only ensure body weight reduction, but may influence dietary habits. AIM: To assess changes in adipose hormones and dietary habits in obese patients after sleeve gastrectomy. MATERIAL AND METHODS: The study set comprised 37 subjects (29 females and 8 males) 24 to 68 years old with body mass index 43.0 ±4.9 kg/m(2). Pre-operative examination included baseline measurements of body composition. Dietary habits and intake frequency were monitored by a questionnaire method. Follow-up examinations were carried out in a scope identical to the pre-operative examination, 6 and 12 months after surgery, respectively. RESULTS: The average patient weight loss 12 months after surgery was 31.7 kg. Excess weight loss was 55.2 ±20.6%. Patients reported reduced appetite (p < 0.001), increasingly regular food intake (p < 0.001), intake of more meal portions per day (p = 0.003) and a decrease in consuming the largest portions during the afternoon and evening (p = 0.030). Plasma levels of fasting glucose, leptin and ghrelin significantly decreased (p = 0.006; p = 0.0.043); in contrast, the level of adiponectin significantly increased (p < 0.001). CONCLUSIONS: Sleeve gastrectomy and follow-up nutritional therapy resulted in a significant body weight reduction within 1 year after surgery. An improvement of certain dietary habits in patients was registered. At 12 months after surgery, there were no statistically significant differences in decreases in ghrelin and leptin concentrations between patients without changed appetite and those reporting decreased appetite.

• Klíčová slova
• bariatric surgery, dietary habits, dietary intake frequency, ghrelin, laparoscopic sleeve gastrectomy, leptin,
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is a bariatric procedure with very good long-term weight-reducing and metabolic effects. AIM: Here we report 6 years' experience with LSG performed in morbidly obese patients by one surgical team focusing on the impact of the degree of sleeve restriction and safety of the procedure without over-sewing the staple line. MATERIAL AND METHODS: From 2006 to 2012, 207 morbid obese patients with average age of 43.4 years and average body mass index 44.9 kg/m(2) underwent LSG without over-sewing the staple line. The complete 5- and 3-year follow-up is recorded in 59 and 117 patients with prospective data collection at 3, 6, 9, 12, 18, 24, 36, 42 and 60 months after LSG. Group 1 patients operated in 2006-2008 had smaller sleeve restriction. Group 2 patients operated in 2009-2012 had major sleeve restriction. All procedures were performed without over-sewing of the staple line. RESULTS: The average %EBMIL (excess body mass index loss) in group 1 patients with minor sleeve restriction reached 54.1% and average %EWL (excess weight loss) was 50.8% while in group 2 with major sleeve restriction the average %EBMIL reached 69.7% and average %EWL was 66.8%. Final weight reduction was significantly higher in group 2 patients compared to group 1 patients with smaller sleeve restriction. Out of 49 patients with preoperatively diagnosed T2DM (type 2 diabetes mellitus) was completely resolved in 70.8%. Pre-operatively diagnosed hypertension normalized in 64.2%, improved in 23.2%, and remained unchanged in 12.6% of patients. CONCLUSIONS: Carefully performed LSG without over-sewing the staple line is feasible and safe. A better weight-reducing effect was present in patients with major sleeve restriction.

• Klíčová slova
• diabetes, laparoscopic sleeve gastrectomy, morbid obesity, staple line,
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Surgical intervention in obesity is today the most effective treatment method in high level obesity management with long-term clinical results and satisfaction of operated patients. Bariatric interventions not only ensure body weight reduction, but may influence lipid and saccharide metabolism as well. AIM: To monitor the dynamics of changes in selected lipid and glucose metabolism parameters after laparoscopic sleeve gastrectomy (LSG) in obese women. MATERIAL AND METHODS: During the period from September 2010 to June 2011, 35 women, operated on by sleeve gastrectomy, were monitored within a pilot open study. Parameters of lipid and glucose metabolism were measured, and body composition was evaluated, using dual X-ray absorptiometry (DXA). Laboratory parameters were assessed prior to LSG and at 3 and 6 months after the surgery. RESULTS: Data of the 35 study subjects are presented. Average age was 41.9 years (27-68 years). Six months after LSG, body weight reduction was achieved from 117.7 ±17.1 kg to 91.2 ±17.2 kg (p < 0.001). The body mass index (BMI) dropped from 42.7 ±4.7 kg/m(2) to 33.0 ±4.9 kg/m(2) (p < 0.001). The excess weight loss (EWL) was 49.01%. High density lipoprotein (HDL) cholesterol increased from 1.29 mmol/l to 1.39 mmol/l (p < 0.025). Triacylglycerols dropped from 1.97 mmol/l to 1.31 mmol/l (p < 0.001). Glycated hemoglobin dropped from 4.03% to 3.59% (p < 0.001), and C-peptide decreased from 1703 pmol/l to 1209 pmol/l (p < 0.002). The observed changes of low density lipoprotein (LDL) cholesterol, total cholesterol or fasting glucose levels were not significant. Six months after LSG, both weight and BMI significantly decreased. CONCLUSIONS: Six months after the operation, glucose homeostasis was improved. Despite the rather short-term monitoring period, our study did confirm LSG to influence not only total weight loss and fat tissue reduction but to improve risk factors, mainly glucose homeostasis and dyslipidemia, as well.

• Klíčová slova
• bariatric surgery, cholesterol, glycemia, laparoscopy, morbid obesity, sleeve gastrectomy,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: In the past few years, laparoscopic sleeve gastrectomy (LSG) became a widely used bariatric method. Based on results of recent LSG studies, LSG is being increasingly used even as a single bariatric method. On contrary with some other reports, we do not reinforce the LSG staple line with over-sewing. Our pilot study presents treatment outcomes and results 18 months after LSG. METHODS: Sixty-one consecutive morbidly obese (MO) patients (19 male and 42 female) who underwent LSG from January 2006 to May 2008 were included into the study. The mean age, height, and weight were 37.3 years (29-57), 168 cm (151-187), and 118 kg (97-181), respectively, while mean body mass index (BMI) was 41.8 (36.1-60.4). LSG started at 6 cm from pylorus and ended at the angle of Hiss. For gastric sleeve calibration 38F, intragastric tube was used. All 61 LSG were performed without over-sewing of the staple line. In the last 24 cases, the staple line was covered with Surgiceltrade mark strips, which were however placed without any fixation to the underlying gastric tissue. RESULTS: Mean operating time was 105 min (80-170) and no conversion to open surgery. An 18-month follow-up was recorded in 39 MO patients. The mean weight loss was 31.3 (range, 21-67 kg) and mean % excess BMI loss reached 72% (range, 64-97%). Neither leak nor disruptions of the staple line and/or sleeve dilatation were recorded. CONCLUSION: LSG is an effective and safe bariatric procedure with low incidence of complications and mortality in our experience.

• MeSH
• chirurgická technika pomocí přístrojů a svorek metody   MeSH
• dospělí MeSH
• gastrektomie * MeSH
• hmotnostní úbytek MeSH
• index tělesné hmotnosti MeSH
• kohortové studie MeSH
• laparoskopie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• morbidní obezita chirurgie   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH