The influence of laparoscopic sleeve gastrectomy on metabolic syndrome parameters in obese patients in own material

Nomogram for Predicting Remission of Metabolic Syndrome 1 Year after Sleeve Gastrectomy Surgery in Chinese Patients with Obesity

PURPOSE

Sleeve gastrectomy (SG) is a widely used and effective treatment for patients with obesity and comorbid metabolic abnormalities. No specialized tool is available to predict metabolic syndrome (MS) remission after SG. We presented a nomogram that evaluated the probability of MS remission in obese patients 1 year after SG.

MATERIALS AND METHODS

Patients with preoperative MS who underwent SG were enrolled in this retrospective study. They were divided into a training set and a validation set. Multivariate logistic regression analysis was performed to identify independent predictors of MS remission, and these predictors were included in the nomogram. Receiver operating characteristic curve was used to evaluate discrimination. Calibration was performed with the Hosmer-Lemeshow goodness-of-fit test. The net benefits of the nomogram were evaluated using decision curve analysis (DCA).

RESULTS

Three hundred and eighteen patients with a median age of 34.0 years were analyzed. A training set and a validation set with 159 individuals each were established. A combination of age, preoperative high-density lipoprotein cholesterol, elevated triglycerides and glycated hemoglobin level independently and accurately predicted MS remission. The nomogram included these factors. The discriminative ability was moderate in training and validation sets (Area under curve 0.800 and 0.727, respectively). The Hosmer-Lemeshow X2 value of the nomogram was 8.477 (P = 0.388) for the training set and 5.361 (P = 0.718) for the validation set, indicating good calibration. DCA showed the nomogram had clinical benefits in both datasets.

CONCLUSION

Our nomogram could accurately predict MS remission in Chinese patients with obesity 1 year after SG.

The Art of Sleeve Gastrectomy

Sleeve gastrectomy (SG) has historically evolved from gastroplasty and anti-reflux procedures into one of the most commonly performed primary metabolic surgeries in the United States and worldwide. Initially initiated in the 1980s as part of the duodenal switch procedure, its standalone effectiveness and simplicity have led to increasing popularity globally. The rise in obesity rates transcends age boundaries, alarmingly affecting not only adults but also the younger demographic. This escalating trend is concerning, as it predisposes these populations to numerous future health complications, as well as highlighting the critical necessity for a safe and potent weight loss strategy. Although sleeve gastrectomy carries a higher risk for gastroesophageal reflux disease (GERD) compared to other bariatric procedures, it stands out as a reliable, safe and effective surgical solution for obesity. It is particularly beneficial for adolescents and patients with complex medical comorbidities, including, but not limited to, heart failure and immunocompromisation. It has also served as a bridge for transplants in morbidly obese patients with end-stage heart, liver and kidney disease due to its favorable safety profile.

Risk Factors for Early and Late Complications after Laparoscopic Sleeve Gastrectomy in One-Year Observation

BACKGROUND

Although laparoscopic sleeve gastrectomy (LSG) is considered a safe bariatric procedure in the treatment of obesity, it still involves a risk of developing postoperative complications. Knowledge of risk factors for possible complications would allow appropriate preoperative planning, optimization of postoperative care, as well as early diagnosis and treatment. The aim of this study was to evaluate risk factors for complications after laparoscopic sleeve gastrectomy.

METHODS

A retrospective study of 610 patients who underwent LSG at a tertiary institution were included in the study through retrospective analysis of the medical data. Complications were categorized as early (<30 days) and late (≥30 days) and evaluated according to the Clavien-Dindo Classification.

RESULTS

Early complications were observed in 35 patients (5.74%) and late complications occurred in 10 patients (1.64%). Independent risk factors of early complications after laparoscopic sleeve gastrectomy included hypercholesterolemia (OR 3.73; p-value = 0.023) and smoking (OR = 274.66, p-value < 0.001). Other factors that may influence the postoperative course are length of hospital stay and operation time. Smoking, peptic ulcer diseases and co-existence of hiatal hernia were found to be an independent predictors of late complications.

CONCLUSIONS

Smoking is associated with the higher risk of both, early and late complications, while hypercholesterolemia with only <30 days complications after laparoscopic sleeve gastrectomy.

