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Enterohormonal Changes After Digestive Adaptation: Five-Year Results of a Surgical Proposal to Treat Obesity and Associated Diseases

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Abstract

Background

Recent physiological knowledge allows the design of bariatric procedures that aim at neuroendocrine changes instead of at restriction and malabsorption. Digestive adaptation is a surgical technique for obesity based in this rationale.

Methods

The technique includes a sleeve gastrectomy, an omentectomy and a jejunectomy that leaves initial jejunum and small bowel totaling at least 3 m (still within normal variation of adult human bowel length). Fasting ghrelin and resistin and fasting and postprandial GLP-1 and PYY were measured pre- and postoperatively.

Results

Patients: 228 patients with initial body mass index (BMI) varying from 35 to 51 kg/m2; follow-up: 1 to 5 years; average EBMIL% was 79.7% in the first year; 77.7% in the second year; 71.6% in the third year; 68.9% in the fourth year. Patients present early satiety and major improvement in presurgical comorbidities, especially diabetes. Fasting ghrelin and resistin were significantly reduced (P < 0.05); GLP-1 and PYY response to food ingestion was enhanced (P < 0.05). Surgical complications (4.4%) were resolved without sequela and without mortality. There was neither diarrhea nor detected malabsorption.

Conclusions

Based on physiological and supported by evolutionary data, this procedure creates a proportionally reduced gastrointestinal (GI) tract that amplifies postprandial neuroendocrine responses. It leaves basic GI functions unharmed. It reduces production of ghrelin and resistin and takes more nutrients to be absorbed distally enhancing GLP-1 and PYY secretion. Diabetes was improved significantly without duodenal exclusion. The patients do not present symptoms nor need nutritional support or drug medication because of the procedure, which is safe to perform.

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Acknowledgments

We deeply thank Mrs. Muriel Hallet and Mrs. Janice H. Hewins for the revision of the English version, Hospital Israelita Albert Einstein for the laboratory work (especially Dr. Morton Scheimberg and Dr. Cristóvão L.P. Mangueira), Dr Luís Fernado Lisboa for the statistical analyses, Ethicon Endosurgery, Inc. and Convidien Inc. for the donation of kits for entero-hormone dosages and some disposable materials used in the initial procedures of nonpaying patients.

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Authors and Affiliations

  1. Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil

    Sérgio Santoro, Carlos Eduardo Malzoni, Sidney Klajner & Pedro C. M. Borges

  2. Department of Surgery, Hospital Vicentino da Sociedade Beneficente São Camilo, Paraná, Brazil

    Fábio Quirilo Milleo

  3. Department of Digestive Surgery, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil

    Marco Aurélio Santo & Fábio Guilherme Campos

  4. Department of Evolutionary Biology and Genetics, State University of Ponta Grossa, Paraná, Brazil

    Roberto Ferreira Artoni

  5. R. São Paulo Antigo 500, Apto. 111 SD, São Paulo (SP), CEP 05684-010, Brazil

    Sérgio Santoro

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  1. Sérgio Santoro
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  2. Fábio Quirilo Milleo
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  3. Carlos Eduardo Malzoni
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  4. Sidney Klajner
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  5. Pedro C. M. Borges
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  6. Marco Aurélio Santo
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Corresponding author

Correspondence to Sérgio Santoro.

Additional information

Locations where the work was developed: Hospital Israelita Albert Einstein, Hospital da Policia Militar, São Paulo, and Hospital Vicentino, Ponta Grossa, Paraná, Brazil.

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Santoro, S., Milleo, F.Q., Malzoni, C.E. et al. Enterohormonal Changes After Digestive Adaptation: Five-Year Results of a Surgical Proposal to Treat Obesity and Associated Diseases. OBES SURG 18, 17–26 (2008). https://doi.org/10.1007/s11695-007-9371-0

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  • DOI: https://doi.org/10.1007/s11695-007-9371-0

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