ObjectiveTo systematically review the efficacy of Roux-en-Y gastric bypass for obesity and its comorbidities. MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 11, 2013), CBM, CNKI, VIP and WanFang Data, etc. were electronically searched from inception to November 2013, for including all studies on Roux-en-Y gastric bypass for obesity and its comorbidities. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. And then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 25 before and after self-control studies involving 2 966 cases with overweight or obesity were included. The results of meta-analysis showed that:after Roux-en-Y gastric bypass operation, the patients had significant reduction in BMI (MD=-16.40, 95%CI-17.42 to-15.38, P < 0.000 01), type 2 diabetes mellitus prevalence (RR=0.23, 95%CI 0.17 to 0.31, P < 0.000 01), and hypertension prevalence (RR=0.34, 95%CI 0.26 to 0.43, P < 0.000 01); besides, fasting glucose, blood pressure and serum lipid levels obviously decreased (P < 0.000 01). ConclusionRoux-en-Y gastric bypass for obesity patients is effective in reducing weight loss, type 2 diabetes mellitus incidence and cardiovascular disease incidence. Due to the limitation of the design of the included studies, the conclusion needs to be verified by further conducting high quality randomized controlled trials with large sample-size.
Objective To compare the effectiveness of three kinds of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy combined with transit bipartition (SG+TB ) as three weight-loss surgical differences in weight loss and glucose control as well as alleviation of nephropathy in obese rats with diabetic nephropathy (DN). MethodsTwelve of 60 SD male rats were randomly selected according to their average body mass and fed with a standard diet (12% fat fever) as normal control (NC) group, and the remaining 48 were fed with high-fat diet (40% fat calories) for 1 month and combined with low-dose 1% streptozotocin method to induce the establishment of obese combined diabetic nephropathy rat model, and subsequently randomized equally into SG group, RYGB group, SG+TB group and sham-operated group. Body mass and food intake were weighed and the fasting blood glucose (FBG) level after fasting for 6 hours was detected before and every month at 1–6 months after operation. At the same time, oral glucose tolerance test (OGTT), insulin tolerance test (ITT), urinary albumin creatinine ratio (UACR), serum creatinine (Scr) and blood urea nitrogen (BUN) were tested before operation and at the 1st and 6th month after operation. Finally, rat kidney tissues were taken to observe the pathological changes. Results Body mass and food intake of the SG group, the RYGB group and the SG+TB group were lower than that of the sham-operated group at 1–6 months after operation (P<0.05). The body mass of the RYGB group and the ST+TB group were lower than that of the SG group at 1–6 months after operation (P<0.05). There was no significant difference in food intake among the SG group, the RYGB group and the SG+TB group (P>0.05). The FBG levels in the SG group, the RYGB group and the SG+TB group were lower than those in the sham-operation group at 1–6 months after operation (P<0.05). The FBG levels in the RYGB group and the SG+TB group were lower than those in the SG group at 4–6 months after operation(P<0.05). The blood glucose levels detected by OGTT and ITT in the SG group, the RYGB group and the SG+TB group after operation were all lower than those in the sham-operation group (P<0.05), and all were lower than before operation (P<0.05), and the blood glucose level detected by OGTT in the RYGB group at the 1st postoperative month was lower than those in the SG group and the SG+TB group (P<0.05). Whereas there was no significant difference in the blood glucose levels detected by OGTT at the 6-month postoperative period between the the RYGB group and the SG+TB group (P>0.05), but were lower than the SG group (P<0.05). The levels of UACR, Scr and BUN in the SG group, the RYGB group and the SG+TB group after operation were lower than those in the sham-operation group (P<0.05) and lower than those before operation (P<0.05). The UACR and Scr levels in the RYGB group and the SG+TB group were lower than those in the SG group at the 1st and 6th month after operation (P<0.05). There was no significant difference in BUN level among the SG group, the RYGB group and the SG+TB group after operation (P>0.05). Typical pathological changes of diabetic nephropathy occurred in the kidney of rats in sham operation group, such as glomerular edema, capillary cavity congestion and congestion, and mesangial matrix increase. The mesangial matrix of rats in the SG group, the RYGB group and the SG+TB group were significantly improved compared with that in the sham-operation group. Conclusion SG, RYGB and SG+TB can effectively reduce weight, reduce blood sugar and relieve diabetic nephropathy, and SG+TB and RYGB are better than SG.