The Effect of Laparoscopic Sleeve Gastrectomy on Glycemic Control in Type 2 Diabetic Patients

Introduction The prevalence of diabetes mellitus type II (T2DM) in Kuwait in 2013 was 23.09%, ranking ninth globally and second in the Middle East and North Africa (MENA) region. It's been frequently reported as a growing public health concern. Our retrospective study will focus on the effect of laparoscopic sleeve gastrectomy (LSG) on the glycemic control of T2DM. Methods From December 2012 to January 2014, 70 patients with T2DM underwent LSG during the study period. A retrospective patient file review was performed and a follow-up on participants was carried out in February 2014. Fasting plasma glucose (FPG) was taken pre- and post-operatively. Patients were followed up to monitor the change in diabetic medications in terms of quantity, type and dose. Results The mean reduction of FPG after surgery was 2.94+3.66 (P < 0.001) over a mean interval of eight days (range, 0-34 days). Immediate reduction in FPG was seen in 61 patients (87%), and the greatest reduction was seen in the age group <40 years. Diabetes remission was seen in 49 patients (70%), while 20 (29%) had reduction in medication. All patients underwent a safe surgical procedure. There were no conversions to open surgery and no significant complications or mortalities. Conclusions Our study shows that LSG procedure has an immediate positive effect on the glycemic control of T2DM, in addition to the long-term evidence of complete resolution of diabetes in most patients or improvement in glycemic control, which has further highlighted the positive outcome of LSG, diminishing morbidity, risk factors, co-morbidities and health-expenditure.

Long-term improvement of dyslipidaemia, hyperuricemia and metabolic syndrome in patients undergoing laparoscopic sleeve gastrectomy

OBJECTIVE

The aim of the study was to assess the long-term impact of laparoscopic sleeve gastrectomy (LSG) on lipid profile, uric acid level and metabolic syndrome.

METHODS

A prospective study was performed between 2009-2014, evaluating long-term percentage of excesso body mass index loss (%EBMIL), lipid profile, uric acid level and metabolic syndrome.

RESULTS

Overall sixty subjects were followed-up. %EBMIL increased significantly, reaching a maximum (86,9 ± 6,3%) at 5 years post-LSG. Therapeutic success rate (%EBMIL ≥ 60%) was 80% at 5 years. The triglyceride level decreased significantly (148 ± 72.1 mg/dL baseline vs 130.7 ± 57.5 mg/dL at 1 month vs 110.7 ± 42.6 mg/dL at 3 months vs 92.5 ± 35.2 mg/dL at 1 year vs 84.2 ± 32.3 mg/dL at 5 years; p < 0.05 for all). HDL-cholesterol increased and uric acid decreased significantly in the first year postoperatively, remaining stable afterwards (46.9 ± 12.3 mg/dL baseline vs 47.4 ± 10 mg/dL at 1 month vs 49.8 ± 9.3 mg/dL at 3 months vs 55.4 ± 10.2 mg/dL at 1 year; p < 0.05 for all for HDL-cholesterol and 6.4 ± 2 mg/dL baseline vs 6 ± 1.7 mg/dL at 1 month vs 5.2 ± 1.3 mg/dL at 3 months vs 4.8 ± 1 mg/dL at 1 year; p < 0.05 for all for uric acid). The prevalence of metabolic syndrome decreased from 66.7% baseline to 8.3% at 5 years postoperatively (p < 0.01).

CONCLUSION

LSG was effective in terms of %EBMIL and metabolic traits improvement for Romanian patients.

Laparoscopic sleeve gastrectomy as a primary bariatric procedure: postoperative outcomes

Background and aims

Laparoscopic sleeve gastrectomy is at present the most popular bariatric procedure due to its significant effect on weight loss, resolution of comorbidities and improvement in the quality of life. However, there are not many studies showing its medium and long term efficacy and safety in Eastern Europe. We aim to report the outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure from a single surgical department.

Methods

This is a retrospective analysis of obese patients who underwent laparoscopic sleeve gastrectomy between 2009 – 2016 in our department. Outcomes were analyzed in terms of weight loss, comorbidity resolution and quality of life changes.

Results

A number of 70 patients were included in the study, with a mean age of 47.6 ± 9.8 years. Mean initial Body Mass Index was 47.4 ± 6.4 kg/m². The mean percentage of excess weight loss during follow-up was 78.2% at 12 months, 80.2%, 76.7%, 74.7%, 72.8%, 73.3%, 74.1%, 67.2%, 64.07%, 69.7% at 24, 36, 48, 60, 72, 84, 96, 108 and 120 months, respectively. Weight regain occurred in 61 (87.1%) patients during the postoperative period. The mean weight regained was 8.1 ± 4.8 kg at 24 months postoperatively. Regarding the quality of life, 83% of patients declared an increase in self-esteem. Resolution of diabetes, arterial hypertension, and obstructive sleep apnea syndrome occurred in 80%, 42.5% and 70.1% of patients respectively.

