Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

A pilot study of long-term effects of a novel obesity treatment: omentectomy in connection with adjustable gastric banding

International Journal of Obesity volume 26, pages 193–199 (2002)Cite this article

Abstract

AIM: To determine whether visceral fat reduction in connection with bariatric surgery could improve weight loss and metabolic profile of obese subjects.

PATIENTS AND METHODS: In a one-center, randomized and controlled pilot trial we assigned 50 subjects with severe obesity (body mass index >35 kg/m2) to either adjustable gastric banding (AGB) alone (11 men and 14 women), or AGB plus surgical removal of the total greater omentum (11 men and 14 women). The patients were followed at regular intervals for 2 y and examined at 0 and 24 months with respect to body composition and metabolic profile.

RESULTS: No significant differences between control and omentectomized patients were observed at baseline. The removed greater omentum constituted 0.8±0.4% (mean±s.d.) of total body fat. At 2 y follow-up there was an expected decrease in body weight and an improvement in metabolic profile in both groups. Although omentectomized subjects tended to lose more weight than control subjects the difference was not statistically significant and changes in waist-to-hip ratio and saggital diameter did not differ between groups. However, the improvements in oral glucose tolerance, insulin sensitivity and fasting plasma glucose and insulin were 2–3 times greater in omentectomized as compared to control subjects (P from 0.009 to 0.04), which was statistically independent of the loss in body mass index. No differences in blood lipids between the groups were recorded. No adverse effects related to omentectomy were observed.

CONCLUSIONS: Omentectomy, when performed together with AGB, has significant positive and long-term effects on the glucose and insulin metabolic profiles in obese subjects.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Modkad AH, Serdula MK, Dietz WH, Boeman BA, Marks JS, Koplan JP . The spread of the obesity epidemic in the United States, 1991–1998 JAMA 1999 282: 1519–1522.

    Article  Google Scholar 

  2. Björntorp P . ‘Portal’ adipose tissue as a generator of risk factors for cardiovascular disease and diabetes Atherosclerosis 1990 10: 493–496.

    Google Scholar 

  3. Kissebah AH, Krakower GR . Regional adiposity and morbidity Physiol Rev 1994 74: 761–811.

    Article  CAS  Google Scholar 

  4. Lemieux S, Després JP . Metabolic complications of visceral obesity: contribution of the aetiology of type 2 diabetes and implications for prevention and treatment Diabetes Metab 1994 20: 375–393.

    CAS  Google Scholar 

  5. Fujioka S, Matsuzawa Y, Tokunaga K et al. Improvement of glucose and lipid metabolism associated with selective reduction of intra-abdominal visceral fat in premenopausal women with visceral fat obesity Int J Obes 1990 15: 853–859.

    Google Scholar 

  6. Riches FM, Watts GF, Hua J, Stewart GR, Naoumova RP, Barrett PHR . Reduction in visceral adipose tissue is associated with improvement in apolipoprotein B-100 metabolism in obese men J Clin Endocrinol Metab 1999 84: 2854–2861.

    CAS  PubMed  Google Scholar 

  7. Arner P . All fat is not alike Lancet 1998 351: 1301–1302.

    Article  CAS  Google Scholar 

  8. Frayn KN, Williams CM, Arner P . Are increased plasma non-esterified fatty acid concentrations a risk marker for coronary heart disease and other chronic diseases? Clin Sci 1996 90: 243–253.

    Article  CAS  Google Scholar 

  9. Mohamed-Ali V, Pinkney JH, Coppack SW . Adipose tissue as an endocrine and paracrine organ Int J Obes Relat Metab Disord 1998 22: 1145–1158.

    Article  CAS  Google Scholar 

  10. Bolinder J, Lithell H, Skarfors E, Arner P . Effects of obesity, hyperinsulinemia, and glucose intolerance on insulin action in adipose tissue of sixty-year-old men Diabetes 1986 35: 282–290.

    Article  CAS  Google Scholar 

  11. Hirst S, Phillips DI, Vines SK, Clark M, Hales CN . Reproducibility of the short insulin tolerance test Diabetes Med 1993 10: 839–842.

    Article  CAS  Google Scholar 

  12. Lindheim SR, Buchanan TA, Duffy DM, Vijod MA, Kojima T, Stanczyk FZ, Lobo RA . Comparison of estimates of insulin sensitivity in pre- and postmenopausal women using the insulin tolerance test and the frequently sampled intravenous glucose tolerance test J Soc Gynecol Invest 1994 1: 150–154.