ObjectiveTo verify the expression change of insulin-like growth factor-Ⅰ (IGF-Ⅰ) protein and its mRNA before and after Roux-en-Y gastric bypass surgery (RYGB) in obese rats, and to investigate the relationship between the expression of IGF-Ⅰ and proliferation/apoptosis of adipose cells. Methods① Seventy male SD rats were raised at the SPF level circumstance and were randomly divided into control group (NC group, 10 rats) and high fat diet group (60 rats). Rats of high fat diet group were given specific high fat formula diet, rats of NC group were given particular formula diet. After 6 weeks, the body weights of the rats in high fat diet group were measured, and the 20 rats of top weight were selected. The 20 obese rats were randomly divided into 2 groups:gastric bypass (GB) group (n=10) and sham-operation group (SO group, n=10). RYGB were administered to the rats of GB group, and for rats of SO group, sham operations were performed. Rats of NC group did not receive any surgery. Inguinal adipose tissues[represented the subcutaneous adipose tissue (SAT)] and epididymal adipose tissues[on behalf of visceral adipose tissue (VAT)] were taken during operation in rats of GB group and SO group respectively (0.5 g), and 12 weeks after operation in all rats of three groups. The expressions of IGF-Ⅰ protein and its mRNA in adipose tissue were detected by Western blot and real-time fluorescence quantitative PCR. ② Transfection experiment. SAT cells were divided into blank control group (BC group, without transfection), IGF-Ⅰ(+) group (gene overexpression group), IGF-Ⅰ(+) empty vector group, IGF-Ⅰ(-) group (gene silencing group), and IGF-Ⅰ(-) empty vector group. Cells were transfected with corresponding vectors with 3 duplicated holes of each group. Cell viability and apoptosis assays were carried out in 48 hours after transfection. Expressions of protein kinase B (AKT), phosphorylated protein kinase B (p-AKT), phosphoinositide 3-kinase (PI3K), and phosphorylated phosphoinositide 3-kinase (p-PI3K) were detected by Western blot meanwhile. ③ Wortmannin experiment. SAT cells were divided into Wortmannin (+) IGF-Ⅰ(+) group, Wortmannin (+) IGF-Ⅰ(-) group, Wortmannin (-) IGF-Ⅰ(+) group, and Wortmannin (-) IGF-Ⅰ(-) group, which were transfected with corresponding vectors for 24 hours, then adding Wortmannin (0.1 mmol/L). After 24 hours, the expression levels of AKT, p-AKT, p-PI3K, PI3K, and GAPDH were detected by Western blot. Results① PCR results showed that, in SAT, compared with preoperative GB group, the expression levels of IGF-Ⅰ mRNA and its protein in postoperative GB group were both lower (P < 0.01). However, the expression levels of IGF-Ⅰ mRNA and its protein between preoperative SO group and postoperative SO group showed no significant difference (P > 0.05). In VAT, the expression levels of IGF-Ⅰ mRNA and its protein in 5 groups showed no significant difference (P > 0.05). ② The MTT results showed that, IGF-Ⅰ(+) group harbored stronger proliferation abilities compared with its negative control group (P=0.04), whereas IGF-Ⅰ(-) group had lower abilities compared with its negative control group (P=0.04). The results of flow cytometry assay showed that, the apoptosis rate of IGF-Ⅰ(+) group was lower (P=0.04) than that of the corresponding negative control group, and it was higher in IGF-Ⅰ(-) group than that of the corresponding negative control group (P=0.04). ③ Compared with IGF-Ⅰ(+) empty vector group, p-PI3K/PI3K ratio (P=0.03) and p-AKT/AKT (P=0.04) ratio of IGF-Ⅰ(+) group were increased; compared with IGF-Ⅰ(-) empty vector group, p-PI3K/PI3K ratio (P=0.04) and p-AKT/AKT ratio (P=0.04) of IGF-Ⅰ(-) group were decreased. The p-AKT/AKT ratio of Wortmannin (-) IGF-Ⅰ(+) group was higher (P < 0.05) than that of Wortmannin (+) IGF-Ⅰ(+) group; the p-AKT/AKT ratio of Wortmannin (-) IGF-Ⅰ(-) group was lower than that of Wortmannin (-) IGF-Ⅰ(+) group (P < 0.05). ConclusionsIGF-Ⅰ is involved in the accumulation of subcutaneous fat in rats. RYGB can significantly reduce the expression levels of IGF-Ⅰ mRNA and its protein in subcutaneous fat of rats, so as to achieve the effect of weight loss.