Conclusions

Laparoscopic sleeve gastrectomy is an effective procedure, with good outcomes in the medium and long term, although a tendency for weight regain was noted after 2 years. Resolution of comorbidities is comparable with that reported in the literature, namely an improvement of the quality of life.

Gender-related metabolic outcomes of laparoscopic sleeve gastrectomy in 6-month follow-up

Introduction

Laparoscopic sleeve gastrectomy (LSG) is recently a leading method in surgical treatment of morbid obesity. The metabolic outcome of intervention may be a result of many factors such as age, gender, preoperative weight loss and dietary restrictions.

Aim

To evaluate gender-related differences in the results of LSG in 6-month follow-up.

Material and methods

The study included 101 patients who underwent LSG at the University Clinical Hospital of Bialystok. Patients were divided and analyzed in 2 groups: males (n = 48) and females (n = 53). The primary analysis included the influence of gender on postoperative weight loss calculated using the percentage of excess weight loss (%EWL) and excess BMI loss (%EBMIL). For secondary outcomes the levels of glucose, insulin, glycated hemoglobin, aspartate transaminase, alanine transaminase, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides and C-reactive protein were analyzed.

Results

A significant influence of patients’ gender was proved for both %EWL (p = 0.026) and %EBMIL (p = 0.001). Females had significantly higher %EWL in 6-month follow-up than males (p = 0.0034). The analysis also showed significantly higher %EBMIL for women at 3 and 6 months observation (p = 0.022 and p < 0.001 respectively).

Conclusions

Laparoscopic sleeve gastrectomy is an effective method of obesity treatment especially in terms of postoperative weight loss. Females seem to benefit more from the procedure when analyzing the parameters of body mass reduction. However, further research is needed to provide strong evidence of an association between gender and the results of LSG.

Complications of bariatric surgery in adolescents

Over the past decade, outcomes data have demonstrated the benefit of bariatric surgery in achieving both sustained weight loss and reversal of co-morbidities. Comparing these data to contemporary known risks of adolescent bariatric surgery informs the patients and providers considering bariatric procedures and provides insight into potential ways to reduce and manage complications. The goal of this article is to review the common surgical and postoperative complications following bariatric procedures and discuss approaches to improve their safety. A systematic review identifying bariatric surgery complications in adolescents was conducted. The review focused on the data relevant to adolescent bariatric surgery. However, when necessary, adult studies were used to address the gaps in available pediatric information. The data pertaining to the intraoperative, short term, and long term surgically related and nutritional related complications show that complication are declining with increasing experience. Specific recommendations and strategies to avoid major complications of bariatric surgery in adolescents are offered.

Short-term effects of Vertical sleeve gastrectomy and Roux-en-Y gastric bypass on glucose homeostasis

The objective of this study was to compare the biochemical changes related to glucose tolerance and lipid metabolism in non-diabetic patients shortly after vertical sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Non-diabetic women and men with morbid obesity were studied the day before and six days after SG (N = 15) or RYGB (N = 16). Patients completed an oral glucose tolerance test (OGTT; 75 g glucose) at both visits. SG and RYGB similarly improved fasting glucose homeostasis six days after surgery, with reduced glucose and insulin concentrations. The OGTT revealed differences between the two surgery groups that were not evident from the fasting serum concentrations. Postprandial (120 min) glucose and insulin concentrations were lower after RYGB but not after SG, whereas concentrations of glucagon-like peptide-1, peptide YY, glucagon and non-esterified fatty acids were elevated after both SG and RYGB. Fasting triacylglycerol concentration did not change after surgery, but concentrations of high density lipoprotein and low density lipoprotein cholesterols were reduced in both surgery groups, with no differences between the groups. To conclude, RYGB induced a more pronounced improvement in postprandial glucose homeostasis relative to SG, possibly due to improved insulin sensitivity rather than augmented insulin concentration.

