Banded gastric bypass - four years follow up in a prospective multicenter analysis

BACKGROUND: The gastric bypass is the gold standard of bariatric surgery. Nevertheless some patients show insufficient weight loss or weight regain. Dilation of the pouch or the pouch outlet may be the cause. The banded gastric bypass tries to overcome dilation by placing an implant around the pouch or pouch outlet. In this study we describe our results using the GaBP™ ring system in banded gastric bypass operations in 3 bariatric centers. METHODS: 183 patients in 3 bariatric reference centers received a banded gastric bypass operation using the GaBP™ ring system. Up to 4 years follow up was evaluated including weight loss and complications. RESULTS: Mean EWL after 6 Months was 60% with a mean BMI of 30.1 kg/m(2). After one year mean EWL reached 75.3% with a mean BMI of 27 kg/m(2) (110 patients). After two and three years the EWL was 78.8% (n = 49) and 79.9% (n = 35). There was a mean EWL of 85% after 4 years. Thirteen patients finished a 4 year follow up period and mean BMI after 4 years was 25.2 kg/m(2). In the perioperative and early postoperative period there was a low complication rate (4.3%). Stenosis or dysphagia was observed in only one patient. There was only one ring related complication. CONCLUSION: Banded gastric bypass using the GaBP™ ring system allows good weight loss with no regain of weight in a four year follow up. The complication rate is low. A randomized controlled trial is currently underway to compare banded and conventional gastric bypass

Studies on dietary intake, eating behavior and meal-related symptoms

Background and aims: Roux-en-Y gastric bypass (RYGB) is now a common treatment for obesity with well-documented effects on long-term weight reduction, health-related quality of life, obesity-related morbidity and mortality. There is a need for a better understanding of changes in dietary intake and meal-related symptoms after RYGB. The aim of this thesis was to study these phenomena and to improve current treatment protocols. Methods: Forty-three adults (31 women, 12 men; mean age 42.6 years, mean BMI 44.5 kg/m²) were followed in a longitudinal cohort study and examined preoperatively and at six weeks, one and two years after surgery (Paper I and II). They completed the Three-Factor Eating Questionnaire (TFEQ-R21) on attitudes to food, and questionnaires on dietary intake and meal pattern; in addition, a test meal ad libitum was administered and portion size and eating rate were assessed. A Dumping Symptom Rating Scale (DSRS) was developed and evaluated for its reliability and construct validity over two years on 124 respondents of whom 43 adults from Paper I and II and in addition 81 adolescents (Paper III). Thirty-one non-obese subjects served as reference group (Paper II and III). Another eight RYGB patients with hypoglycemia -like symptoms and eight patients with no hypoglycemia -like symptoms ingested a liquid carbohydrate meal. Insulin, plasma glucose, glucagon-like peptide 1 (GLP-1) and glucagon were measured intermittently up to 180 minutes after the meal. Results: The dietary questionnaire showed decreased energy intake, Food weight fell initially but was not lower two years after surgery resulting in a significantly decreased dietary energy density at two years after surgery. The meal test showed decreased portion size despite meal duration remaining constant, resulting in a reduced eating rate. Number of meals increased, with more meals in the mornings. TFEQ-R21 revealed decreased emotional and uncontrolled eating, whereas there was a transient increase in cognitive restraint six weeks after surgery. Most subjects reported mild or no dumping symptoms, although 6–12% had persistent problems – in particular, postprandial fatigue, need to lie down, nausea, and feeling faint – two years after surgery. The result of the validation process of DSRS was satisfactory overall. The patients with a history of hypoglycemia-like symptoms after RYGB demonstrated neither lower plasma glucose nor greater insulin response compared to asymptomatic patients in response to a liquid carbohydrate meal, but they perceived more symptoms. Conclusion: After RYGB, patients displayed major changes in eating behavior and meal pattern, suggesting that RYGB drives the individual to an eating behavior that promotes weight loss. Despite lack of association between the reduction in dietary energy density and percentage weight loss, changes in food choice were overall nutritionally beneficial. Dumping symptoms were rarely evident, but some patients reported persistent problems up to two years after surgery. DSRS is a reliable clinical screening instrument to identify patients with pronounced dumping symptoms. The mechanisms of action behind the origin of hypoglycemia-like symptoms remain obscure and need further exploration

Neurotrophic activity of human adipose stem cells isolated from deep and superficial layers of abdominal fat.

New approaches to the clinical treatment of traumatic nerve injuries may one day utilize stem cells to enhance nerve regeneration. Adipose-derived stem cells (ASC) are found in abundant quantities and can be harvested by minimally invasive procedures that should facilitate their use in such regenerative applications. We have analyzed the properties of human ASC isolated from the deep and superficial layers of abdominal fat tissue obtained during abdominoplasty procedures. Cells from the superficial layer proliferate significantly faster than those from the deep layer. In both the deep and superficial layers, ASC express the pluripotent stem cell markers oct4 and nanog and also the stro-1 cell surface antigen. Superficial layer ASC induce the significantly enhanced outgrowth of neurite-like processes from neuronal cell lines when compared with that of deep layer cells. However, analysis by reverse transcription with the polymerase chain reaction and by enzyme-linked immunosorbent assay has revealed that ASC isolated from both layers express similar levels of the following neurotrophic factors: nerve growth factor, brain-derived neurotrophic factor and glial-derived neurotrophic factor. Thus, human ASC show promising potential for the treatment of traumatic nerve injuries. In particular, superficial layer ASC warrant further analysis of their neurotrophic molecules