Icssg 2012 sleeve component needed after intestinal metabolic surgeryPresentation Transcript
Laparo-Obeso Centre ‘Metabolic Surgery’ is here to stayRCTs : STAMPEDE –Shauer et al :MINGROVE et alLong Term results: COHEN ET ALNewer STUDIES: COSMID
Laparo-Obeso Centre COSMID Randomized Controlled TrialComparison Shah SS- Ruby Hall Clinic , Pune.Of Cummings DE- Washington University, USASurgery vs. Kim K –Celebration Hosp, USAMedicines Buffington C –Celebration Hosp, USAforIndian Yajnik CJ – KEMH, PuneDiabetes Phadke U –Ruby Hall Clinic, Pune
Laparo-Obeso CentreSleeve Gastrectomy- Other Gastric Pouches:Physiological Restriction, -Restriction,Rapid Transit. -Dumping
Laparo-Obeso Centre BENEFITS OF GASTRIC COMPONENT:•Restriction,•Increase Transit,•Vagotomy,•Ghrelin,•Duodenal exclusion, or Modified stimulation•Change in ‘ph’ of chyme,•?Change in microflora.
Laparo-Obeso Centre Metabolic Surgery for Type II DM:Diabetes GastroparesisGLP 1 Physiological Gastroparesis? Gastric Atony / Dilatation? Only Intestinal Procedure Stomach ? Pacemaker for intestines
Laparo-Obeso CentreProspective controlled study of effect of laparoscopicsleeve gastrectomy on small bowel transit time and gastricemptying half-time in morbidly obese patients with type 2diabetes mellitusShashank Shah, M.S., Poonam Shah, M.D.,Jayashree Todkar, M.S., Michel Gagner, M.D.Conclusion:A decreased gastric emptying half-time and SBTT after SGcan possibly contribute to better glucose homeostasis inpatients with T2DM. SOARD March 2010 138-141
Markedly reduced fasting and postprandialghrelin levels in addition to increased PYYlevels after LSG are associated withgreater appetite suppression and excessweight loss as compared with LRYGBP…………… prospective , double blind study. Ann Surg 2008 March 247 Karamanakas Laparo-Obeso Center
PYY(3-36)• DPP IV activity is increased in obese• Obesity decreases both basal and meal stimulated PYY levels.• Specific Y2 receptor agonist• Suppresses appetite and stimulates weight loss through hypothalamic mediated mechanism• Increases insulin sensitivity (Van den Hoek et al Am J Physio Endocrino,Met ab 2007) PYY levels increase after SG Laparo-Obeso Center
Laparo-Obeso Sleeve Gastrectomy:Mechanisms- Centre volume (restriction) • GLP Restriction by pylorus • Satiation Ghrelin (fasting and meal • Gastric emptying stimulus) • Small bowel PYY transit timeAll Complimentary to Intestinal ……….. Anti-Diabetic effects
Laparo-Obeso Centre GASTRIC COMPONENT:Sleeve Gastrectomy for Type II DMSG CAN BE CONVERTED Gastric Component Preserved &Intestinal Component Added.
Laparo-Obeso CentreA ‘Gastric’ Component is essential forbetter outcomes of Metabolic Surgery