Overview
Investigation of underlying metabolic mechanisms and impact on the two surgical procedures on inflammatory factors.
Description
The aim of this project is to investigate underlying metabolic mechanisms in a subpopulation of patients of the SLIM trial, where a laparoscopic proximal Roux-en-Y gastric bypass (LRYGB) with a longer biliopancreatic limb (BPL) is compared to a standard LRYGB. For this purpose, the aim is to examine differences in number of intestinal enteroendocrine cells, subpopulations of intestinal macrophages, and gene expression or DNA-methylation in tissue samples obtained by colonoscopy from the ileum and transverse colon. In addition, gut microbiota (from colon biopsy and fecal samples), meal-stimulated gut hormone profiles, glycemic control, and metabolite patterns (metabolomics; in blood, urine, stool and breath) including plasma bile acid concentrations preoperatively and 6 months post-surgery will be examined. Body composition (fat mass and lean mass) will be measured by means of BIA (bioimpedance analysis; Biacorpus).
Eligibility
Inclusion Criteria:
- 2 x 25 patients with morbid obestiy (BMI of 35 kg/m2 or higher) who comply with the regulatory rules for bariatric surgery in Switzerland (SMOB guidelines) and participate in the SLIM Trial
- 15 healthy lean controls
Exclusion Criteria:
- general contraindications to kind of surgery
- known or suspected non-compliance
- inability to follow the procedures of the study, e.g. due to language problems, psychological disorders etc. of the participant
- participation in another interventional study
- BMI > 60 kg/m2
- height < 145 cm
- CL length of < 180 cm as measured intraoperatively
- ASA physical status classification > III
- inflammatory bowel disease
- diabetes
- intake of corticosteroids, anti-inflammatory/ immunosuppressive drugs potentially altering immune cells
- clinical signs of current infection
- known anemia (e.g. hemoglobin < 110g/L for males, < 100g/L for females)
- known neutropenia (e.g. leucocyte count < 1.5 x 10^9/L or ANC < 0.5 x 10^9/L)
- known immunodeficiency, e.g. HIV
- known vasculitis, collagenosis
- known adrenal insufficiency and/or substitution with glucocorticoids
- risky daily alcohol consumption (> 24g/d for males, > 12g/d for females)
- drug abuse
- known liver cirrhosis Child B or C
- known uncontrolled congestive heart failure
- known uncontrolled malignant disease
- currently pregnant or breastfeeding