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Postoperative Body Mass Index Changes in Gastric Cancer Patients according to Reconstruction Type: Effectiveness of Long Jejunal Bypass on Weight Loss in Obese Patients after Distal Gastrectomy

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Abstract

The aim of this study was to investigate and compare the change of body mass index (BMI) in patients after gastrectomy for cancer according to the type of reconstruction. BMI was followed in 260 patients who had undergone curative surgery for gastric cancer from March 2003 to December 2009. The procedures were Billroth I in 63 patients, Billroth II in 52 patients, Roux-en-Y in 54 patients, long Roux-en-Y (bypassed proximal jejunum over 100 cm) in 47 patients, and total gastrectomy in 44 patients. BMI reduction was greatest in the total gastrectomy group at postoperative 6 months, 1 year, and 2 years. Postoperative 3-year BMI reduction was greatest in the long Roux-en-Y group. BMI reductions of the total gastrectomy and long Roux-en-Y groups were similar during the follow-up period. Among the subtotal gastrectomy groups, BMI reduction was greatest in the long Roux-en-Y group, and there was statistical significance in comparing with Billroth I and II groups, but no statistical difference with the Roux-en-Y group. Given the limitations of patient number and follow-up period, it can be concluded that obese patients with gastric cancer not requiring total gastrectomy may benefit from long Roux-en-Y reconstruction with adequate BMI reduction and accompanying health improvement.

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References

  1. Oh SW (2011) Obesity and metabolic syndrome in Korea. Diabetes Metab J 35(6):561–566

    Article  PubMed Central  PubMed  Google Scholar 

  2. Tanaka S, Matsuo K, Matsumoto H, Maki T, Nakano M, Sasaki T et al (2011) Clinical outcomes of Roux-en-Y and Billroth I reconstruction after a distal gastrectomy for gastric cancer: What is the optimal reconstructive procedure? Hepatogastroenterology 58(105):257–262

    PubMed  Google Scholar 

  3. Stael von Holstein C, Walther B, Ibrahimbegovic E, Akesson B (1991) Nutritional status after total and partial gastrectomy with Roux-en-Y reconstruction. Br J Surg 78(9):1084–1087

    Article  CAS  PubMed  Google Scholar 

  4. Chareton B, Landen S, Manganas D, Meunier B, Launois B (1996) Prospective randomized trial comparing Billroth I and Billroth II procedures for carcinoma of the gastric antrum. J Am Coll Surg 183(3):190–194

    CAS  PubMed  Google Scholar 

  5. Inabnet WB, Quinn T, Gagner M, Urban M, Pomp A (2005) Laparoscopic Roux-en-Y gastric bypass in patients with BMI <50: a prospective randomized trial comparing short and long limb lengths. Obes Surg 15(1):51–57

    Article  PubMed  Google Scholar 

  6. Stefanidis D, Kuwada TS, Gersin KS (2011) The importance of the length of the limbs for gastric bypass patients—an evidence-based review. Obes Surg 21(1):119–124

    Article  PubMed  Google Scholar 

  7. Leifsson BG, Gislason HG (2005) Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients. Obes Surg 15(1):35–42

    Article  PubMed  Google Scholar 

  8. Zub-Pokrowiecka A, Rembiasz K, Konturek PC, Budzynski A, Konturek SJ, Winiarski M et al (2011) Ghrelin and gastrin in advanced gastric cancer before and after gastrectomy. World J Gastroenterol 17(4):449–458

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Scheufler O, Erdmann D (2007) Current concepts and trends in post-bariatric plastic surgery. Chirurg 78(4):316–325

    Article  CAS  PubMed  Google Scholar 

  10. Konturek SJ, Konturek JW, Pawlik T, Brzozowski T (2004) Brain-gut axis and its role in the control of food intake. J Physiol Pharmacol 55(1 Pt 2):137–154

    CAS  PubMed  Google Scholar 

  11. De Ambrogi M, Volpe S, Tamanini C (2003) Ghrelin: central and peripheral effects of a novel peptydil hormone. Med Sci Monit 9(9):RA217–RA224

