Abstract: Objective:To investigate the effects of sleeve gastrectomy (SG) plus sidetoside jejunoileal anastomosis on weight loss and metabolic control in a rat model of type 2 diabetes mellitus.
Methods:Thirty male Zucker diabetic fatty (ZDF) rats aged 7 weeks were divided into the JISG group, the SG group and the control group based on the random number table. Ten rats in the JISG group received SG plus sidetoside jejunoileal anastomosis, 10 rats in the SG group receive SG and 10 rats in the control group received sham surgery. Body weight and fasting blood glucose were detected at preoperative day 1 and at preoperative week 1, 2, 4, 6, 8, 10, 12. Fasting plasma insulin, ghrelin and glucagonlike peptide 1 (GLP1) were detected at preoperative day 1 and postoperative week 6 and 12. The measurement data with normal distribution were presented as ±s. The comparison between groups was analyzed using the LSDt test and comparisons among many groups were done using ANOVA. The repeated measurement data were analyzed by the repeated measures ANOVA.
Results:The body weight of rats in the JISG, SG and control group were changed from (297.2±2.1)g, (302.0±1.8)g and (296.0±2.1)g before operation to (242.7±13.2)g, (380.4±16.5)g and (440.1±15.1)g at postoperative week 12, there was an upward trend between the control group and the SG group and a steady trend in the JISG group, with a significant difference among the 3 groups (F=42.5, P<0.05). The levels of blood glucose in JISG, SG and control group before operation were (11.7±1.7)mmol/L, (11.4±3.1)mmol/L and (12.4±1.5)mmol/L, with no significant difference among the 3 groups (F=18.2, P>0.05). The levels of blood glucose in JISG group, the SG group and the control group were changed from (5.7±0.7)mmol/L, (6.2±1.6)mmol/L and (7.4±0.5)mmol/L at postoperative week 1 to (6.9±2.5)mmol/L, (13.9±2.8)mmol/L and (22.2± 2.9)mmol/L at postoperative week 12, showing a slow upward trend between the JISG group and the SG group, with significant differences among the 3 groups (F=18.3, P<0.05). The levels of fasting insulin in the JISG group, the SG group and the control group were changed from (5.2±1.1)mU/L, (5.1±1.2)mU/L and (5.3± 0.8)mU/L before operation to (4.5±1.3)mU/L, (5.6±1.4)mU/L and (7.5±1.6)mU/L at postoperative week 12, showing an upward trend between the control group and the SG group and a descending trend in the JISG group, with a significant difference (F=7.8, P<0.05). The levels of insulin in the JISG group was lower than that in the SG group (t=6.7, P<0.05). The levels of ghrelin in the JISG group, the SG group and the control group were changed from (223±35)ng/L, (232±36)ng/L, (238±31)ng/L before operation to (168±20)ng/L, (175±21)ng/L, (223±12)ng/L at postoperative week 12, showing a descending trend between the JISG group and the SG group, with a significant difference (F=12.3, P<0.05). There was no significant difference in the levels of ghrelin between the JISG group and the SG group (t=0.4, P>0.05). The levels of GLP1 in the JISG group, the SG group and the control group were changed from (1.69±0.12)pmol/L, (1.71±0.19)pmol/L and (1.69±0.10)pmol/L before operation to (2.22±0.11)pmol/L, (1.81±0.12)pmol/L and (1.61±0.10)pmol/L at postoperative week 12. There was a significant difference and an upward trend in the levels of postoperative GLP1 among the JISG, SG and control group (F=5.5, P<0.05). The levels of GLP1 in the JISG group were significantly higher than those in the SG group (t=2.4, P<0.05).
Conclusion:SG plus sidetoside jejunoileal anastomosis on weight loss and metabolic control has better efficacies compared with SG.