Discussion
obesity, hyperglycemia, T2DM, postoperative decrease in fasting ghrelin, weight loss
OBESITY, HYPERGLYCEMIA, REMISSION, INSULIN RESISTANCE, INSULIN SENSITIVITY
In the present study, LRYGBP+FR did not elicit enhanced glycemic control and, interestingly, it was not related with a significant postoperative decrease in fasting ghrelin levels, compared to LRYGBP. Glycemic control in both types of surgery was attributed to successful weight loss and to remarkably increased postprandial secretion of GLP-1 and PYY. The first phase of insulin secretion and the second phase were exceptionally improved, demonstrating a progressive recovery of b-cell function and increased insulin sensitivity respectively. A noteworthy finding was the statistically significant decrease in BMI at 12 months following LRYGBP+FR. Nevertheless, this finding was not accompanied by significant changes in the studied neuroendocrine factors.Ghrelin, the hormone of the gastric fundus, is an attractive target for obesity and T2DM, since it promotes insulin resistance and hyperglycemia [In this recent study, 95% of patients showed complete T2DM remission, which was attributed to different mechanisms according to the literature [According to the hindgut theory, LRYGBP provokes increased GLP-1 and PYY secretion, through the transfer of nutrients to the distal intestine [From studies so far, it is known that PYY is not only an anorexigenic hormone, related to weight loss, but also is involved in the improvement and survival of b-cells [Another important finding of this RCT was the statistically significant reduction in BMI after LRYGBP+FR, compared to LRYGBP. Chronaiou et al. with an RCT comparing these procedures did not show any changes in BMI, despite lower ghrelin levels in the fundus resection group [Even though the current study led to some valuable conclusions, there are a number of limitations that should be taken into account. First and foremost, the small number of participants might be responsible for the non-significant differences by creating variation in the measured values. GI hormones were assayed after the collection of all samples; hence, the variability was difficult to predict in order to increase the number of studied patients during the trial. Lack of pilot data regarding GI hormones levels further contributed to the variability of the results. Therefore, the small sample size may lead to arbitrary conclusions and these results have to be cautiously interpreted. Although our study showed a significant difference in BMI after LRYGBP+FR, the mean BMI at baseline was marginally not significant in the fundus resection group (