Ahmed Almamar, MD, Daniel W Birch, FRCSC, Shahzeer Karmali, FRCSC, Arya M Sharma, FRCPC, Andrea M Haqq, MD. Centre for the Advancement of Minimally Invasive Surgery, University of Alberta.
Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric procedure that has been proposed as definitive treatment for severe obesity. However, the mechanism of action of LSG remains unclear.
METHODS AND PROCEDURES
A cross-sectional study of 30 matched obese patients following LSG, Laparoscopic Adjustable Gastric Banding (LAGB) and obese controls. Hormones (active and total ghrelin, Glucagon-like peptide-1 (GLP-1), peptide YY (PYY) and Insulin) and satiety scores were compared among the groups before and after a standardized test meal.
Weight loss defined as excess weight loss percentage (EWL%) was 39.9±18.7 for SG versus 20.8±21.45 for LAGB group (p= 0.068). Average follow-up time for the LSG group was 16.7 month versus 25.2 month for the AGB group. Ghrelin area under the curve 0–120 (AUC) for both active and total were significantly suppressed in the LSG group as compared to AGB group (P<0.0001). Furthermore, AUC 0–120 of GLP-1 and PYY were significantly elevated for the LSG group as compared to LAGB (p< 0.0001). These hormonal changes translated to a significant decrease in hunger and increase in fullness as determined by VAS AUC 0–120 (P< 0.05).
The changes in active ghrelin, GLP-1 and PYY 3-36 after LSG appear to be related to the augmented satiety effect suggesting that LSG is an effective metabolic procedure for the treatment of severe obesity.