Banded Sleeve Gastrectomy Versus Banded Ring Gastric Bypass in Morbidly Obese Patients

NCT00873405 | Unknown DMC

• 1 other identifier: 049/06
• Study Type: interventional
• Target: 65
• Locations: 1 country
• Sites: 1

Brief Summary

Obesity is a multifactorial disease that affects millions of people worldwide. It is the main independent risk factor for developing type 2 diabetes mellitus (T2DM). Most patients with T2DM and glucose intolerance (GI) are overweight, a condition known as diabesity. In patients with the most severe form of obesity, i.e., morbid obesity, the likelihood of developing diseases associated with obesity is increased. The investigators currently know that bariatric surgery provides sustained weight loss and well-documented remission of T2DM. Patients who undergo bariatric surgery show long-term reduced mortality from coronary artery disease, cancer and diabetes; 136 lives are saved per 10,000 surgical procedures performed. Bariatric surgery is a relatively safe procedure that is becoming increasingly well-accepted; in 2007, approximately 170,000 bariatric procedures were performed in the USA. Currently, bariatric surgery is the most effective choice of treatment of morbidly obese patients with diabetes. The surgical procedures that are currently performed to treat morbid obesity are divided into two main groups: gastric restrictive procedures and combination procedures; the latter combine gastric restriction and malabsorption. The roux-en-Y gastric bypass (RYGB) is the combination procedure most frequently performed, whereas sleeve gastrectomy (SG) is an emerging restrictive procedure. SG can be performed as the first of a two-stage operation in patients at high risk of death, or as a definitive surgical procedure. It has shown good results with regard to weight loss and glycemic control in various studies. The potential advantages of SG include lower probability of vitamin and mineral deficiencies because this procedure has no malabsorptive component; access to the entire intestinal tract; no need for a subcutaneous access port or adjustments; absence of dumping syndrome and lower probability of intestinal obstruction. In addition, SG can be performed in patients who have inflammatory bowel disease or who have undergone bowel surgery, and it can be easily converted into RYGB. Both SG and RYGB can be performed with or without the placement of a Silastic® ring. The metabolic control achieved with bariatric procedures has been demonstrated and reproduced in various medical centers worldwide. Metabolic control can be achieved with gastric restrictive procedures such as vertical banded gastroplasty, adjustable gastric banding and, more recently, SG. However, it has been shown that glucose homeostasis is affected by various intestinal mechanisms observed exclusively in procedures that include a malabsorptive element, such as RYGB. A systematic review of 22,094 cases of morbidly obese patients submitted to bariatric surgery has shown that resolution of T2DM was achieved in 76.8% of the cases, improvement being achieved in 86% of cases. Among the criteria used to diagnose metabolic syndrome, fasting glucose levels are the first to return to normal in patients submitted to Silastic® ring gastric bypass (SRGB), a modification of the traditional RYGB which consists in adding a Silastic® ring to the gastric bypass operation. Normoglycemia after bariatric procedures, as well as diabesity itself, is multifactorial. Normoglycemia is observed as a result of dietary control, decreased plasma levels of ghrelin, weight loss and reduction of body fat, as well as of the release of gastrointestinal hormones that interfere with the function of pancreatic β cells (incretins). The main purpose of this study was to compare the weight loss of morbidly obese patients submitted to either a Silastic® ring sleeve gastrectomy (SRSG) or an SRGB, as well as to compare the effects of both procedures on glucose homeostasis in morbidly obese patients.

Conditions

Obesity

Keywords

Type 2 diabetes mellitus; Metabolic control; Bariatric Surgery; Weight Loss; Sleeve gastrectomy; BMI reduction; Waist circumference reduction; Percentage of excess BMI loss; Glucose homeostasis

Outcome Measures

Primary Outcomes (1)

• Weight loss, BMI reduction and waist circumference reduction

  12 months

Secondary Outcomes (1)

• Glucose homeostasis, metabolic control.

  12 months

Study Arms (2)

SRSG

ACTIVE COMPARATOR

Silastic® ring sleeve gastrectomy (SRSG).

Procedure: Silastic® ring sleeve gastrectomy

SRGB

OTHER

Silastic® ring gastric bypass.

