Effect of Roux-en-Y Gastric Bypass Vs Sleeve Gastrectomy on Glucose and Gut Hormones: a Prospective Randomised Trial

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2012 Mar 10

PMID 22402955

Citations 72

Authors

Jose Manuel Ramon

Silvia Salvans

Xenia Crous

Sonia Puig

Albert Goday

David Benaiges

Lourdes Trillo

Manuel Pera

Luis Grande

Affiliations

Soon will be listed here.

Abstract

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most common bariatric technique. Laparoscopic sleeve gastrectomy (LSG) is a restrictive procedure; the metabolic and endocrine effects of which remain unknown. We compared the effects of both procedures on glucose metabolism and fasting and meal-stimulated gut hormone levels.

Methods: Seven patients were randomised to LRYGB and eight to LSG. All patients were evaluated before and at 3 and 12 months postoperatively. Plasma levels of glucose, insulin, ghrelin, leptin, peptide YY (PYY), GLP-1 and pancreatic polypeptide were measured before and after 10 and 60 min of a standard test meal ingestion.

Results: Age, body mass index and preoperative hormone levels were similar in both groups. A significant reduction of plasma glucose and insulin levels was observed after surgery. Moreover, a normalisation of homeostatic model assessment for insulin resistance value was also seen after both procedures. The fasting and postprandial leptin levels were significantly lower in the LRYGB group. LSG was followed by a significant reduction in fasting ghrelin levels. In the LRYGB group, GLP-1 levels increased significantly after the test meal.

Conclusions: LRYGB and LSG markedly improved glucose homeostasis. Only LSG decreased fasting and postprandial ghrelin levels, whereas GLP-1 and PYY levels increased similarly after both procedures.

Citing Articles

[Sleeve gastrectomy for the surgical management of obesity at the Essos Hospital Center (Yaoundé, Cameroon): a retrospective case series study evaluating medium-term weight loss].

Bang G, Oumarou B, Savom E, Nketcha J, Essomba A Pan Afr Med J. 2025; 49:49.

PMID: 39867550 PMC: 11760207. DOI: 10.11604/pamj.2024.49.49.32728.

Integrated Insights into Metabolic and Bariatric Surgery: Improving Life Quality and Reducing Mortality in Obesity.

Marin R, Radu A, Negru P, Radu A, Negru D, Aron R Medicina (Kaunas). 2025; 61(1).

PMID: 39858996 PMC: 11767230. DOI: 10.3390/medicina61010014.

SICOB Italian clinical practice guidelines for the surgical treatment of obesity and associated diseases using GRADE methodology on bariatric and metabolic surgery.

De Luca M, Zese M, Bandini G, Zappa M, Bardi U, Carbonelli M Updates Surg. 2024; .

PMID: 39419949 DOI: 10.1007/s13304-024-01996-z.

Bariatric Surgery in Obesity: Metabolic Quality Analysis and Comparison of Surgical Options.

Engin A Adv Exp Med Biol. 2024; 1460:697-726.

PMID: 39287870 DOI: 10.1007/978-3-031-63657-8_24.

The Role of Dietary Intake in the Weight Loss Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Systematic Review and Meta-analysis.

Qanaq D, OKeeffe M, Cremona S, Bernardo W, McIntyre R, Papada E Obes Surg. 2024; 34(8):3021-3037.

PMID: 38907132 PMC: 11289176. DOI: 10.1007/s11695-024-07183-8.

