The intraabdominal fat is associated with insulin resistance, a condition that is in the basis of diabetes, metabolic syndrome and some cardiovascular diseases. It is not clear whether it is the origin of it or a surrogate marker only. We intend to compare the effects of bariatric surgery with versus without omentectomy in morbidly obese people intended to go through bariatric surgery, accessing insulin sensitivity by metabolic tests. If the visceral fat is causative of insulin resistance, its surgical removal (omentectomy) might lead to improvement of insulin action, as seen in animal studies and in one study with morbidly obese human volunteers.
In order to verify a potential additional benefit of omentectomy combined to Roux-en-Y silastic ring gastric bypass, insulin sensitivity will be studied by the gold-standard test, euglycemic-hyperinsulinemic clamp, since early postoperative follow-up (before significant weight variation), compared to a control group of bariatric surgery (same technique) alone. The variables will be analyzed in the post surgical evolution for correlation to metabolic changes: adiposity-related hormones and cytokines; lipid profile and other cardiovascular risk factors; molecular expression of biopsied subcutaneous adipocytes in vitro; anthropometrics; ultrasonography of abdominal subcutaneous and intra-abdominal fat depots and carotid intima-media thickness (preclinical atherosclerosis evaluation).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Roux-en-Y Gastric Bypass plus total omentectomy
Roux-en-Y Gastric Bypass without omentectomy
LIMED (Laboratory of Investigation of Metabolism and Diabetes)/GASTROCENTRO/Univeristy of Campinas (UNICAMP)
Campinas, São Paulo, Brazil
Increase of insulin sensitivity as measured by euglycemic-hyperinsulinemic clamp.
Time frame: one month, six months and one year.
increase of insulin secretion as measured by intravenous glucose tolerance test
Time frame: one month, six months, one year
regression of carotid intima-media thickness
Time frame: one month, six months, one year
Improvement of the insulin cell signalling in the subcutaneous adipose tissue.
Time frame: one month, six months
increase of adipocytokines linked to greater insulin sensitivity and decrease of others linked to insulin resistance
Time frame: one month, six months, one year
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