ObjectiveTo investigate the difference of DNA methylation before and after bariatric surgery.MethodThe relevant literatures of the research on the changes of DNA methylation level and gene expression regulation in blood and tissues before and after bariatric surgery were retrieved and reviewed.ResultsDNA methylation was an important method of epigenetic regulation in organisms and its role in bariatric surgery had been paid more and more attention in recent years. Existing studies had found that there were changes of DNA methylation in blood and tissues before and after bariatric surgery. The degree of methylation varies with different follow-up time after bariatric surgery and the same gene had different degrees of methylation in different tissues, and some even had the opposite results.ConclusionsDNA methylation levels before and after bariatric surgery are different in different tissues. And studies with larger sample size and longer follow-up time are needed, to further reveal relationship among DNA methylation, obesity, and bariatric surgery.
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.
Objective To systematically evaluate the effectiveness of frequently-used bariatric surgery versus conventional medical therapy for obese patients with type 2 diabetes. Methods Such databases as The Cochrane Library (Issue 12, 2012), PubMed, CNKI, CBM, VIP and WanFang Data were searched to collect the randomized controlled trails (RCTs) about frequently-used bariatric surgery vs. conventional therapy for obese patients with type 2 diabetes. The retrieval time was from inception to May, 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality. Then the meta-analysis was performed using RevMan 5.1.2 software. Results A total of three RCTs involving 340 patients were included finally. The results of meta-analysis showed that, compared with conventional medical therapy, bariatric surgery could improve the diabetes remission, decrease both glycated hemoglobin level and patient’s weight. At the same time, the postoperative complications were fairly mild. Conclusion Frequently-used bariatric surgery is superior to conventional medical therapy when treating obese patients with type 2 diabetes, and it deserves to be recommended in clinic. However more studies are required to further confirm this conclusion because of the quality and quantity limitation of the included studies.
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 explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.
ObjectivesTo compare the effects of different bariatric surgeries on reducing hemoglobin A1c (HbA1c) in overweight/obese patients with type 2 diabetes.MethodsRandomized controlled trials (RCTs) of bariatric surgery were systematically searched in PubMed, EMbase, The Cochrane Library, ClinicalTrials.gov, CNKI, WanFang Data and VIP databases from inception to February 20th, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 14.0 software and R 3.6.2 software.ResultsA total of 24 RCTs were included. Compared with non-surgical treatments, 5 out of 9 procedures significantly reduced HbA1c, and the probability order for the effect was as follows: sleeve gastrectomy with transit bipartition (SGTB) (MD=−3.60%, 95%CI −5.89 to −1.31, P=0.002), mini-gastric bypass (MGB) (MD=−2.36%, 95%CI −4.13 to −0.58, P=0.009), duodenal-jejunal bypass liner (DJBL) (MD=−1.85%, 95%CI −2.75 to −1.96, P<0.000 01), sleeve gastrectomy (SG) (MD=−1.48%, 95%CI −2.49 to −0.47, P=0.004), and Roux-en-Y gastric bypass (RYGB) (MD=−1.31%, 95%CI −2.02 to −0.59, P=0.003). The effects of biliopancreatic diversion with duodenal switch and gastric plication were uncertain. Adjustable gastric banding and Roux-en-Y gastrojejunostomy had no significant effects on HbA1c. Because of the limitations of small sample size and high risk of bias, the results of SGTB requires further validation. ConclusionsThe current evidence suggests that the bariatric surgeries that have relatively beneficial effects for lowering HbA1c treatment are MGB, DJB, SG and RYGB in sequence.
Objective To review the changes of gut microbiota after bariatric surgery and the related mechanisms of improving metabolism. Method Domestic and international literatures in recent ten years on the changes of gut microbiota in bariatric surgery and the mechanisms of improving metabolism were collated and summarized. Result The common bariatric procedures performed to date were vertical sleeve gastrectomy (VSG) and laparoscopic Roux-en-Y gastric bypass (RYGB). The changes of gut microbiota vary in different surgical procedures, which were related to the changes of diet habits, gastrointestinal anatomy, gastrointestinal hormone levels and metabolic complications. The gut microbiota might improve the body metabolism by regulating the levels of short chain fatty acids, branched chain amino acids and bacterial endotoxin in the intestinal lumen. Conclusions Significant changes are found in gut microbiota after bariatric surgery, which may be involved in the improvement of body metabolism by regulating the level of bacterial endotoxin and microbial metabolite. However, more in-depth mechanisms need to be further clarified.
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 present situation and effect of da Vinci robot in the treatment of obesity.MethodThe literatures about the application of da Vinci surgical robot in metabolic surgery for weight loss were reviewed.Resultsda Vinci surgical robot was a minimally invasive surgical system in recent years. Because of its unique structure, it broke through the limitations of traditional laparoscopic surgery, such as lack of field of vision, two-dimensional imaging, unstable lens, limited range of movement, and so on. It provided a solution way for metabolic surgery for weight loss with narrow operation space and high technical difficulty. At present, there were differences in operation time and postoperative complications between da Vinci surgical robot and laparoscopic weight loss.ConclusionsIn recent years, da Vinci surgical robot has been widely used in metabolic surgery for weight loss. It not only overcomes many limitations of laparoscopic assisted weight loss surgery, but also it is safe, feasible, and has a similar clinical effect. It provides a new choice for metabolic surgery for weight loss.
Both bariatric surgery and pharmacotherapy, particularly glucagon-like peptide-1 receptor agonist (GLP-1RA), are effective interventions for obesity, yet each has its own advantages and limitations. Drawing on the “bridging” concept from cancer therapy, this commentary explores an innovative obesity management strategy that involves the combined application of GLP-1RA and bariatric surgery during the perioperative period, with the aim of optimizing treatment outcomes. The present analysis focuses specifically on the potential value of this approach: preoperatively, GLP-1RAs serve as a “bridging therapy” to promote weight loss and reduce surgical risks in severely obese patients; postoperatively, they might be used to manage weight rebound or insufficient weight loss. This multimodal integrated strategy is designed to overcome the inherent limitations of single therapies and offer patients more comprehensive treatment options. Emphasizing that future research must urgently focus on optimizing treatment parameters (e.g., timing, dosage), evaluating long-term safety and efficacy, and establishing patient selection criteria for combination therapy. Integrating surgical and pharmacological treatments, this comprehensive strategy based on the oncological “bridging” concept represents a highly promising paradigm shift in obesity management.