What does the volume of stomach resected during Laparoscopic Sleeve Gastrectomy depend on and what impact does it have on postoperative results?

Introduction: Obesity is a chronic, multifactorial disease and its extent is equal to pandemics. Sleeve gastrectomy is one of the methods of obesity treatment. Constantly, research is conducted on factors influencing postoperative bariatric-metabolic results. In this study, a correlation between the volume of stomach resected during LSG with preoperative anthropometric measurements and its influence on postoperative results was analysed. Material and methods: The study included 196 patients who qualified and were subjected to laparoscopic sleeve gastrectomy in the study Centre. Surgery was conducted by the same surgical team according to standard procedure. The volume of the stomach resected was analysed, filling it with CO2 under the pressure of 15 mm Hg. The influence of the volume of stomach resected on bariatric efficiency as well as parameters of lipid and carbohydrate profile results in a 1-year follow-up was analysed. Results: The statistically significant connection between the volume of the stomach resected with preoperative body mass, height and body surface was proved. A correlation between BMI and stomach volume was not found. The volume of stomach resected did not influence body mass loss in a 1-year follow-up. The influence of the volume of the stomach resected on the percentage of glycated haemoglobin and HDL was proved. A significant decrease in body mass and BMI in a 1-year follow-up, as well as an improvement in lipid and carbohydrate balance, was observed. Conclusions: LSG is an efficient method of obesity treatment and for the improvement of biochemical parameters. The volume of stomach resected correlates with preoperative measurements of body mass, height and body surface, but not BMI. There is a lack of correlation between the volume of stomach resected with postoperative body mass loss results

The activity of gastric ghrelin positive cells in obese patients treated surgically.

Ghrelin is a 28 amino acid peptide hormone regulating food intake and stimulating releasement of growth hormone. It is produced in a distinct endocrine call known as X/A - like cells. The most abundant source of this very important factor in energy homeostasis is gastric fundus. Regulatory mechanisms of ghrelin synthesis and secretion in physiological and pathological states are not discovered completely. The aim of our study was evaluation of the activity of gastric X/A-like cells in obese patients before and after the most popular surgical bariatric procedures - Roux - Y Gastric Bypass (RYGB) and Laparoscopic Adjustable Gastric Banding (LAGB). Obese patients in number 18 took part in the study. LAGB was performed in 7 patients and RYGB in 11 patients. Peripheral blood was taken from each patient before operation and first day, seventh day, one month and three months after surgery. Ghrelin level was determined by RIA technique. The specimen of stomach was taken from circular stapler after gastrojejunostomy during RYGB and immunohistochemical study of gastric mucosa, using the EnVision method and specific monoclonal antybodies against ghrelin was performed. The intensity of ghrelin-immunoreactivity in X/A-like cells was analyzed using Olympus Cell D image analysis system. Efficiency of bariatric procedures was estimated by EWL- excess weight loss. We observed very strong immunohistochemical reactions of gastric X/A-like cells, accompanied by lower ghrelin plasma concentration, in comparison to the control group. LAGB procedure induced increase of ghrelin plasma level while RYGB procedure induced decrease of this hormone. The main finding of the present study is the hypoactivity of gastric X/A-like cells in obese patients in comparison to the control group

Clusters of Glycemic Response to Oral Glucose Tolerance Tests Explain Multivariate Metabolic and Anthropometric Outcomes of Bariatric Surgery in Obese Patients

Glycemic responses to bariatric surgery are highly heterogeneous among patients and defining response types remains challenging. Recently developed data-driven clustering methods have uncovered subtle pathophysiologically informative patterns among patients without diabetes. This study aimed to explain responses among patients with and without diabetes to bariatric surgery with clusters of glucose concentration during oral glucose tolerance tests (OGTTs). We assessed 30 parameters at baseline and at four subsequent follow-up visits over one year on 154 participants in the Bialystok Bariatric Surgery Study. We applied latent trajectory classification to OGTTs and multinomial regression and generalized linear mixed models to explain differential responses among clusters. OGTT trajectories created four clusters representing increasing dysglycemias that were discordant from standard diabetes diagnosis criteria. The baseline OGTT cluster increased the predictive power of regression models by over 31% and aided in correctly predicting more than 83% of diabetes remissions. Principal component analysis showed that the glucose homeostasis response primarily occurred as improved insulin sensitivity concomitant with improved the OGTT cluster. In sum, OGTT clustering explained multiple, correlated responses to metabolic surgery. The OGTT is an intuitive and easy-to-implement index of improvement that stratifies patients into response types, a vital first step in personalizing diabetic care in obese subjects

Effectiveness of laparoscopic sleeve gastrectomy and one anastomosis gastric bypass on the resolution of metabolic syndrome — a review

The main cause of the development of metabolic syndrome seems to be an imbalance of calorie intake and energy expenditure. However genetic and epigenetic factors, sedentary lifestyle, poor food quality, and disturbances in gut microbiota also play a major role. There is no single effective method of treatment for metabolic syndrome. Dietary therapy and an increase in physical activity along with pharmacological treatment are not fully effective to recommend them as a therapy for metabolic syndrome. Today, modern bariatric-metabolic procedures such as laparoscopic sleeve gastrectomy or single anastomosis gastric bypass give the best chances of successful resolution of metabolic syndrome

The right of freedom of press under the Printing Presses and Publication Act 1984 / Ahmad al-Hady Abdul Razak … [et al.]