    Article  CAS  Google Scholar 

  13. Gelding SV, Robinson S, Lowe S, Niththyananthan R, Johnston DG . Validation of the low dose short insulin tolerance test for evaluation of insulin sensitivity J Clin Endocrinol 1994 40: 611–615.

    Article  CAS  Google Scholar 

  14. Bonora E, Moghetti P, Zancanaro C, Cigolini M, Querena M, Cacciatori V, Corgnati A, Muggeo M . Estimates of in vivo insulin action in man: comparison of insulin tolerance tests with euglycemic and hyperglycemic glucose clamp studies J Clin Endocrinol Metab 1989 68: 374–378.

    Article  CAS  Google Scholar 

  15. Graci S, Baratta R, Degano C, Luppa A, Vigneri R, Frittittta L, Trischitta V . The intravenous insulin tolerance test is an accurate method for screening a general population for insulin resistance and related abnormalities J Endocrinol Invest 1999 22: 472–475.

    Article  CAS  Google Scholar 

  16. Lönnqvist F, Nordfors L, Jansson M, Thörne A, Schalling M, Arner P . Leptin secretion from adipose tissue in women. Relationship to plasma levels and gene expression J Clin Invest 1997 99: 2398–2404.

    Article  Google Scholar 

  17. Eriksson P, Reynisdottir S, Lönnqvist F, Stemme V, Hamsten A, Arner P . Adipose tissue secretion of plasminogen activator inhibitor-I in non-obese and obese individuals Diabetologia 1998 41: 65–71.

    Article  CAS  Google Scholar 

  18. Lövig T, Haffner JFW, Kaaresen R, Nygaard K, Stadaas JO . Gastric banding for morbid obesity: five years follow up Int J Obes Relat Metab Disord 1993 17: 453–457.

    PubMed  Google Scholar 

  19. Näslund E, Backman L, Granström L, Stockeld D . Seven year results of vertical banded gastroplasty for morbid obesity Eur J Surg 1997 163: 281–286.

    PubMed  Google Scholar 

  20. DeFronzo RA, Bonadonna RC, Ferrannini L . Pathogenesis of NIDDM. A balanced overview Diabetes Care 1992 15: 318–368.

    Article  CAS  Google Scholar 

  21. Kissebah AH . Insulin resistance in visceral obesity Int J Obes 1991 15: 109–115.

    CAS  PubMed  Google Scholar 

  22. Despres JP . Abdominal obesity as important component of insulin-resistance syndrome Nutrition 1993 9: 452–459.

    CAS  PubMed  Google Scholar 

  23. Del Prato S . Measurement of insulin resistance in vivo Drugs 1999 58: S3–S6.

    Article  Google Scholar 

  24. Bujalska IJ, Kumar S, Stewart PM . Does central obesity reflect ‘Cushing's disease of the omentum’? Lancet 1997 349: 1210–1213.

    Article  CAS  Google Scholar 

  25. Barzilai N, She L, Liu B-Q et al. Surgical removal of visceral fat reverses hepatic insulin resistance Diabetes 1999 48: 94–98.

    Article  CAS  Google Scholar 

  26. Berntorp E, Berntorp K, Brorson H, Frick K . Liposuction in Dercum's disease: impact on haemostatis factors associated with cardiovascular disease and insulin sensitivity J Intern Med 1998 243: 197–201.

    Article  CAS  Google Scholar 

  27. Legato MJ . Gender-specific aspects of obesity Int J Fertil Women Med 1997 42: 184–197.

    CAS  Google Scholar 

Download references

Acknowledgements

The invaluable help of research nurse Britt Marie Leijonhufvud is greatly appreciated. We are grateful for statistical advise from Anna Hagman.

This study was supported by grants from the Swedish Medical Research Council, the Swedish Diabetes Foundation, the Söderberg Foundation, the Novo Nordic Foundation and the Swedish Heart and Lung Association.

Author information

Authors and Affiliations

  1. Department of Surgery, Karolinska Institute at Huddinge University Hospital, Stockholm, Sweden

    A Thörne, J Apelman & G Hellers

  2. Department of Medicine, Karolinska Institute at Huddinge University Hospital, Stockholm, Sweden

    F Lönnqvist & P Arner

Authors
  1. A Thörne
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F Lönnqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Apelman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G Hellers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P Arner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P Arner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thörne, A., Lönnqvist, F., Apelman, J. et al. A pilot study of long-term effects of a novel obesity treatment: omentectomy in connection with adjustable gastric banding. Int J Obes 26, 193–199 (2002). https://doi.org/10.1038/sj.ijo.0801871

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0801871

Keywords

This article is cited by

Search

Advanced search

Quick links