Oral metformin transiently lowers post-prandial glucose response by reducing the apical expression of sodium-glucose co-transporter 1 in enterocytes.

Metformin (MET) is the most prescribed antidiabetic drug, but its mechanisms of action remain elusive. Recent data point to the gut as MET's primary target. Here, we explored the effect of MET on the gut glucose transport machinery.

The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons.

Background: Bariatric surgery in patients with BMI over 50 kg/m is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey.

Methods: An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m was ideated by 15 bariatric surgeons from 9 different countries.

Characterization of one anastomosis gastric bypass and impact of biliary and common limbs on bile acid and postprandial glucose metabolism in a minipig model.

The alimentary limb has been proposed to be a key driver of the weight-loss-independent metabolic improvements that occur upon bariatric surgery. However, the one anastomosis gastric bypass (OAGB) procedure, consisting of one long biliary limb and a short common limb, induces similar beneficial metabolic effects compared to Roux-en-Y Gastric Bypass (RYGB) in humans, despite the lack of an alimentary limb. The aim of this study was to assess the role of the length of biliary and common limbs in the weight loss and metabolic effects that occur upon OAGB.

Mammary Volume-to-Body Mass Index Ratio: Preoperative Predictor of Cardiovascular Risk Factor and Indicator of Long-term Postoperative Remission of Comorbidities in Premenopausal Women Undergoing Sleeve Gastrectomy.

Purpose: A correct preoperative selection of candidates to undergo a sleeve gastrectomy (SG) is advisable. However, there is a dearth of available literature addressing outcome predictors after SG, besides surgical factors. To assess the accuracy of the mammary volume-to-body mass index (MV-BMI) ratio as an indicator of cardiovascular disease (CVD) risk in morbidly obese patients and as a preoperative predictor of long-term outcomes after SG.

Prevalence of Endoscopic Findings Before Bariatric Surgery and Their Influence on the Selection of the Surgical Technique.

Purpose: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most popular procedures performed. The decision of which technique is most appropriate depends on the surgeon's preferences and experience. However, several factors strongly influence the decision of the procedure performed, including gastrointestinal disorders or asymptomatic upper gastrointestinal endoscopy (UGE) findings.

Correlation of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with metabolic parameters in patients undergoing sleeve gastrectomy.

Background: Obesity and its related diseases, type 2 diabetes (T2D) and overall metabolic syndrome, often show a low-grade of chronic inflammation due to loss of balance between pro- and anti-inflammatory signals. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are considered cost-effective markers for the detection of this subclinical inflammation.

Objectives: To evaluate the potential prognostic factor of NLR and PLR as inflammatory biomarkers on weight loss and T2D remission after sleeve gastrectomy (SG).

Analgesic effect of postoperative laparoscopic-guided transversus abdominis plane (TAP) block, associated with preoperative port-site infiltration, within an enhanced recovery after surgery protocol in one-anastomosis gastric bypass: a randomized clinical trial.

Background: The use of ultrasonography to assist needle placement during transverse abdominal plane (TAP) technique has provided direct visualization of surround anatomical musculature and facial planes. However, the increased girth in patients undergoing bariatric surgery is challenging to visualize via ultrasonography which may lead to poor postoperative analgesia.

Objective: The aim of the study is to investigate whether the addition of postoperative laparoscopic-guided TAP block as part of a multimodal analgesic regimen within the ERAS protocol compared to no block provides better postoperative analgesia in patients undergoing one-anastomosis gastric bypass surgery.

Correction to: Training Courses in Laparoscopic Bariatric Surgery on Cadaver Thiel: Results of a Satisfaction Survey on Students and Professors.

The name of author Ramon Vilallonga was misspelled in the original article. It is correct here.

Validation of biochemical scores for liver steatosis before and 1 year after sleeve gastrectomy.

Background: Bariatric surgery is a potential treatment for liver steatosis in morbidly obese patients, showing an improvement in approximately 90% of cases of fatty liver after surgery. Liver biopsy is the gold standard method to monitor liver steatosis. Imaging tests, such as magnetic resonance (MR) spectroscopy, have shown a good accuracy in the diagnosis of liver steatosis.

