Prospective controlled study of effect of laparoscopic sleeve gastrectomy on small bowel transit time and gastric emptying half-time in morbidly obese patients with type 2 diabetes mellitus

Surgery for Obesity and Related Diseases 6 (2010) 152–157

Original article

Prospective controlled study of effect of laparoscopic sleeve gastrectomy on small bowel transit time and gastric emptying half-time in morbidly obese patients with type 2 diabetes mellitus
Shashank Shah, M.S.a,*, Poonam Shah, M.D.a, Jayashree Todkar, M.S.a, Michel Gagner, M.D.b, S. Sonar, M.D.c, S. Solav, M.D.c
ba Laparascopic and Bariatric Surgery, Ruby Hall Clinic, Pune, India Department of Surgery, Florida International University, Mount Sinai Medical Center, Miami Beach, FL c Department of Nuclear Medicine, Ruby Hall Clinic, Pune, India Received May 29, 2009; revised October 22, 2009; accepted November 29, 2009

Abstract

Background: Published data on sleeve gastrectomy (SG) have indicated betterremission of type 2 diabetes mellitus (T2DM) and improvement in satiety compared with other restrictive procedures. Mechanisms in addition to rapid, extensive weight loss are responsible for the restoration of the euglycemic state. To prospectively evaluate the role of laparoscopic SG on gastric emptying half-time and small bowel transit time (SBTT) and effect of these on weight loss, satiety, andimprovement in T2DM. Methods: A total of 67 subjects were studied. Of these 67 subjects, 24 were lean controls (body mass index 22.2 2.84 kg/m2), 20 were severely and morbidly obese patients with T2DM who had not undergone SG (body mass index 37.73 5.35 kg/m2), and 23 were severely and morbidly obese patients with T2DM after SG (body mass index 40.71 6.59 kg/m2). All 67 patients were evaluatedfor gastric emptying half-time and SBTT using scintigraphic imaging. Imaging was performed every 15 minutes up to the ileocecal region. The Three-Factor Eating Questionnaire was administered simultaneously. Fasting blood sugar, postprandial blood sugar, and glycated hemoglobin were assessed. Nonparametric analysis of variance and the Mann-Whitney U test were applied. Results: The mean SBTT wassignificantly lower (P .05) in the post-SG group (199 65.7 minutes) than in the non-SG group (281.5 46.2 minutes) or control group (298.1 9.2 minutes). The gastric emptying half-time values were also significantly shorter (P .05) in the post-SG (52.8 13.5 minutes) than in the non-SG (73.7 29.0 minutes) and control (72.8 29.6 minutes) groups. The glycated hemoglobin, fasting blood sugar, and postprandialsugar were all significantly lower after SG. The Three-Factor Eating Questionnaire findings revealed significantly earlier satiety (29.0 7.2) for the post-SG patients (P .05) compared with the non-SG (45.8 9.0) and control (37.9 6.2) subjects. Conclusion: A decreased gastric emptying half-time and SBTT after SG can possibly contribute to better glucose homeostasis in patients with T2DM. (Surg ObesRelat Dis 2010;6:152–157.) © 2010 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Sleeve gastrectomy; Morbid obesity; Bariatric surgery; Type 2 diabetes mellitus

Keywords:

Presented at the 26th Annual Meeting of the American Society for Metabolic and Bariatric Surgery *Correspondence: Shashank Shah, M.S., Department of Surgery, Ruby Hill Clinic, Sasoon Road, Pune,India E-mail: drshashankshah@ediffmail.com

Laparoscopic sleeve gastrectomy (LSG) is an increasingly popular procedure among bariatric surgeons to promote weight loss in the morbidly obese and confer resolution of type 2 diabetes mellitus (T2DM) [1]. LSG is, by and large, considered a restrictive procedure, along the same lines as vertically banded gastroplasty, silastic ring vertical gastroplasty,and laparoscopic adjustable gastric banding

1550-7289/10/$ – see front matter © 2010 American Society for Metabolic and Bariatric Surgery. All rights reserved. doi:10.1016/j.soard.2009.11.019

S. Shah et al. / Surgery for Obesity and Related Diseases 6 (2010) 152–157

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[2]. These procedures primarily enable weight loss presumably by reducing the gastric volume and thereby...