Role of Hunger Hormone "Ghrelin" in Long-Term Weight Loss Following Laparoscopic Sleeve Gastrectomy

Introduction

Laparoscopic sleeve gastrectomy (LSG) has become a popular weight loss technique in morbidly obese patients. The aim of our study was to evaluate the changes in plasma ghrelin levels in relation to weight loss following LSG and to study the efficacy of LSG in terms of long-term glycemic control and resolution of diabetes.

Methodology

The study was conducted on 70 morbidly obese patients (body mass index [BMI] >40 kg/m²) or severely obese patients (BMI >35 kg/m²) with comorbidities who underwent LSG in Dayanand Medical College and Hospital, Ludhiana, India. Ghrelin levels were measured preoperatively and postoperatively at 1 week, 3 months, and 6 months along with measurements of various weight loss parameters and glycosylated hemoglobin.

Results

A significant decrease in plasma ghrelin levels was observed in relation to the mean weight and percentage excess weight loss at 3 months postoperatively. However, at 6 months, fall in ghrelin reached a plateau phase while weight loss was still sustained and significant. There was a significant fall in glycosylated hemoglobin levels with patients achieving good control/resolution of diabetes Type II.

Conclusion

LSG is an effective weight loss surgery and brings about excellent weight loss in morbidly obese individuals in addition to achievement of good glycemic control in diabetic individuals. Serum levels of ghrelin fall significantly after sleeve gastrectomy. However, long term implications of ghrelin induced weight loss cannot be elucidated.

Different surgical approaches in laparoscopic sleeve gastrectomy and their influence on metabolic syndrome: A retrospective study

Obesity is a growing health, social, and economic issue and became an epidemic, according to recent report of World Health Organization.The only method with scientifically proved efficiency of body mass loss is a surgical treatment. Laparoscopic sleeve gastrectomy (LSG) is recently a leading method in metabolic surgery. There are no standards of operative technique for LSG so far. The influence of technique modification on metabolic effect has not been described clearly.The aim of this study was to evaluate metabolic effects in patients with morbid obesity who underwent various surgical approaches of LSG.The study included 120 patients who were randomly divided into 3 groups: Group I, where bougie size was 32 French (Fr), Group II-36 Fr and Group III-40 Fr. Each group was divided into 2 subgroups, based on the distance of resection beginning from the pylorus-2 or 6 cm. Statistical analysis of: body mass index (BMI), the Percentage of Excess Weight Loss (%EWL), the Percentage of Excess BMI Loss (%EBMIL), levels of glucose and insulin on an empty stomach, glycated hemoglobin (HbA1c), insulin resistance (Homeostatic Model Assessment of Insulin Resistance Index-HOMA-IR), aspartate transaminase (AST), alanine transaminase (ALT), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and C-reactive protein (CRP) were under investigation.Statistically significant decrease in body mass, BMI, %EWL, %EBL, glucose, and insulin concentrations has been observed in all studied groups. It was the highest when the smallest calibration tube has been used (32 Fr). Similar results were observed in HOMA-IR and HbA1c levels. Statistically significant decrease of total cholesterol, LDL, and TG concentrations have been observed. Significant increase of HDL in every group has been also noted. Postoperative CRP values were the lowest when the smallest bougie was used.LSG is effective method of obesity treatment. Metabolic effects of LSG are the most noticeable when a small bougie size is used.

The Regulations and Mechanisms of Laparoscopic Sleeve Gastrectomy (LSG) for Obesity and Type 2 Diabetes: A Systematic Review

Obesity and diabetes mellitus are becoming 2 of the most leading risk factors that threaten public health worldwide. Obesity is a very strong but preventable risk factor for getting type 2 diabetes. Laparoscopic sleeve gastrectomy (LSG) has been a main approach to the surgical management of morbid obesity and type 2 diabetes but its role remains undefined. Here, we overviewed the clinical outcomes and regulatory mechanisms of LSG, aiming at providing thorough theoretical supports and effective technical guidance to the pathogenesis, prognosis, treatment and prevention of type 2 diabetes with obesity. Futher more, the prospectives and main drawbacks (such as considerable heterogeneity and unicity, little comparability and relevance) of LSG are also discussed.

Effects of Laparoscopic Sleeve Gastrectomy on Central Obesity and Metabolic Syndrome in Indian Adults- A Prospective Study

INTRODUCTION

Increasing incidence of obesity in Indian population has led to an exponential rise in the number of bariatric operations performed annually. Laparoscopic Sleeve Gastrectomy (LSG) has been proposed to cause rapid remission of Type 2 Diabetes Melitus (T2DM) and metabolic syndrome in a weight loss independent manner.