Objective To study the therapeutic effect of Roux-en-Y gastric bypass （RYGB） on type 2 diabetes mellitus （T2DM） rats and explore the possible mechanism of vaspin in RYGB on T2DM. Methods Twenty SD rats with T2DM and 20 age- and sex-matched normal SD rats were randomly divided into 4 groups according to the random digits table：T2DM-RYGB group， T2DM-sham operation （SO） group，RYGB group，and SO group，10 rats in each group. Fasting plasma glucose （FPG） level，serum insulin （INS） level，vaspin level，and homeostasis model of insulin resistance （HOMA-IR） were determined before operation and on week 4，8 after operation，respectively．At the same time，the correlation between vaspin and the indicators （FPG，INS，or HOMA-IR） was analyzed．Results Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not significantly different between the T2DM-RYGB group and T2DM-SO group （P＞0.05） or between the RYGB group and SO group （P＞0.05），but the FPG level，INS level，vaspin level，and HOMA-IR in the T2DM-RYGB group and T2DM-SO group were significantly higher than those in the RYGB group （P＜0.05） and SO group （P＜0.05），respectively. On week 4 after operation，the FPG level，INS level，vaspin level，and HOMA-IR decreased in the T2DM-RYGB group，except for the FPG level，the other indexes had no significant differences as compared with the values before operation. On week 8 after operation，the FPG level，INS level，vaspin level，and HOMA-IR further decreased in the T2DM-RYGB group，there were significant differences of these indicators between before operation and on week 8 after operation. Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not statistically significant （P＞0.05） in the T2DM-SO group，RYGB group，or SO group. The changes in serum vaspin level correlated positively with those in INS and HOMA-IR before operaion and on week 4，8 after operaion in the T2DM-RYGB group and T2DM SO group rats （P＜0.05），respectively. Conclusions RYGB surgery has a therapeutic effect on T2DM rats，and serum vaspin level decreases and insulin resistance is improved after RYGB surgery，which may be one of the mechanisms of the treatment for T2DM.
With the swift evolution of bariatric and metabolic surgery, additional procedures building upon sleeve gastrectomy have consistently surfaced. Recent studies suggest that sleeve gastrectomy with jejunojejunal bypass (SG-JJB) yields superior short-term weight reduction outcomes compared to sleeve gastrectomy alone, with weight loss and glycemic control effects akin to Roux-en-Y gastric bypass, and without significant complications. As a result, SG-JJB is regarded as a safe and efficacious bariatric procedure, noted for its technical simplicity and reversibility, presenting substantial clinical utility. Nonetheless, high-quality, multicenter, large-sample, long-term follow-up randomized controlled trials are essential to further ascertain its long-term efficacy and safety, and to facilitate its standardized implementation. This article seeks to review the advancements in SG-JJB research, evaluate its effectiveness and safety in managing obesity and associated comorbidities, and explore its future developmental trajectory.
ObjectiveTo investigate the possible mechanism of the improvement of type 2 diabetes mellitus with insulin resistance of skeletal muscles after Roux-en-Y gastric bypass surgery (RYGB). MethodsThirty GK rats were randomly divided into GK-RYGB group, sham operation group (GK-SO group), and control group (GK-control group); in addition, 10 Wistar rats served as normal control group.On day 28, the animals were sacrificed.The ghrelin concen-tration and PI3Kp85α, Akt/PKB, and GLUT4 levels were measured by ELISA, Western blot, and real-time PCR me-thods, respectively. Results①Compared with the GK-SO group and GK-control group, the plasma ghrelin levels were significantly increased in the normal control group (P < 0.01) and GK-RYGB group (P < 0.01).②Compared with the GK-SO group and GK-control group, p-/t-PI3Kp85α, p-/t-Akt/PKB, and m-/t-GLUT4 proteins were significantly incre-ased in the normal control group (P < 0.01, P < 0.05, and P < 0.01, respectively) and GK-RYGB group (P < 0.01, P < 0.05, and P < 0.01, respectively).③Compared with the GK-SO group and GK-control group, PI3Kp85α, Akt, and GLUT4 mRNA were significantly increased in the normal control group (P < 0.01, P < 0.05, and P < 0.05, respectively) and GK-RYGB group (P < 0.01, P < 0.05, and P < 0.05, respectively). ConclusionRYGB could elevate the ghrelin level obviously and upregulate PI3Kp85α, Akt/PKB, and GLUT4 levels and thus improve the insulin resistance of skeletal muscles of rats with T2DM.
Laparoscopic Roux-en-Y gastric bypass (RYGB) is a classic operation in the field of obesity metabolic surgery. It not only obviously reduces body weight but also exhibits notable therapeutic efficacy in treating metabolic diseases such as type 2 diabetes. However, it can result in complications such as postoperative dumping syndrome and a lack of satiety after meals. So our team has further modified the RYGB, introducing a long and narrow pouch in RYGB (LN-RYGB), its core is reserving the length of the gastric pouch, then the long and narrow pouch could make maintaining a small gastric volume for a prolonged period, make food pass through slowly, and reduce reflux and decrease the incidences of dumping syndrome and intestinal bile acid reflux relevant to RYGB. The gastric contents could be thoroughly mixed, not only leading to a stronger satiety after meals but also reducing risk of postoperative bounce back. Furthermore, ulcer complications relevant to RYGB markedly declined, the therapeutic outcome is better especially in patients with type 2 diabetes. In future, more results and data relevant to LN-RYGB can be accumulated in clinic to further confirm its safety and effectiveness. Mearnwhile, it should still be paid attended to that LN-RYGB still faccs certain difficulties and has a clear indication. At present, the indications of RYGB are served as reference, and postoperative malnutrition and element deficiency need to be prevented and a long-term follow-up is also necessary.