Training Courses in Laparoscopic Bariatric Surgery on Cadaver Thiel: Results of a Satisfaction Survey on Students and Professors.

Introduction: For the acquisition of skills in laparoscopic surgery, practices in experimental labs are gaining increasing relevance. Activities in experimental labs include Pelvitrainers, virtual reality simulators, and experimental animals (frequently pigs). However, the best model for surgical formation is the performance of interventions on cadavers.

Importance of the gastrointestinal tract in type 2 diabetes. Metabolic surgery is more than just incretin effect.

Bariatric and metabolic surgery is creating new concepts about how the intestine assimilates food. Recent studies highlight the role of the gastrointestinal tract in the genesis and evolution of type 2 diabetes. This article has been written to answer frequent questions about metabolic surgery results and the mechanisms of action.

Incidence of postoperative nausea and vomiting after laparoscopic sleeve gastrectomy with staple line reinforcement with oversewing and staple line inversion vs buttressing material: A randomized clinical trial.

Background: Postoperative nausea and vomiting are relevant complications after restrictive bariatric procedures, such as sleeve gastrectomy, mainly secondary to a drastic reduction in the gastric volume. However, other causes can be involved. The aim of this study was to determine the incidence of postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG), with staple line reinforcement with oversewing vs buttressing material.

Long-term follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass versus one-anastomosis gastric bypass: a prospective randomized comparative study of weight loss and remission of comorbidities.

Background: One-Anastomosis Gastric Bypass (OAGB) has exponentially increased in the last decade, as it is associated with very low complications, mortality, readmissions and reoperations rates, and shows excellent short- and long-term benefits of weight loss and resolution of comorbidities. The aim of this study was to compare the effect of SG, RYGB, and OAGB, on short- and long-term weight loss and comorbidities resolution.

Methods: A prospective randomized clinical study of all morbidly obese patients undergoing SG, RYGB, and OAGB, as primary bariatric procedures, was performed.

Food Tolerance and Quality of Alimentation Following Laparoscopic Sleeve Gastrectomy Calibrated with a 50-Fr Bougie: Long-Term Results.

Background: Adjustable gastric banding and vertical banded gastroplasty are associated with the worst postoperative food tolerance of all bariatric techniques. However, food tolerance tends to improve over time. The aim of this study was to assess food tolerance and diet quality in patients undergoing a sleeve gastrectomy, 1 and 5 years after surgery.

Changes in Frequency Intake of Foods in Patients Undergoing Sleeve Gastrectomy and Following a Strict Dietary Control.

Purpose: Dietary intake and food preferences change after bariatric surgery, secondary to gastrointestinal symptoms and dietitian counseling. The aim of this study was to evaluate the changes in the frequency intake of different foods in patients undergoing sleeve gastrectomy and following a strict dietary control.

Patients And Methods: A prospective observational study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between 2007 and 2012 was performed.

The Effects of One-Anastomosis Gastric Bypass on Glucose Metabolism in Goto-Kakizaki Rats.

Background: The improvement in glucose metabolism after bariatric surgery is well established. The aim of this study was to investigate the hormones and glycemic control in diabetes after a one-anastomosis gastric bypass (OAGB) variant in an animal model of non-obese type 2 diabetes mellitus.

Methods: Thirty-six Goto-Kakizaki rats were randomly assigned to undergo one of the following procedures: OAGB (18 rats) or sham intervention (18 rats).

[Not Available].

Introducción y objetivo: el IMC puede resultar engañoso para ciertas complexiones corporales, por lo que se han propuesto otros parámetros como la adiposidad (calculada a través de fórmula CUN-BAE,) el índice de Framingham de riesgo cardiovascular (IF) y el índice aterogénico (IA) (rCT/HDL-c) como predictores de riesgo cardiovascular. Se propone comparar estos factores como marcadores de éxito terapéutico tras cirugía en pacientes obesos sometidos a gastrectomía vertical laparoscópica (GVL) como procedimiento de cirugía bariátrica.Material y métodos: realizamos un estudio observacional prospectivo de pacientes sometidos a GVL y con un periodo de seguimiento mínimo de 1 año.