AIM

To evaluate the effects of LSG on metabolic syndrome and central obesity in morbidly and severely obese Indian adults. Material and Methods: Study was conducted on 91 morbidly obese [Body Mass Index (BMI)>40 kg/m2] and severely obese (BMI>35 kg/m2) individuals who were suffering from diabetes, hypertension or dyslipidemia. The patients were followed up for six months and the trends of glycaemic control, mean blood pressure, lipid profile, weight loss parameters and changes in parameters of central obesity were studied.

RESULTS

Weight loss was significant at three months postsurgery and was sustained through six months. There was significant improvement in glycaemic control leading to reduction in need for oral hypoglycaemic agents or insulin in majority of them and even discontinuation of these medications in few patients. Hypertension and dyslipidemia also showed an improving trend through six months postsurgery. There was a significant impact on reduction of central obesity in these patients as marked by significant reduction in waist to hip ratio.

CONCLUSION

LSG produces sustainable weight loss with significant improvement in glycaemic status and control of metabolic syndrome in severe to morbidly obese patients. LSG is also efficacious in reducing central obesity in Indian population which is a major depressive ailment amongst obese individuals.

Perfil farmacoterapêutico de pacientes obesos no pós-operatório de cirurgia bariátrica

Contexto

A obesidade pode estar relacionada a doenças como diabetes, hipertensão arterial e dislipidemia. A cirurgia bariátrica é um dos tratamentos mais eficazes, levando à diminuição de peso e comorbidades.

Objetivo

Avaliar o perfil metabólico e farmacoterapêutico de pacientes obesos após cirurgia bariátrica.

Métodos

Trata-se de um estudo observacional transversal retrospectivo, realizado em um hospital localizado na cidade de Porto Alegre, RS, Brasil. Foram avaliados 70 prontuários de pacientes que realizaram cirurgia bariátrica, nos períodos de antes de 2 meses e mais de 6 meses após a cirurgia bariátrica. A análise estatística foi realizada no programa SPSS 17.0®.

Resultados

A pressão arterial inicial foi de 130/85 mmHg, passando para 120/80 mmHg (p < 0,01). Com relação ao perfil metabólico antes de dois meses, o HDL foi de 34 mg/dL, o colesterol total foi de 195,07 ± 40,17 mg/dL, o LDL foi de 118,22 ± 41,28 mg/dL, os triglicerídeos foram de 141,09 ± 43,39 mg/dL, e a glicemia de jejum foi de 90 mg/dL. Após 6 meses de cirurgia, os valores passaram para 43 mg/dL, 133,67 ± 28,14 mg/dL, 65,53 ± 24,3 mg/dL, 104,41 ± 29,6 mg/dL, e 77 mg/dL, respectivamente (p < 0,01). Com relação ao uso de medicamentos, 41% utilizaram anti-hipertensivos, 39% utilizaram hipolipemiantes, 10% utilizaram hipoglicemiantes orais e 97% utilizaram suplementos antes dos 2 meses de cirurgia. Após os 6 meses, os percentuais foram alterados para 21%, 19%, 9% e 99%, respectivamente.

Conclusões

O estudo mostra o sucesso da cirurgia bariátrica em pacientes obesos com comorbidades, revelando melhora no perfil metabólico e redução na utilização de medicamentos para tratamento de comorbidades.

Variation in blood levels of hormones in obese patients following weight reduction induced by endoscopic and surgical bariatric therapies

BACKGROUND

Beneficial clinical effects of weight reduction following bariatric therapies is not fully understood and maybe related to the complex interactions between leptin, adiponectin, visfatin, omentin, and ghrelin. The aim of study was to investigate their timeline changes associated with weight reduction and their profile in relation to the type of treatment and its efficacy.

METHODS

Circulating hormones levels were analyzed before and after endoscopic and surgical procedures in 67 obese patients and compared to non-obese healthy controls.