References

Biertho L, Steffen R, Ricklin T, Horber F, Pomp A, Inabnet W . Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases. J Am Coll Surg. 2003; 197(4):536-44. DOI: 10.1016/S1072-7515(03)00730-0. View

Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K . Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999; 402(6762):656-60. DOI: 10.1038/45230. View

Ponce J, Haynes B, Paynter S, Fromm R, Lindsey B, Shafer A . Effect of Lap-Band-induced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg. 2004; 14(10):1335-42. DOI: 10.1381/0960892042583932. View

Goday A, Gabriel R, Ascaso J, Franch J, Ortega R, Martinez O . [Cardiovascular risk in subjects with high probability of metabolic syndrome and insulin resistance. DESIRE study]. Rev Clin Esp. 2008; 208(8):377-85. DOI: 10.1157/13126339. View

Liou J, Lin J, Lee W, Wang H, Lee Y, Chiu H . The serial changes of ghrelin and leptin levels and their relations to weight loss after laparoscopic minigastric bypass surgery. Obes Surg. 2007; 18(1):84-9. DOI: 10.1007/s11695-007-9305-x. View

Haslam D, James W . Obesity. Lancet. 2005; 366(9492):1197-209. DOI: 10.1016/S0140-6736(05)67483-1. View

Tschop M, Weyer C, Tataranni P, Devanarayan V, Ravussin E, Heiman M . Circulating ghrelin levels are decreased in human obesity. Diabetes. 2001; 50(4):707-9. DOI: 10.2337/diabetes.50.4.707. View

Yada T, Dezaki K, Sone H, Koizumi M, Damdindorj B, Nakata M . Ghrelin regulates insulin release and glycemia: physiological role and therapeutic potential. Curr Diabetes Rev. 2008; 4(1):18-23. DOI: 10.2174/157339908783502352. View

Cummings D, Weigle D, Frayo R, Breen P, Ma M, Dellinger E . Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002; 346(21):1623-30. DOI: 10.1056/NEJMoa012908. View

10.

Maggard M, Shugarman L, Suttorp M, Maglione M, Sugerman H, Sugarman H . Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005; 142(7):547-59. DOI: 10.7326/0003-4819-142-7-200504050-00013. View

11.

Kelesidis T, Kelesidis I, Chou S, Mantzoros C . Narrative review: the role of leptin in human physiology: emerging clinical applications. Ann Intern Med. 2010; 152(2):93-100. PMC: 2829242. DOI: 10.7326/0003-4819-152-2-201001190-00008. View

12.

Braghetto I, Davanzo C, Korn O, Csendes A, Valladares H, Herrera E . Scintigraphic evaluation of gastric emptying in obese patients submitted to sleeve gastrectomy compared to normal subjects. Obes Surg. 2009; 19(11):1515-21. DOI: 10.1007/s11695-009-9954-z. View

13.

Schauer P, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G . Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003; 238(4):467-84. PMC: 1360104. DOI: 10.1097/01.sla.0000089851.41115.1b. View

14.

Sjostrom C, Lissner L, Wedel H, Sjostrom L . Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res. 1999; 7(5):477-84. DOI: 10.1002/j.1550-8528.1999.tb00436.x. View

15.

Karamanakos S, Vagenas K, Kalfarentzos F, Alexandrides T . Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008; 247(3):401-7. DOI: 10.1097/SLA.0b013e318156f012. View

16.

le Roux C, Aylwin S, Batterham R, Borg C, Coyle F, Prasad V . Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2005; 243(1):108-14. PMC: 1449984. DOI: 10.1097/01.sla.0000183349.16877.84. View

17.

Colquitt J, Picot J, Loveman E, Clegg A . Surgery for obesity. Cochrane Database Syst Rev. 2009; (2):CD003641. DOI: 10.1002/14651858.CD003641.pub3. View

18.

Rubino F, Gagner M, Gentileschi P, Kini S, Fukuyama S, Feng J . The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004; 240(2):236-42. PMC: 1356398. DOI: 10.1097/01.sla.0000133117.12646.48. View

19.

Meier J, Gallwitz B, Salmen S, Goetze O, Holst J, Schmidt W . Normalization of glucose concentrations and deceleration of gastric emptying after solid meals during intravenous glucagon-like peptide 1 in patients with type 2 diabetes. J Clin Endocrinol Metab. 2003; 88(6):2719-25. DOI: 10.1210/jc.2003-030049. View

20.

Jayasena C, Bloom S . Role of gut hormones in obesity. Endocrinol Metab Clin North Am. 2008; 37(3):769-87, xi. DOI: 10.1016/j.ecl.2008.07.001. View