Procedure: Silastic® ring sleeve gastrectomy; Procedure: Silastic® ring gastric bypass

Interventions

Silastic® ring sleeve gastrectomy PROCEDURE

SRSG group: ligation of the vessels of the greater curvature of the body and fundus of stomach; resection of the fundus and part of the body of stomach using a linear stapler (80 mm, Tyco®) and a 32-Fr tube to calibrate the remaining stomach; placement of a 6.2 cm Silastic® ring around the stomach, 5.0 cm below the esophagogastric junction.

Also known as: Sleeve gastrectomy

SRGB; SRSG

Silastic® ring gastric bypass PROCEDURE

SRGB group: creation of a small, proximal gastric pouch using a linear stapler (80 mm, Tyco®) and a 32-Fr tube to calibrate the gastric pouch; creation of an intestinal loop of 150 cm and a biliopancreatic loop of 40 cm; placement of a 6.2 cm Silastic® ring around the stomach, 5.0 cm below the esophagogastric junction.

Also known as: gastric bypass

SRGB

Eligibility Criteria

• Age: 20 Years - 60 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• female patients aged 20-60 years
• BMI 40-45 (inclusive)
• agreed on giving written informed consent

You may not qualify if:

• secondary obesity
• alcohol or drug use
• severe psychiatric disorder
• binge-eating of sweets
• previous stomach or bowel surgery

Sponsors & Collaborators

• Federal University of Espirito Santo: lead
• Federal University of São Paulo: collaborator

Study Sites (1)

Cassiano Antonio Moraes University Hospital, Federal University of Espírito Santo

Vitória, Espírito Santo, 29040-091, Brazil

Location

Related Publications (19)

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  PMID: 17356932 BACKGROUND

• Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, Ramanathan R, Schauer P. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006 Jun;20(6):859-63. doi: 10.1007/s00464-005-0134-5. Epub 2006 Apr 22.

  PMID: 16738970 BACKGROUND

• Silecchia G, Boru C, Pecchia A, Rizzello M, Casella G, Leonetti F, Basso N. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006 Sep;16(9):1138-44. doi: 10.1381/096089206778392275.

  PMID: 16989696 BACKGROUND

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  PMID: 16197783 BACKGROUND

• Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005 Nov-Dec;15(10):1469-75. doi: 10.1381/096089205774859227.

  PMID: 16354529 BACKGROUND

• Vidal J, Ibarzabal A, Romero F, Delgado S, Momblan D, Flores L, Lacy A. Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg. 2008 Sep;18(9):1077-82. doi: 10.1007/s11695-008-9547-2. Epub 2008 Jun 3.

  PMID: 18521701 BACKGROUND

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  PMID: 10775946 BACKGROUND

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  PMID: 17715408 BACKGROUND

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  PMID: 15181031 BACKGROUND

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  PMID: 16105401 BACKGROUND

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• Cai J, Zheng C, Xu L, Chen D, Li X, Wu J, Li J, Yin K, Ke Z. Therapeutic effects of sleeve gastrectomy plus gastric remnant banding on weight reduction and gastric dilatation: an animal study. Obes Surg. 2008 Nov;18(11):1411-7. doi: 10.1007/s11695-008-9490-2. Epub 2008 Apr 26.

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MeSH Terms

Conditions

Obesity; Diabetes Mellitus, Type 2; Weight Loss

Interventions

Gastric Bypass

Condition Hierarchy (Ancestors)

Overweight; Overnutrition; Nutrition Disorders; Nutritional and Metabolic Diseases; Body Weight; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Diabetes Mellitus; Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Body Weight Changes

Intervention Hierarchy (Ancestors)

Bariatric Surgery; Bariatrics; Obesity Management; Therapeutics; Gastroenterostomy; Anastomosis, Surgical; Surgical Procedures, Operative; Digestive System Surgical Procedures

Study Officials

• Gustavo PS Miguel, Surgery Assistant Professor

  Federal University of Espírito Santo

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER

Study Record Dates

• First Submitted: March 31, 2009
• First Posted: April 1, 2009
• Study Start: June 1, 2006
• Primary Completion: June 1, 2009
• Last Updated: April 1, 2009

Record last verified: 2009-03

Locations

BR (1)