RESULTS

Obese patients had higher leptin levels and lower levels of adiponectin, visfatin, omentin, and ghrelin than non-obese controls. During the consecutive follow-up visits after treatment, there was a gradual decrease in leptin levels and an increase in adiponectin levels to the levels observed in non-obese. At 50-54weeks, the ghrelin levels were lower and the levels of adiponectin and visfatin, but not omentin, were higher compared to their baseline values. BMI correlated with ghrelin and leptin levels. The percentage of total weight loss correlated positively with adiponectin levels and negatively with leptin levels. Patients with adequate weight loss had a significantly lower leptin concentration than those with treatment failure. There were timeline variations in hormone levels between endoscopic and bariatric therapies, however there were no significant differences in the median their concentration at 50-54weeks after therapy.

CONCLUSION

Our study supports observations that weight loss itself, rather than the procedure type, is responsible for hormonal variation. The leptin levels reflect the best the body weight changes after bariatric therapies.

Mechanisms underlying weight loss and metabolic improvements in rodent models of bariatric surgery

Obesity is a growing health risk with few successful treatment options and fewer still that target both obesity and obesity-associated comorbidities. Despite ongoing scientific efforts, the most effective treatment option to date was not developed from basic research but by surgeons observing outcomes in the clinic. Bariatric surgery is the most successful treatment for significant weight loss, resolution of type 2 diabetes and the prevention of future weight gain. Recent work with animal models has shed considerable light on the molecular underpinnings of the potent effects of these 'metabolic' surgical procedures. Here we review data from animal models and how these studies have evolved our understanding of the critical signalling systems that mediate the effects of bariatric surgery. These insights could lead to alternative therapies able to accomplish effects similar to bariatric surgery in a less invasive manner.

Dietary intake and ghrelin and leptin changes after sleeve gastrectomy

INTRODUCTION

Surgical intervention in obesity is today the most effective treatment method in high level obesity management. Bariatric interventions not only ensure body weight reduction, but may influence dietary habits.

AIM

To assess changes in adipose hormones and dietary habits in obese patients after sleeve gastrectomy.

MATERIAL AND METHODS

The study set comprised 37 subjects (29 females and 8 males) 24 to 68 years old with body mass index 43.0 ±4.9 kg/m(2). Pre-operative examination included baseline measurements of body composition. Dietary habits and intake frequency were monitored by a questionnaire method. Follow-up examinations were carried out in a scope identical to the pre-operative examination, 6 and 12 months after surgery, respectively.

RESULTS

The average patient weight loss 12 months after surgery was 31.7 kg. Excess weight loss was 55.2 ±20.6%. Patients reported reduced appetite (p < 0.001), increasingly regular food intake (p < 0.001), intake of more meal portions per day (p = 0.003) and a decrease in consuming the largest portions during the afternoon and evening (p = 0.030). Plasma levels of fasting glucose, leptin and ghrelin significantly decreased (p = 0.006; p = 0.0.043); in contrast, the level of adiponectin significantly increased (p < 0.001).

CONCLUSIONS

Sleeve gastrectomy and follow-up nutritional therapy resulted in a significant body weight reduction within 1 year after surgery. An improvement of certain dietary habits in patients was registered. At 12 months after surgery, there were no statistically significant differences in decreases in ghrelin and leptin concentrations between patients without changed appetite and those reporting decreased appetite.

Creatinine or cystatin C - which is a better index of renal function in morbid obesity?

PURPOSE

The most important index of renal function is estimated glomerular filtration rate (eGFR) which can be calculated from creatinine or cystatin C concentration in serum. There is uncertainty, which formula is best suited to assess renal function in morbidly obese patients. The aim of this study was to evaluate eGFR in patients with morbid obesity using formulas: Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Grubb, Le Bricon, Hoek, Larsson, and to compare the obtained results.

MATERIAL AND METHODS

In 40 morbidly obese patients, serum concentration of cystatin C and creatinine were assayed. Values of eGFR were calculated using the above-mentioned formulas.

RESULTS

The mean value of eGFR ranged from 85.9 to 111.1 ml/min/1.73 m², depending on the formula. The biggest difference between the obtained values was 29% (Grubb vs. Hoek p<0.01). After calculation of eGFR from creatinine concentration (MDRD), 7 patients were qualified to the 2nd and 3rd stage of chronic renal disease, while application of Hoek's formula, based on cystatin C concentration, allotted 27 patients to 2nd and 3rd stage of chronic renal disease. Le Bricon formula gave eGFR values, that correlated best with albuminuria.

CONCLUSION

eGFR calculated using Le Bricon formula based on the cystatin C concentration was significantly lower than eGFR calculated from creatinine concentration and was more closely associated with albuminuria. Relying only on creatinine concentration to estimate glomerular filtration rate can lead to underestimation of renal malfunction in obese patients.

