Journal of Obesity & Weight Loss Therapy
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Ghrelin is a gastrointestinal peptide hormone (a 28 ?amino acid peptide) produced primarily by X/A cells in
the oxyntic glands of the stomach fundus and cells lining the duodenum cavern. It suppresses insulin secretion and action and
commands a significant role in regulating food intake. The aim of the present study was to show that modified laparoscopic sleeve
gastrectomy(MLSG), in which a significant part of the gastric fundus and body of the stomach is removed up to 1 inch from the
pylorus vein, may contribute to decreasing circulating ghrelin levels.
A study population consisting of 150 individuals was monitored after undergoing a MLSG, with individuals chosen
based on a documented history of diabetes mellitus type 2 and metabolic syndrome, clinical results determining a body mass
index (BMI) of 35 to 60 kg/m2, peptide C level greater than 1, negative anti-GAD, negative anti-insulin, and confirmed stability
of drug/insulin treatment and glycosylated hemoglobin greater than 6.5% for at least 24 and 3 months, respectively, before
Twenty-four months after surgery, 150 patients (86.6%) presented with normal glycemic levels between 77 and 99 mg/
dL. All patients improved average serum insulin levels by 9 mU/L and average glycosylated hemoglobin levels by 5.1% (normal
range, 4%? 6%). All patients tested negative for Helicobacter pylori and stopped using insulin, with 3 patients prescribed twice-
daily use of an oral hypoglycemiant. In 14% of cases, patients experienced partial hair loss with low serum zinc levels and were
prescribed oral zinc reposition and topical hair stimulants. The average weight loss recorded was 44.6% for patients with a BMI
less than 45 kg/m2 and 58% for patients with a BMI greater than 50 kg/m2.
The MLSG is a safe procedure with a low morbidity rate (2.7%) (4 cases of fistula and 2 of bleeding) and no surgical
mortality. This surgery can promote control of diabetes mellitus type 2 and aid the treatment of exogenous overweight and
morbidly obese individuals. The results of this study show that only through resection of the ghrelin-producing gastric area can
most obesity cases and diabetes type II conditions be reverted to nonobese and controlled diabetes
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