Basic Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2016; 22(32): 7332-7341
Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7332
Effects of sleeve gastrectomy with jejuno-jejunal or jejuno-ileal loop on glycolipid metabolism in diabetic rats
Ming-Wei Zhong, Shao-Zhuang Liu, Guang-Yong Zhang, Xiang Zhang, San-Yuan Hu
Ming-Wei Zhong, Shao-Zhuang Liu, Guang-Yong Zhang, Xiang Zhang, San-Yuan Hu, Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Zhong MW performed the majority of experiments, analyzed the data and prepared the manuscript; Liu SZ, Zhang GY and Hu SY designed the experiments and revised the manuscript; Zhang X prepared figures and revised the manuscript; all authors have approved the final version to be published.
Supported by the National Natural Science Foundation of China, No. 81471019 (to Hu SY), No. 81300286 (to Liu SZ), and No. 81370496 (to Zhang GY); and the Taishan Scholar Foundation (to Hu SY).
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Qilu Hospital of Shandong University, Jinan, China.
Institutional animal care and use committee statement: All procedures involving animals were reviewed and approved by the Ethics Committee on Animal Experiment of Shandong University Qilu Hospital (IACUC protocol number: DWLL-2015-014).
Conflict-of-interest statement: All authors declared no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. San-Yuan Hu, Professor, Department of General Surgery, Qilu Hospital of Shandong University, No. 107, Wenhua Xi Road, Jinan 250012, Shandong Province, China. husanyuan1962@hotmail.com
Telephone: +86-531-82166351 Fax: +86-531-82166351
Received: June 17, 2016
Peer-review started: June 17, 2016
First decision: July 12, 2016
Revised: July 26, 2016
Accepted: August 8, 2016
Article in press: August 8, 2016
Published online: August 28, 2016
Processing time: 67 Days and 17.6 Hours
Abstract
AIM

To explore the effect of sleeve gastrectomy (SG) with jejuno-jejunal or jejuno-ileal loop on glycolipid metabolism in diabetic rats.

METHODS

Diabetic rats, which were induced by high-fat diet (HFD), nicotinamide and low-dose streptozotocin, underwent sham operations, SG, SG with jejuno-ileal loop (SG-JI) and SG with jejuno-jejunal loop (SG-JJ) followed by postoperative HFD. Then, at the time points of baseline and 2, 12 and 24 wk postoperatively, we determined and compared several variables, including the area under the curve for the results of oral glucose tolerance test (AUCOGTT), serum levels of triglyceride, cholesterol and ghrelin in fasting state, homeostasis model assessment of insulin resistance (HOMA-IR), body weight, calorie intake, glucagon-like peptide (GLP)-1 and insulin secretions after glucose gavage at dose of 1 g/kg.

RESULTS

At 2 wk postoperatively, rats that underwent SG, SG-JJ and SG-JI, compared with sham-operated (SHAM) rats, demonstrated lower body weight, calorie intake and ghrelin (P < 0.05 vs SHAM), enhanced secretion of insulin and GLP-1 after glucose gavage (P < 0.05 vs SHAM), improved AUCOGTT, HOMA-IR, fasting serum triglyceride and cholesterol (AUCOGTT: 1616.9 ± 83.2, 837.4 ± 83.7, 874.9 ± 97.2 and 812.6 ± 81.9, P < 0.05 vs SHAM; HOMA-IR: 4.31 ± 0.54, 2.94 ± 0.22, 3.17 ± 0.37 and 3.41 ± 0.22, P < 0.05 vs SHAM; Triglyceride: 2.35 ± 0.17, 1.87 ± 0.23, 1.98 ± 0.30 and 2.04 ± 0.21 mmol/L, P < 0.05 vs SHAM; Cholesterol: 1.84 ± 0.21, 1.53 ± 0.20, 1.52 ± 0.20 and 1.46 ± 0.23 mmol/L). At 12 wk postoperatively, rats receiving SG-JJ and SG-JI had lower body weight, reduced levels of triglyceride and cholesterol and elevated level of GLP-1 compared to those receiving SG (P < 0.05 vs SG). At 24 wk after surgery, compared with SG, the advantage of SG-JJ and SG-JI for glucolipid metabolism was still evident (P < 0.05 vs SG). SG-JI had a better performance in lipid metabolism and GLP-1 secretion of rats than did SG-JJ.

CONCLUSION

SG combined with intestinal loop induces better glycolipid metabolism than simple SG, with the lipid metabolism being more improved with SG-JI compared to SG-JJ.

Keywords: Sleeve gastrectomy; Jejuno-jejunal loop; Jejuno-ileal loop; Diabetes; Glucolipid metabolism

Core tip: To improve the effect of sleeve gastrectomy (SG), surgeons sporadically use different intestinal loops; however, these innovative surgical procedures lack a theoretical foundation. We explored the effect of SG with jejuno-jejunal loop (SG-JJ) or jejuno-ileal loop (SG-JI) on glycolipid metabolism in diabetic rats. We discovered that SG-JJ and SG-JI were superior to SG in improving glycolipid metabolism. Compared with SG-JJ, the improvement in lipid metabolism after SG-JI was more apparent. These findings might help surgeons select procedures for individual patients.