ObjectiveTo research the change and significance of Ghrelin and Visfatin in plasma after Roux-en-Y gastric bypass surgery (RYGB) in type-2 diabetes (T2DM) rats. MethodsThirty healthy Sprague Dawley (SD) rats (8 weeks) were divided into T2DM group (n=22) and blank control group (CSO group, n=8). Then rats of T2DM group were fed with high calorie and high sugar diet for 6 weeks, following by one dose of streptozotocin via intraperitioneal injection. Finally, there were 18 T2DM rats were successfully established. Then those 18 T2DM rats were divided into two groups:RYGB group (n=10) and sham operation group (DSO group, n=8). Rats of RYGB underwent RYGB, rats of DSO group and CSO group underwent sham operation. Levels of fasting serum glucose (FBG), fasting serum insulin (FINS), Ghrelin, and Visfatin of rats in 3 groups were detected by enzyme-linked immunoassay (EIA) before and 4 weeks after operation, and calculating the lee index and insulin sensitivity index (ISI). ResultsIn RYGB group, compared with before operation, the body weight, lee index, levels of FBG, FINS, and Visfatin decreased after 4 weeks after operation (P < 0.050), but level of ISI and Ghrelin increased (P < 0.050), while there was no significant difference in body weight, body length, lee index, ISI, levels of FBG, FINS, Ghrelin, and Visfatin in DSO and CSO group before and 4 weeks after operation (P > 0.050). In addition, there was statistical difference among the 3 groups in difference before and after operation of Ghrelin and Visfatin, the difference before and after operation of Ghrelin and Visfatin was larger than those of DSO group and CSO group (P < 0.050), but the difference was not significant differed between DSO group and CSO group (P > 0.050). ConclusionsThe increase of plasma Ghrelin and the decrease of Visfatin play important role in the mechanism after RYGB in treatment of T2DM rats.
ObjectiveTo systematically review the efficacy and safety of laparoscopic Roux-en-Y gastric bypass (LRYGB) versus laparoscopic sleeve gastrectomy (LSG) for obesity and type 2 diabetes mellitus (T2DM). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 8, 2014), CNKI and WanFang Data from inception to December 2014, to collect randomized controlled trials (RCTs) of LRYGB vs. LSG for obesity and T2DM. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 8 RCTs including 828 patients were included. The results of meta-analysis showed that:There were no significant differences between the LRYGB group and the LSG group in body mass index (MD=-1.02, 95%CI -2.90 to 0.86, P=0.29), remission rate of T2DM (OR=1.11, 95%CI 0.71 to 1.73, P=0.64), reoperation rate (OR=2.74, 95%CI 1.01 to 7.42, P=0.05), level of fasting plasma glucose (MD=2.71, 95%CI -0.80 to 6.21, P=0.13), and level of serum low density lipoprotein (MD=-23.85, 95%CI -47.20 to -0.50, P=0.05). However, the LSG group had lower postoperative complication rate (OR=2.28, 95%CI 1.43 to 3.62, P=0.000 5) than that of the LRYGB group. ConclusionIn short term, both LRYGB and LSG were equally efficient in the treatment of obesity and T2DM, but LSG has lower postoperative complication rate than LRYGB. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo understand the status of Roux-en-Y gastric bypass (RYGB) surgery for treating type 2 diabetes mellitus, and to summarize its effectiveness and existing problems. MethodThe related literatures which discussed the treatment for type 2 diabetes mellitus by RYGB were reviewed and analyzed. ResultsThe therapeutic effect of RYGB for type 2 diabetes mellitus with obesity was tentatively confirmed.But the underlying mechanism was unclear.And there was no standard length of exclusion of the Roux loop and biliopancreatic loop.Postoperative long-term effect was unknown.Whether RYGB was suitable for non-obese type 2 diabetes mellitus that needed further to be rese-arched. ConclusionsThe mechanism of RYGB surgery in treatment for type 2 diabetes mellitus is complex.With the progress of basic and clinical research, the improvement of surgical technique, the elucidation of the mechanism, the affirmation of the long-term effect, and there are more benefits in patients with type 2 diabetes mellitus.