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Sleeve Gastrectomy with Bypass of Proximal Small Intestine Provides Better Diabetes Control than Sleeve Gastrectomy Alone Under Postoperative High-Fat Diet

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Abstract

Background

Sleeve gastrectomy (SG) plus procedures have been developed to strengthen the effect of SG on diabetes control. The aim of this study was to compare diabetes control after SG plus bypass of the proximal small intestine with SG alone under adverse conditions for diabetes remission.

Methods

SG plus duodenojejunal bypass (SG-DJB), SG plus jejunojejunal bypass (SG-JJB), SG alone, and sham surgeries were performed in diabetic rats. A high-fat diet (HFD) was fed postoperatively to induce diabetes recurrence. Body weight, food intake, glucose tolerance, insulin sensitivity, serum hormones, hepatic function, and lipid profiles were measured postoperatively.

Results

SG-DJB, SG-JJB, and SG groups exhibited significant improvement in glucose tolerance and insulin sensitivity compared with the sham-operated group at 2 weeks postoperatively. Postoperative HFD induced obvious diabetes relapse and re-impaired insulin sensitivity at 16 weeks postoperatively. The SG-DJB and SG-JJB groups exhibited superior glucose tolerance and similar insulin sensitivity to SG alone at 16 weeks postoperatively. Compared with the SG alone, the SG-DJB and SG-JJB groups exhibited similar food intake, weight loss, fasting ghrelin, glucose-stimulated insulin secretion, and higher glucose-stimulated GLP-1 secretion.

Conclusion

SG-DJB and SG-JJB provided better diabetes control than SG alone in rats fed a HFD postoperatively. Further clinical studies are expected to confirm the superiority of SG plus bypass of proximal small intestine.

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Funding

This work was supported by the National Natural Science Foundation of China (81770795, 81300286, and 81700708), China Postdoctoral Science Foundation (2015M582096), Special Research Fund for the Doctoral Program of Higher Education (20130131120069), Special Research Fund for the Doctoral Program of Shandong Province (BS2013YY031), and the Taishan Scholar Foundation of Shandong Province.

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Authors and Affiliations

  1. Department of General Surgery, Qilu Hospital, Shandong University, No.107 Wenhua West Road Lixia District, Jinan, 250012, Shandong Province, China

    Yugang Cheng, Xin Huang, Dong Wu, Qiaoran Liu, Mingwei Zhong, Teng Liu, Xiang Zhang, Guangyong Zhang, Sanyuan Hu & Shaozhuang Liu

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  1. Yugang Cheng
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  2. Xin Huang
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  3. Dong Wu
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  7. Xiang Zhang
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Correspondence to Shaozhuang Liu.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was performed in accordance with the National Institutes of Health Guidelines on the Use of Laboratory Animals and was approved by the Ethics Committee on Experimental Animals of Qilu Hospital, Shandong University.

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Cheng, Y., Huang, X., Wu, D. et al. Sleeve Gastrectomy with Bypass of Proximal Small Intestine Provides Better Diabetes Control than Sleeve Gastrectomy Alone Under Postoperative High-Fat Diet. OBES SURG 29, 84–92 (2019). https://doi.org/10.1007/s11695-018-3520-5

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  • DOI: https://doi.org/10.1007/s11695-018-3520-5

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