Assessment of different bariatric surgeries in the treatment of obesity and insulin resistance in mice.
Assessment of different bariatric surgeries in the treatment of obesity and insulin resistance in mice.
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DOI：
10.1097/sla.0000000000000319
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发表时间：
2014
影响因子：
9
通讯作者：
A. Iannelli;A. Schneck;J. Gugenheim
中科院分区：
文献类型：
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作者：
A. Iannelli;A. Schneck;J. Gugenheim
致编者：在2011年7月出版的《外科年鉴》上，Yin等人1报道了不同减肥手术治疗小鼠肥胖和胰岛素抵抗的结果。作者发现，套筒胃切除术和改良的Roux-en-Y胃旁路术（mRYGBP）是可靠的限制性和胃肠旁路减肥模型。关于这两种手术对超重、肝脂肪变性、葡萄糖耐量改变和胰岛活力的疗效，他们发现mRYGBP比袖式胃切除术提供更好和更持久的效果。事实上，接受袖式胃切除术的动物在4至8周内逐渐恢复了体重。我们祝贺作者的杰出工作；然而，我们同时感到，他们的报告提出了一些需要进一步讨论的问题。首先，在套筒胃切除术的情况下，只切除了前胃的90%这一事实与整个胃底被切除的说法相矛盾。根据我们的经验，10%的残余前胃在手术后4 - 8周不可避免地扩张，导致作者观察到的体重增加（图3A）。我们在准备小鼠的袖式胃切除模型时也遇到了同样的问题。当不小心完全切除前胃时，动物的体重逐渐增加，同时每日摄入的食物量也增加。在术后4至8周的尸检中，我们发现残余前胃扩张。这促使了对手术技术的修改，包括完整和仔细地切除前胃以及切除腺胃。作者表示，他们在袖胃切除术时切除了70%至80%的胃，并提供了有趣的胃肠道成像数据，显示手术后7至10天胃体积缩小。然而，没有集体数据支持
To the Editor: I n the July 2011 issue of Annals of Surgery, Yin et al1 reported the results of different bariatric surgical procedures in the treatment of obesity and insulin resistance in mice. The authors found that the sleeve gastrectomy and a modified Roux-en-Y gastric bypass (mRYGBP), in which the whole stomach is bypassed, represent reliable restrictive and gastrointestinal bypass bariatric models. With respect to the efficacy of these 2 procedures against excess weight, liver steatosis, altered glucose tolerance, and pancreatic islet viability, they found that the mRYGBP provides better and more durable results than sleeve gastrectomy. Indeed, animals undergoing sleeve gastrectomy progressively regained the lost weight between 4 and 8 weeks. We congratulate the authors for their remarkable work; however, we feel, at the same time, that their report raises a few issues that need further discussion. First, in the case of the sleeve gastrectomy, the fact that only 90% of the forestomach is removed conflicts with the statement that the whole gastric fundus is removed. In our experience, 10% of the residual forestomach inevitably dilates between 4 and 8 weeks after surgery, leading to weight gain as observed by the authors (Fig. 3A). We encountered the same problem during the preparation of a sleeve gastrectomy model in the mouse. When the forestomach was not carefully and completely resected, animals showed progressive weight gain that was paralleled by an increase in the daily quantity of ingested food. At necropsy between 4 and 8 weeks after surgery, we found a dilatation of the remnant forestomach. This prompted a modification of the surgical technique that includes the complete and careful removal of the forestomach along with the resection of the glandular stomach. The authors state that they remove 70% to 80% of the stomach at the time of sleeve gastrectomy and provide interesting imaging data of the gastrointestinal tract showing the reduction of the stomach volume at 7 to 10 days after surgery. However, no collective data are pro-