    PubMed  Google Scholar 

  12. Castaneda TR, Tong J, Datta R, Culler M, Tschop MH (2010) Ghrelin in the regulation of body weight and metabolism. Front Neuroendocrinol 31(1):44–60

    Article  CAS  PubMed  Google Scholar 

  13. Abeles D, Shikora SA (2008) Bariatric surgery: current concepts and future directions. Aesthet Surg J 28(1):79–84

    Article  CAS  PubMed  Google Scholar 

  14. Lamers CB, Diemel CM, Jansen JB (1982) Serum pancreatic polypeptide responses to food and secretion in patients with Billroth I and Billroth II gastrectomies and in normal subjects. Surgery 91(3):288–292

    CAS  PubMed  Google Scholar 

  15. Paakkonen M, Alhava EM, Karjalainen P, Korhonen R, Savolainen K, Syrjanen K (1984) Long-term follow-up after Billroth I and II partial gastrectomy. Gastrointestinal tract function and changes in bone metabolism. Acta Chir Scand 150(6):485–458

    CAS  PubMed  Google Scholar 

  16. Nakamura H, Murakami Y, Morifuji M, Uemura K, Hayashidani Y, Sudo T et al (2009) Analysis of fat digestive and absorptive function after subtotal gastrectomy by a 13 C-labeled mixed triglyceride breath test. Digestion 80(2):98–103

    Article  CAS  PubMed  Google Scholar 

  17. Takachi K, Doki Y, Ishikawa O, Miyashiro I, Sasaki Y, Ohigashi H et al (2006) Postoperative ghrelin levels and delayed recovery from body weight loss after distal or total gastrectomy. J Surg Res 130(1):1–7

    Article  CAS  PubMed  Google Scholar 

  18. Kim S, Lee JH, Heo JS, Kwak MJ, Kim SJ, Sohn YB et al (2009) Serum obestatin/ghrelin ratio is altered in patients after distal gastrectomy. Dig Surg 26(2):143–148

    Article  CAS  PubMed  Google Scholar 

  19. Brolin RE, Kenler HA, Gorman JH, Cody RP (1992) Long-limb gastric bypass in the superobese. A prospective randomized study. Ann Surg 215(4):387–395

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Brolin RE, LaMarca LB, Kenler HA, Cody RP (2002) Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg 6(2):195–203, discussion 4–5

    Article  PubMed  Google Scholar 

  21. Bruder SJ, Freeman JB, Brazeau-Gravelle P (1991) Lengthening the Roux-Y limb increases weight loss after gastric bypass: a preliminary report. Obes Surg 1(1):73–77

    Article  PubMed  Google Scholar 

  22. Ciovica R, Takata M, Vittinghoff E, Lin F, Posselt AM, Rabl C et al (2008) The impact of roux limb length on weight loss after gastric bypass. Obes Surg 18(1):5–10

    Article  PubMed  Google Scholar 

  23. Christou NV, Look D, Maclean LD (2006) Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg 244(5):734–740

    Article  PubMed Central  PubMed  Google Scholar 

  24. Choban PS, Flancbaum L (2002) The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, randomized clinical trial. Obes Surg 12(4):540–545

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, Daerim-1 Dong, Yeongdeungpo-gu, Seoul, 150-950, South Korea

    Ji Won Kim, So Young Jung, Ji Woong Cho, Byung Chun Kim, Kyung Suk Chung & Dae Hyun Yang

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  1. Ji Won Kim
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  2. So Young Jung
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  3. Ji Woong Cho
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  4. Byung Chun Kim
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Correspondence to Dae Hyun Yang.

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Kim, J.W., Jung, S.Y., Cho, J.W. et al. Postoperative Body Mass Index Changes in Gastric Cancer Patients according to Reconstruction Type: Effectiveness of Long Jejunal Bypass on Weight Loss in Obese Patients after Distal Gastrectomy. Indian J Surg 76, 187–192 (2014). https://doi.org/10.1007/s12262-012-0651-0

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