Postoperative pain after laparoscopic sleeve gastrectomy: comparison of three analgesic schemes (isolated intravenous analgesia, epidural analgesia associated with intravenous analgesia and port-sites infiltration with bupivacaine associated with intravenous analgesia).

Introduction: Although bariatric surgery is actually mainly performed laparoscopically, analgesic optimization continues being essential to reduce complications and to improve the patients' comfort. The aim of this study is to evaluate the postoperative pain after analgesia iv exclusively, or associated with epidural analgesia or port-sites infiltration with bupivacaine.

Patients And Methods: A prospective randomized study of patients undergoing laparoscopic sleeve gastrectomy between 2012 and 2014 was performed.

Effect of Peritoneal Lavage with Clindamycin-Gentamicin Solution on Post-Operative Pain and Analytic Acute-Phase Reactants after Laparoscopic Sleeve Gastrectomy.

Background: Peritoneal lavage has been proposed to remove bacterial contamination and other materials promoting bacterial proliferation and pro-inflammatory cytokines that may enhance local inflammation. The aims of this study were to evaluate the effects of peritoneal lavage with physiologic saline or an antibiotic solution (clindamycin-gentamicin) on post-operative pain and analytic acute-phase reactants and to determine the microbiologic impact of both irrigations on peritoneal contamination in patients undergoing laparoscopic sleeve gastrectomy (LSG) as a bariatric procedure.

Methods: The patients were randomized into two groups: Those undergoing an intra-abdominal lavage with physiologic saline (Group 1; n = 40) and those undergoing a similar lavage with a gentamicin-clindamycin solution (Group 2; n = 40).

Maintenance of Multivitamin Supplements After Sleeve Gastrectomy.

Introduction: After all bariatric procedures, multivitamin supplements are uniformly prescribed to minimize eventual deficiencies. These supplements are usually maintained long time, even during the whole life after malabsorptive techniques, while these are maintained at least during 1 year after restrictive procedures. Given that sleeve gastrectomy does not alter intestinal absorption, the supplements are possibly unnecessary, once the patient can take an adequate diet.

Preoperative Regular Diet of 900 kcal/day vs Balanced Energy High-Protein Formula vs Immunonutrition Formula: Effect on Preoperative Weight Loss and Postoperative Pain, Complications and Analytical Acute Phase Reactants After Laparoscopic Sleeve Gastrectomy.

Background: Between 2 and 8 weeks before surgery, most bariatric surgery groups establish strict dietary treatments with a total caloric intake of less than 1,000 kcal/day in order to maximize weight loss during this period of time.

Methods: A prospective randomized clinical trial of all the patients undergoing laparoscopic sleeve gastrectomy (LSG) was performed. Patients were randomly assigned into 3 groups: those patients receiving a preoperative regular diet of 900 kcal/day (group 1), those receiving a preoperative balanced energy high-protein formula (group 2) and those receiving preoperative Immunonutrition (group 3).

Effect of Lavage with Gentamicin vs. Clindamycin vs. Physiologic Saline on Drainage Discharge of the Axillary Surgical Bed after Lymph Node Dissection.

Background: To date, without placement of a drain, seroma formation cannot be avoided after axillary lymph node dissection (ALND). The purpose of this study was to evaluate the effect on drainage volume of pre-closure axillary lavage with physiologic saline, gentamicin solution, or clindamycin solution.

Methods: A randomized study was performed between January 2013 and October 2014.

Long-term Weight and Metabolic Effects of Laparoscopic Sleeve Gastrectomy Calibrated with a 50-Fr Bougie.

Background: Most surgeons calibrate the sleeve with 32-French (Fr) to 40-Fr bougies hypothesizing that smaller bougies are associated with greater weight loss and long-term lower weight regain. The purpose of this study was to assess the weight loss results and resolution of comorbidities 5 years after laparoscopic sleeve gastrectomy (LSG).

Methods: A prospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy calibrated with a 50-Fr bougie between October 2007 and February 2010 was performed.