CSOWM Metabolic and Bariatric Surgery
Bariatric & Metabolic Surgery Procedures - ANS -Group of surgical procedures that impact the
physiological regulation of body weight and improve morbidity and mortality rates
Purely restrictive weight loss surgery - ANS -Laparoscopic adjustable gastric band (LAGB)
Weight loss surgeries that are combination (Malabsorptive & restrictive) -Gastric manipulation,
causing some restriction & neural/hormonal) - ANS -Sleeve gastrectomy (SG) & Roux-en-Y
Gastric bypass (RYGBP)
Bypass surgery that is combination of malabsorptive/restriction and of both macronutrients &
micronutrients - ANS -Biliopancreatic Diversion (BPD/DS)
Cholecystokinin (CCK) - ANS -Hormone secreted by the duodenum; suppresses appetite and
levels decrease during dieting and weight loss
Glucose-dependent insulinotropic polypeptide (GIP) - ANS -Hormone secreted by the
duodenum and jejunum; normal function for energy storage; Levels increase during dieting and
weight loss
Ghrelin - ANS -Hormone from the gastric fundus; Functions to stimulate appetite for high fat,
high sugar foods; Levels increase during diet and weight loss
Glucagon-like peptide 1 (GLP-1) - ANS -Hormone secreted in the ileum of the small I;
Functions to suppress appetite and increase satiety; Levels have a decreased functionality with
diet and weight loss
Peptide YY (PYY) - ANS -Hormone secreted in the distal small I; Suppresses appetite; There is
a decrease in this hormone found in obese persons with weight loss
Insulin - ANS -Hormone secreted from the beta cells of the pancreas; Functions to regulate
energy balance and signal satiety in the brain; There is resistance to this hormone in obese
persons; Levels decrease after dieting
Leptin - ANS -Hormone secreted from the adipocytes; Regulates energy balance & suppresses
appetite; Levels decrease during weight loss
Metabolic and bariatric surgery changes to gut hormones? - ANS -The opposite of restrictive
dieting
, RYGB + SG changes in gut hormones - ANS -They don't see a decrease in RMR; decrease in
appetite and hunger; increase in satiety; decrease in ghrelin, increase in GLP-1, PYY, CCK, and
amylin
Amylin - ANS -co-secreted with insulin by beta cells in response to nutrient stimuli. Delays
nutrient uptake and suppresses glucagon secretion after meals. Satiating effect.
LAGB + Hunger hormones - ANS -Studies show an increase in ghrelin 6-12 months s/p
procedure; may be why decrease in wt loss with this Adjustments and food choices essential for
wt loss and maintenance
LAGB - Too tight fitting - ANS -Dysphagia, reflux/cough, regurgitation, maladaptive eating
LAGB- Goal of fill (Saline fill) - ANS -Satiety, small meals satisfying
LAGB- Needing a fill (saline fill) - ANS -Hungry, big meals, looking for food
LAGB downside - ANS -Soft meals still go in easy, which can still allow for increase in calorie
intakes to weight gain (Ex: increase in refined, icecream, etc)
LAGB history - ANS -First approved in 2001 in US; Lost <25-30% of excess weight in up to
40% of patients; Many complications found: Band erosion, infection, intolerance to band
symptoms, slippage of band, difficulty swallowing, GERD, Pouch dilation, port infection (Most
now having removed than put in)
These two procedures impact the physiological regulation of body weight with being restrictive
mainly in the 1st 3 post-op months - ANS -RYGB + SG
The largest endocrine organ in the body - ANS -The GI tract
Sleeve Gastrectomy procedure - ANS -Laparoscopically (~6 small inserts) ; ~80% of the gastric
fundus removed; Food will empty into the duodenum normally through gastric sphincter; ghrelin
still produced in GI
The primary place where ghrelin is produced - ANS -Gastric fundus
Advantages of SG - ANS -Performed more quickly, decrease in complications and micronutrient
deficiencies; decreased risk of long term complications (Intestinal obstructions, ulcers, dumping
syndromes, severe hypoglycemia, other dysfunctional glycemic syndromes); Allows access to
both biliary and pancreatic ducts; Can be revised or converted to a variety of other procedures
(Bypass or BPD)
Disadvantages of SG - ANS -May exacerbate GERD; contraindicated in pts with severe GERD,
lower esophageal-sphincter incompetence; Barrett's esophagus; There is a lack in long term
