Doctor Articles 2010-2014

01 April 2013

Mounting evidence suggests that the mechanisms of weight loss and the improvement in glucose metabolism seen after LSG are related not only to gastric restriction but also to neurohormonal changes.

Methods

Fasting and postprandial levels at 60 and 120 minutes after a standard test meal of the above peptides and glucose metabolism indices were evaluated in 15 consecutive morbidly obese (MO) subjects before and 6 and 12 months after LSG. As study controls, 15 lean subjects matched for age and sex were also assessed.

Results

Body mass index values notably decreased at 6 and 12 months (P < 0.01), postoperatively. In addition, an overall improvement of the glycemic profile of MO patients was noted. After LSG, markedly decreased fasting and postprandial levels of ghrelin, amylin, and leptin were observed. A significant postprandial increase of PYY and GLP-1 levels was also noted postoperatively. Interestingly, significantly increased levels of PP were noted only at 60 minutes postprandially after LSG.

Conslusions

LSG markedly improved glucose homeostasis and generated significant changes in ghrelin, PP, PYY, GLP-1, amylin, and leptin levels. These multiple hormonal actions may have several beneficial effects on the underlying mechanism of weight loss, demonstrating that LSG could be more than just a restrictive bariatric operation.

Publication date: 2013/4/1- Journal: Annals of surgery - Publisher: LWW

Authors: Efstathios Dimitriadis, Markos Daskalakis, Marilena Kampa, Anastasia Peppe, John A Papadakis, John Melissas

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01 April 2013

Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy.

Background: Sleeve gastrectomy is gaining popularity whether as a primary, staged or revisional operation. The aim of this study is to evaluate the perioperative safety and the learning curve for laparoscopic sleeve gastrectomy (LSG).

Methods: We performed a retrospective review of the prospectively collected data for all patients who underwent LSG for the treatment of morbid obesity at our institution from January 2003 to December 2008.

Results: Data from 230 consecutive patients [male 47%, female 53%; mean age 44.0 ± 10.0 years, mean preoperative body mass index (BMI) 56.7 ± 11.5 kg/m(2)], who were operated upon by three surgeons with different degrees of bariatric experience, were analyzed. There was no 30-day mortality, but there were two cases of late mortality (0.87%). Early complications were noted in 23 cases (10.0%), including 10 cases of leak (4.3%) and 10 cases of hemorrhage (4.3%). In 17 cases (7.4%) reoperations were performed. The rates of overall and major complications did not differ among surgeons or between early and late period of experience for the three surgeons; this trend held true individually and in subgroups. Overall, over the course of the learning curve, a significant decrease in operative time was noted. The only factor that was independently associated with complications was use of buttress material; the likelihood of complications was found to be 72% lower in patients in whom buttress material was used.

Conclusions: LSG constitutes a potentially safe anti-obesity procedure with acceptable morbidity. Experience at the beginning can be discouraging, even for surgeons with advanced laparoscopic skills. LSG can be performed safely, with proper mentoring and in appropriate settings, even by less experienced bariatric surgeons. The use of staple-line reinforcement was associated with improved perioperative outcomes, and it should be considered in an attempt to decrease leaks.

Publication date: 2010 Jun 5.- Journal: Surg Endosc. 2011 Jan;25(1):88-97.

Authors: Markos Daskalakis, Yakup Berdan, Sophia Theodoridou, Gerhard Weigand, Rudolf A Weiner

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01 April 2013

Adipose tissue fatty acid composition in Greek patients with breast cancer versus those with benign breast tumors.

Background: Fatty acid composition of adipose tissue is a most reliable biomarker of long-term dietary fatty acid intake. Few studies have implemented biomarkers of fatty acid intake in relation to breast cancer. In this study the relation between adipose tissue composition and breast cancer was investigated.

Patients and methods: Fatty acid composition in breast and buttock adipose tissue from 94 Greek women with breast cancer and 57 with benign breast tumors was determined. Multivariate analysis was performed to determine the association between fatty acid groups and breast cancer risk.

Results: In pre-menopausal women, elevated total polyunsaturated fatty acids (PUFA) in breast adipose tissue and N-3 PUFA in buttock adipose tissue were associated with reduced odds of breast cancer (odds ratio, OR=0.19; 95% confidence interval, CI=0.05-0.76, p<0.02 and OR=0.02; 95% CI=0.0009-0.36, p<0.009).

Conclusion: Adipose total PUFA and N-3 PUFA were inversely-related to breast cancer risk in Greek pre-menopausal women. These results may have specific impact on habitual fat intake recommendations

Publication date: 2013 April - Journal: Anticancer Res
Authors: Eelco De Bree, George Mamalakis, Elias Sanidas, Christos Hatzis, Ioannis Askoxylakis, Markos Daskalakis, Vasileios Charalampakis, George Tsibinos, Dimitris D Tsiftsis, Anthony Kafatos

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Mounting evidence suggests that the mechanisms of weight loss and the improvement in glucose metabolism seen after LSG are related not only to gastric restriction but also to neurohormonal changes.

Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy.

Adipose tissue fatty acid composition in Greek patients with breast cancer versus those with benign breast tumors.

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