Laparoscopic sleeve gastrectomy without over-sewing of the staple line is effective and safe

INTRODUCTION

Laparoscopic sleeve gastrectomy (LSG) is a bariatric procedure with very good long-term weight-reducing and metabolic effects.

AIM

Here we report 6 years' experience with LSG performed in morbidly obese patients by one surgical team focusing on the impact of the degree of sleeve restriction and safety of the procedure without over-sewing the staple line.

MATERIAL AND METHODS

From 2006 to 2012, 207 morbid obese patients with average age of 43.4 years and average body mass index 44.9 kg/m(2) underwent LSG without over-sewing the staple line. The complete 5- and 3-year follow-up is recorded in 59 and 117 patients with prospective data collection at 3, 6, 9, 12, 18, 24, 36, 42 and 60 months after LSG. Group 1 patients operated in 2006-2008 had smaller sleeve restriction. Group 2 patients operated in 2009-2012 had major sleeve restriction. All procedures were performed without over-sewing of the staple line.

RESULTS

The average %EBMIL (excess body mass index loss) in group 1 patients with minor sleeve restriction reached 54.1% and average %EWL (excess weight loss) was 50.8% while in group 2 with major sleeve restriction the average %EBMIL reached 69.7% and average %EWL was 66.8%. Final weight reduction was significantly higher in group 2 patients compared to group 1 patients with smaller sleeve restriction. Out of 49 patients with preoperatively diagnosed T2DM (type 2 diabetes mellitus) was completely resolved in 70.8%. Pre-operatively diagnosed hypertension normalized in 64.2%, improved in 23.2%, and remained unchanged in 12.6% of patients.

CONCLUSIONS

Carefully performed LSG without over-sewing the staple line is feasible and safe. A better weight-reducing effect was present in patients with major sleeve restriction.

Metabolic syndrome prevalence and associations in a bariatric surgery cohort from the Longitudinal Assessment of Bariatric Surgery-2 study

BACKGROUND

Metabolic syndrome is associated with higher risk for cardiovascular disease, sleep apnea, and nonalcoholic steatohepatitis, all common conditions in patients referred for bariatric surgery, and it may predict early postoperative complications. The objective of this study was to determine the prevalence of metabolic syndrome, defined using updated National Cholesterol Education Program criteria, in adults undergoing bariatric surgery and compare the prevalence of baseline co-morbid conditions and select operative and 30-day postoperative outcomes by metabolic syndrome status.

METHODS

Complete metabolic syndrome data were available for 2275 of 2458 participants enrolled in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), an observational cohort study designed to evaluate long-term safety and efficacy of bariatric surgery in obese adults.

RESULTS

The prevalence of metabolic syndrome was 79.9%. Compared to those without metabolic syndrome, those with metabolic syndrome were significantly more likely to be men, to have a higher prevalence of diabetes and prior cardiac events, to have enlarged livers and higher median levels of liver enzymes, a history of sleep apnea, and a longer length of stay after surgery following laparoscopic Roux-en-Y gastric bypass (RYGB) and gastric sleeves but not open RYGB or laparoscopic adjustable gastric banding. Metabolic syndrome status was not significantly related to duration of surgery or rates of composite end points of intraoperative events and 30-day major adverse surgical outcomes.

CONCLUSIONS

Nearly four in five participants undergoing bariatric surgery presented with metabolic syndrome. Establishing a diagnosis of metabolic syndrome in bariatric surgery patients may identify a high-risk patient profile, but does not in itself confer a higher risk for short-term adverse postsurgery outcomes.

Effects of laparoscopic sleeve gastrectomy in patients with morbid obesity and metabolic disorders

PURPOSES

Obesity and its correlation with other pathological conditions determine the onset of the metabolic syndrome, which exposes the patient to a higher risk of major cardiovascular complications. Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical procedure that appears to influence both the reduction of fat mass and the action of some gastrointestinal hormones.

PATIENTS AND METHODS

Between January 2011 and July 2013, 23 patients with morbid obesity underwent LSG and follow-up. In the evaluation of patients, the criteria for metabolic syndrome given by the International Diabetes Federation were followed. A multidisciplinary team of experts evaluated patients before surgery and in subsequent scheduled postoperative visits at 7, 30, 60, and 90 days and 4, 5, 6, 9, and 12 months. Anthropometric and metabolic parameters were analyzed.