Media plays a crucial role in shaping and altering public opinion through various means of reporting. Freedom of press is not a right exclusive for the media community only. Malaysian citizen also should be attentive to fight for freedom of press as it should be their right to freedom of expression. Freedom of expression includes one right to receive information. In other country such as India, freedom of press is included under freedom of speech and expression. In Malaysia, the situation is different where by press freedom is not clearly protected as one of the fundamental liberties in Federal Constitution. The extent of freedom of press in Malaysia can be seen in one of the legislation in the country, i.e. Printing Presses and Publications Act 1984(the Act). The Act has attracted much criticisms and disapproval especially among media community and Malaysian journalists. Their rights to express opinion and information are always oppressed by the extensive scope imposed under the Act. The absolute discretionary power of the Home Minister is seen as a hindrance to the pave of press freedom. With exclusion of judicial review and principles of natural justice under the Act, it strengthens the power of the Home Minister and consequently weakened press freedom. This project paper composed of in-depth study of the position of freedom of press under Article 10 (1) (a) of the Federal Constitution and the extent of freedom of press under the Act

Quality of life evaluation after selected bariatric procedures using the Bariatric Analysis and Reporting Outcome System

Introduction: Morbid obesity leads to significant decrease in quality of life. The Bariatric Analysis and ReportingOutcome System (BAROS) was created for objective evaluation of surgical treatment for morbid obesity outcomes. Aim: Evaluation of late results of surgical treatment for morbid obesity with laparoscopic adjustable gastric banding(LAGB) and Roux-en-Y gastric bypass (RYGB) procedures, together with evaluation of quality of life in the postoperativeperiod. Material and methods: Sixty patients treated surgically for morbid obesity were included in the study. Group 1 constitutedpatients who underwent LAGB – n = 30 patients with mean age 34 ±9.67, mean BMI 44.3 ±3.7. Group 2 constitutedpatients who underwent RYGB – n = 30 patients with mean age 50.9 ±7.8 years, mean BMI 54.5 ±6.72.Patients were operated on in the period 2007-2008. At least 6 months after the operation, they received questionnairesbased on the BAROS scale in the authors’ own modification. Results: In both groups of patients treated with LAGB and RYGB, an excellent result of surgical treatment wasachieved in 17% of patients, very good in 57%, good in 23%, fair in 1.5% and failure in 1.5%. In the final evaluation ofquality of life (QoL) in both groups treated with LAGB and RYGB, QoL was significantly better in 55% of patients, betterin 42%, while in 3% QoL was unchanged. Conclusions: The quality of life of patients with morbid obesity, evaluated at least six months after the surgery,improves significantly following the bariatric operations performed most often so far, in both laparoscopic and classictechnique

The Influence of Laparoscopic Sleeve Gastrectomy on Metabolic Syndrome Parameters in Obese Patients in Own Material

# The Author(s) 2011. This article is published with open access at Springerlink.com Abstract Popularity of laparoscopic sleeve gastrectomy (LSG) has been growing gradually. The aim of this study was to determine changes in metabolic syndrome parameters as well as insulin, total cholesterol, and LDL cholesterol, and to describe the influence of body weight loss on comorbidities in obese patients after LSG with 1-year followup. The material consists of 130 patients who underwent LSG (2007–2010) in order to treat morbid obesity and who had met before the surgery at least three criteria necessary for the diagnosis of metabolic syndrome according to the International Diabetes Federation. The influence of LSG on comorbidities was also analyzed. During 1-year follow-up after LSG, we obtained a statistically significant decrease in BMI (from 53.18±7.5 kg/m 2 to 31.4±3.75 kg/m 2, p<0.00001) and a reduction in waist circumference. Twelve months after the surgery, excess weight loss (EWL) was 59.42±7.21% and excess body mass index loss (EBL) was 61.03±6.50%. One year after LSG, the amount of patients with diagnosed metabolic syndrome decreased in 61 patients (53.08%). After 1 year, none of the patients met five criteria of metabolic syndrome. According to efficiency in body mass loss presented by %EWL and %EBL, LSG is gaining approval as a method of obesity and metabolic syndrome treatment, although it is a relatively new procedure. LSG is rather an easy procedure; the time of performance and hospitalization are shorter which entails normalization in all parameters of metabolic syndrome and decreases the percentage of obese patients with metabolic syndrome