Bariatric & Metabolic Surgery Procedures - ANS -Group of surgical procedures that impact the
physiological regulation of body weight and improve morbidity and mortality rates
Purely restrictive weight loss surgery - ANS -Laparoscopic adjustable gastric band (LAGB)
Weight loss surgeries that are combination (Malabsorptive & restrictive) -Gastric manipulation,
causing some restriction & neural/hormonal) - ANS -Sleeve gastrectomy (SG) & Roux-en-Y
Gastric bypass (RYGBP)
Bypass surgery that is combination of malabsorptive/restriction and of both macronutrients &
micronutrients - ANS -Biliopancreatic Diversion (BPD/DS)
Cholecystokinin (CCK) - ANS -Hormone secreted by the duodenum; suppresses appetite and
levels decrease during dieting and weight loss
Glucose-dependent insulinotropic polypeptide (GIP) - ANS -Hormone secreted by the
duodenum and jejunum; normal function for energy storage; Levels increase during dieting and
weight loss
Ghrelin - ANS -Hormone from the gastric fundus; Functions to stimulate appetite for high fat,
high sugar foods; Levels increase during diet and weight loss
Glucagon-like peptide 1 (GLP-1) - ANS -Hormone secreted in the ileum of the small I;
Functions to suppress appetite and increase satiety; Levels have a decreased functionality with
diet and weight loss
Peptide YY (PYY) - ANS -Hormone secreted in the distal small I; Suppresses appetite; There is
a decrease in this hormone found in obese persons with weight loss
Insulin - ANS -Hormone secreted from the beta cells of the pancreas; Functions to regulate
energy balance and signal satiety in the brain; There is resistance to this hormone in obese
persons; Levels decrease after dieting
Leptin - ANS -Hormone secreted from the adipocytes; Regulates energy balance & suppresses
appetite; Levels decrease during weight loss
Metabolic and bariatric surgery changes to gut hormones? - ANS -The opposite of restrictive
dieting
, RYGB + SG changes in gut hormones - ANS -They don't see a decrease in RMR; decrease in
appetite and hunger; increase in satiety; decrease in ghrelin, increase in GLP-1, PYY, CCK, and
amylin
Amylin - ANS -co-secreted with insulin by beta cells in response to nutrient stimuli. Delays
nutrient uptake and suppresses glucagon secretion after meals. Satiating effect.
LAGB + Hunger hormones - ANS -Studies show an increase in ghrelin 6-12 months s/p
procedure; may be why decrease in wt loss with this Adjustments and food choices essential for
wt loss and maintenance
LAGB - Too tight fitting - ANS -Dysphagia, reflux/cough, regurgitation, maladaptive eating
LAGB- Goal of fill (Saline fill) - ANS -Satiety, small meals satisfying
LAGB- Needing a fill (saline fill) - ANS -Hungry, big meals, looking for food
LAGB downside - ANS -Soft meals still go in easy, which can still allow for increase in calorie
intakes to weight gain (Ex: increase in refined, icecream, etc)
LAGB history - ANS -First approved in 2001 in US; Lost <25-30% of excess weight in up to
40% of patients; Many complications found: Band erosion, infection, intolerance to band
symptoms, slippage of band, difficulty swallowing, GERD, Pouch dilation, port infection (Most
now having removed than put in)
These two procedures impact the physiological regulation of body weight with being restrictive
mainly in the 1st 3 post-op months - ANS -RYGB + SG
The largest endocrine organ in the body - ANS -The GI tract
Sleeve Gastrectomy procedure - ANS -Laparoscopically (~6 small inserts) ; ~80% of the gastric
fundus removed; Food will empty into the duodenum normally through gastric sphincter; ghrelin
still produced in GI
The primary place where ghrelin is produced - ANS -Gastric fundus
Advantages of SG - ANS -Performed more quickly, decrease in complications and micronutrient
deficiencies; decreased risk of long term complications (Intestinal obstructions, ulcers, dumping
syndromes, severe hypoglycemia, other dysfunctional glycemic syndromes); Allows access to
both biliary and pancreatic ducts; Can be revised or converted to a variety of other procedures
(Bypass or BPD)
Disadvantages of SG - ANS -May exacerbate GERD; contraindicated in pts with severe GERD,
lower esophageal-sphincter incompetence; Barrett's esophagus; There is a lack in long term
