Sleeve gastrectomy and pancreatic omentoplasty decrease insulin resistance: Impact on pro-inflammatory and anti-inflammatory cytokine gene expression

Abstract

Background

Chronic systemic inflammation in obesity impairs insulin sensitivity and contributes to insulin resistance. Laparoscopic sleeve gastrectomy results in substantial weight loss and improved diabetic status, although 25 % of patients do not achieve optimal insulin production due to pancreatic fat accumulation. Addressing pancreatic inflammation is essential for better glycemic control. Pancreatic omentoplasty may enhance vascularization and reduce inflammation. This study examines the effects of sleeve gastrectomy and pancreatic omentoplasty on insulin resistance by analyzing the gene expression of pro- and anti-inflammatory cytokines and their correlation with HOMA-IR values.

Method

An experimental study with post-test only control design was conducted with obese and type 2 diabetes mellitus (T2DM) rat subjects which underwent sleeve gastrectomy treatment (SG), a combination of pancreatic omentoplasty and sleeve gastrectomy (SG + PO), without any intervention or a positive control group (+control), and rats which were neither obese nor T2DM or a negative control group (−control). On day 10 after surgery, blood samples from the rats were taken to assess blood glucose and insulin level in order to calculate HOMA-IR. Then, the pancreatic tissue of each rats was taken to extract the mRNA of TNF-α, IL-1, IL-6, and IL-10 by reverse-transcription polymerase chain reaction.

Result

The expression of the pro-inflammatory cytokine TNF-α in the SG + PO group was lower compared to the SG group (p = 0.008), IL-1 in the SG + PO group was lower than in the SG group (p = 0.043), and IL-6 in the SG + PO group was lower compared to the control group (p = 0.001). In contrast, the anti-inflammatory cytokine IL-10 was higher in the SG + PO group compared to the SG group (p = 0.001). Additionally, HOMA-IR in the SG + PO group was lower compared to the SG group (p = 0.001).

Conclusion

The combination of sleeve gastrectomy and pancreatic omentoplasty reduces pro-inflammatory cytokints (TNF-α, IL-1, IL-6) and increases anti-inflammatory cytokine IL-10, compared to sleeve gastrectomy alone. It also significantly lowers insulin resistance (HOMA-IR), suggesting that the combined procedure improves insulin sensitivity and glycemic control, cytokine modulation.