RESULTS

The mean excess weight loss was 8.57±3.02%, 17.65±6.40%, 25.47±7.90%, 33.76±9.27%, 41.83±10.71%, 46.02±13.90%, 52.60±14.05%, 58.48±16.07%, and 62.59±21.29% at 7, 30, 60, and 90 days and 4, 5, 6, 9, and 12 months, respectively. In the same observational period there was an excellent improvement of metabolic indices. None of the patients previously taking prescribed hypoglycemic drugs restarted therapy. Mean fasting plasma glucose significantly decreased compared with the preoperative values. Blood pressure had a statistically significant improvement. Modification in the lipid profile was more variable. During the period of observation 22 of 23 patients reported in this study did not fit the criteria for metabolic syndrome.

CONCLUSIONS

Morbid obesity and related diseases may benefit from a surgical approach in selected patients. Randomized controlled trials are needed to evaluate the role of LSG.

Bariatric surgery for severe obesity in two adolescents with type 1 diabetes

Bariatric surgery has been effective in treating type 2 diabetes mellitus (T2DM); it has not been used frequently in obese patients with type 1 diabetes mellitus (T1DM). This is the first case series reporting on the effect of bariatric surgery on diabetes control in adolescents with T1DM. Patient A is a 19-year-old obese man with T1DM who underwent vertical sleeve gastrectomy. At 12 months after surgery he demonstrated 28% reduction in BMI. His daily total insulin requirement had decreased; however, hemoglobin A1c remained primarily unchanged at 8.8%. Patient B is a 13-year-old obese girl with an initial clinical diagnosis of T2DM controlled on only metformin. She underwent Roux-en-Y gastric bypass; at 1 month after surgery she presented in diabetic ketoacidosis and was found to have positive islet cell antibodies, which were also present before surgery. Her diagnosis was revised to T1DM, and she was started on insulin. By 28 months after surgery her BMI had decreased by 42%. Since initiation of insulin, her daily total insulin requirement had decreased, but hemoglobin A1c had significantly worsened from 6.3% to 10%. We found that despite significant weight loss, improvements in cardiovascular risk factors (dyslipidemia and obstructive sleep apnea), and quality of life in our patients, bariatric surgery does not necessarily lead to improved glycemic control of T1DM. Patients with T1DM have ongoing dependency on exogenous insulin, and optimal glycemic control still depends on patient compliance with diabetes care.

Evolution of low-grade systemic inflammation, insulin resistance, anthropometrics, resting energy expenditure and metabolic syndrome after bariatric surgery: a comparative study between gastric bypass and sleeve gastrectomy

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) for morbid obesity is gaining in popularity as it offers several advantages over laparoscopic Roux-en-Y gastric bypass (LRYGBP), but comparative data between these two procedures have rarely been reported.

METHODS

This case control study compared the incidence of low-grade systemic inflammation, insulin resistance, anthropometrics, resting energy expenditure and metabolic syndrome in 30 patients undergoing LRYGBP and 30 patients undergoing LSG, matched for age, sex, body mass index (BMI), and glycosylated hemoglobin (HbA1c).

RESULTS

At 1-year after surgery, the percent of excess weight loss was 67.8 ± 20.9 for LRYGBP and 61.6 ± 19.4 for LSG. Patients undergoing LRYGBP showed significantly lower plasma levels of C-reactive protein (3.3 ± 2.7 mg/dL vs. 5.3 ± 3.9 mg/dL; P < 0.05), waist circumference (97.4 ± 16.0 vs. 105.5 ± 14.7 cm; P < 0.05), total cholesterol (4.6 ± 1.0 vs. 5.7 ± 0.9 mmol/L; P < 0.01) and LDL cholesterol (2.6 ± 0.8 vs. 3.6 ± 0.8 mmol/L; P < 0.01). Insulin resistance (HOMA index 1.6 ± 1.0 after LRYGBP vs. 2.3 ± 2.4 after LSG), resting energy expenditure (1666.7 ± 320.5 after LRYGBP vs. 1600.4 ± 427.3 Kcal after LSG) and remission of metabolic syndrome (92.9% after LRYGBP vs. 80% after LSG) were not different between the two groups.

CONCLUSION

In this study, patients undergoing LRYGBP demonstrated significantly improved lipid profiles, decreased systemic low-grade inflammation compared with those undergoing LSG at 1-year follow-up.