open access

Vol 64, No 1 (2013)
Original papers
Published online: 2013-02-28
Submitted: 2013-05-14
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The impact of the repair of staple line dehiscence in post-RYGB patients on glucose homeostasis and gut hormones — a preliminary study

Adam Durczynski, Dariusz Szymanski, Michal Nowicki, Piotr Hogendorf, Katarzyna Wojciechowska-Durczyńska, Leszek Czupryniak, Janusz Strzelczyk
Endokrynologia Polska 2013;64(1):7-12.

open access

Vol 64, No 1 (2013)
Original papers
Published online: 2013-02-28
Submitted: 2013-05-14

Abstract

Introduction: Staple-line disruption (SLD) following Roux-en-Y gastric bypass (RYGB) results in weight regain. This study evaluated glucose homeostasis and gut hormonal changes following surgical repair of gastrogastric fistula.
Material and methods: Three patients with SLD underwent an oral 75 g glucose tolerance test (OGTT) before (baseline) and one week after gastric pouch restoration. Plasma glucose, insulin and glucagon glucose-dependent insulinotropic polypeptide (GIP) and glucagonlike peptide–1 (GLP-1) were measured in the OGTT samples. Fasting plasma levels of ghrelin and leptin were assessed.
Results: Restoration of gastric pouch provided moderate amelioration of glucose metabolism and gut hormones, yet without complete normalisation of glucose homeostasis at one week after surgery. Duodenal passage exclusion resulted in early improvement of control fasting plasma glucose with decrease of glucagon from 18.5 to 15 (ng/mL, by 19%), relatively stable insulin and decline of incretin hormones (GIP and GLP-1). Post-challenge measurements confirmed amelioration of glycaemic control with decrease of plasma glucose from 182 to 158 mg/dL at 60 minutes. Surgical re-intervention resulted in exacerbation of GIP response with brisk rise in plasma level, accompanied by considerable increase of peak insulin concentration. The overall post-challenge glucagon and GLP-1 responses were decreased. Marked decrease in fasting plasma ghrelin and leptin were observed.
Conclusions: Our report gives further insight into the hormonal mechanisms underlying the effects of surgically altered anatomy of different parts of the small intestine on glucose homeostasis that is highly important, since it may facilitate novel conservative therapies of diabetes without the need for surgery.

Abstract

Introduction: Staple-line disruption (SLD) following Roux-en-Y gastric bypass (RYGB) results in weight regain. This study evaluated glucose homeostasis and gut hormonal changes following surgical repair of gastrogastric fistula.
Material and methods: Three patients with SLD underwent an oral 75 g glucose tolerance test (OGTT) before (baseline) and one week after gastric pouch restoration. Plasma glucose, insulin and glucagon glucose-dependent insulinotropic polypeptide (GIP) and glucagonlike peptide–1 (GLP-1) were measured in the OGTT samples. Fasting plasma levels of ghrelin and leptin were assessed.
Results: Restoration of gastric pouch provided moderate amelioration of glucose metabolism and gut hormones, yet without complete normalisation of glucose homeostasis at one week after surgery. Duodenal passage exclusion resulted in early improvement of control fasting plasma glucose with decrease of glucagon from 18.5 to 15 (ng/mL, by 19%), relatively stable insulin and decline of incretin hormones (GIP and GLP-1). Post-challenge measurements confirmed amelioration of glycaemic control with decrease of plasma glucose from 182 to 158 mg/dL at 60 minutes. Surgical re-intervention resulted in exacerbation of GIP response with brisk rise in plasma level, accompanied by considerable increase of peak insulin concentration. The overall post-challenge glucagon and GLP-1 responses were decreased. Marked decrease in fasting plasma ghrelin and leptin were observed.
Conclusions: Our report gives further insight into the hormonal mechanisms underlying the effects of surgically altered anatomy of different parts of the small intestine on glucose homeostasis that is highly important, since it may facilitate novel conservative therapies of diabetes without the need for surgery.
Get Citation

Keywords

Roux-en-Y gastric bypass; staple-line disruption; weight regain; glucose homeostasis

About this article
Title

The impact of the repair of staple line dehiscence in post-RYGB patients on glucose homeostasis and gut hormones — a preliminary study

Journal

Endokrynologia Polska

Issue

Vol 64, No 1 (2013)

Pages

7-12

Published online

2013-02-28

Bibliographic record

Endokrynologia Polska 2013;64(1):7-12.

Keywords

Roux-en-Y gastric bypass
staple-line disruption
weight regain
glucose homeostasis

Authors

Adam Durczynski
Dariusz Szymanski
Michal Nowicki
Piotr Hogendorf
Katarzyna Wojciechowska-Durczyńska
Leszek Czupryniak
Janusz Strzelczyk

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