Daniel P Andersson1, Anders Thorell2, Patrik Löfgren1, Mikael Wirén3, Eva Toft4, Veronica Qvisth4, Ulf Riserus5, Lars Berglund6, Erik Näslund7, Sven Bringman8, Anders Thörne8, Peter Arner1, Johan Hoffstedt9. 1. Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden. 2. Karolinska Institutet, Department of Surgery, Ersta Hospital, 116 91 Stockholm, Sweden. 3. Department of Clinical Science, Intervention and Technology (CLINTEC) (H9), Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden. 4. Department of Medicine, Karolinska Institutet, Ersta Hospital, 116 91 Stockholm, Sweden. 5. Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism Uppsala University, Uppsala Science Park, 751 85 Uppsala, Sweden. 6. Uppsala Clinical Research Center, Uppsala University, Uppsala Science Park, 751 85 Uppsala, Sweden. 7. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden. 8. CLINTEC and Department of Surgery, Södertälje Hospital, 152 86 Södertälje, Sweden. 9. Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden. Electronic address: johan.hoffstedt@ki.se.
Abstract
BACKGROUND & AIMS: Accumulation of visceral adipose tissue is associated with insulin resistance and cardio-vascular disease. The aim of this study was to elucidate whether removal of a large amount of visceral fat by omentectomy in conjunction with Roux en-Y gastric bypass operation (RYGB) results in enhanced improvement of insulin sensitivity compared to gastric bypass surgery alone. METHODS:Eighty-one obese women scheduled for RYGB were included in the study. They were randomized to RYGB or RYGB in conjunction with omentectomy. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp before operation and sixty-two women were also reexamined 2 years post-operatively. The primary outcome measure was insulin sensitivity and secondary outcome measures included cardio-metabolic risk factors. RESULTS: Two-year weight loss was profound but unaffected by omentectomy. Before intervention, there were no clinical or metabolic differences between the two groups. The difference in primary outcome measure, insulin sensitivity, was not significant between the non-omentectomy (6.7 ± 1.6 mg/kg body weight/minute) and omentectomy groups (6.6 ± 1.5 mg/kg body weight/minute) after 2 years. Nor did any of the cardio-metabolic risk factors that were secondary outcome measures differ significantly. CONCLUSION: Addition of omentectomy to gastric bypass operation does not give an incremental effect on long term insulin sensitivity or cardio-metabolic risk factors. The clinical usefulness of omentectomy in addition to gastric bypass operation is highly questionable. CLINICAL TRIAL REGISTRATION NUMBER: NCT01785134.
RCT Entities:
BACKGROUND & AIMS: Accumulation of visceral adipose tissue is associated with insulin resistance and cardio-vascular disease. The aim of this study was to elucidate whether removal of a large amount of visceral fat by omentectomy in conjunction with Roux en-Y gastric bypass operation (RYGB) results in enhanced improvement of insulin sensitivity compared to gastric bypass surgery alone. METHODS: Eighty-one obesewomen scheduled for RYGB were included in the study. They were randomized to RYGB or RYGB in conjunction with omentectomy. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp before operation and sixty-two women were also reexamined 2 years post-operatively. The primary outcome measure was insulin sensitivity and secondary outcome measures included cardio-metabolic risk factors. RESULTS: Two-year weight loss was profound but unaffected by omentectomy. Before intervention, there were no clinical or metabolic differences between the two groups. The difference in primary outcome measure, insulin sensitivity, was not significant between the non-omentectomy (6.7 ± 1.6 mg/kg body weight/minute) and omentectomy groups (6.6 ± 1.5 mg/kg body weight/minute) after 2 years. Nor did any of the cardio-metabolic risk factors that were secondary outcome measures differ significantly. CONCLUSION: Addition of omentectomy to gastric bypass operation does not give an incremental effect on long term insulin sensitivity or cardio-metabolic risk factors. The clinical usefulness of omentectomy in addition to gastric bypass operation is highly questionable. CLINICAL TRIAL REGISTRATION NUMBER: NCT01785134.
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