Sleeve gastrectomy: Globalization and its controversies

Surgical Treatment of Obesity. Special Mention to Roux-en-Y Gastric Bypass and Vertical Gastrectomy

INTRODUCTION

The prevalence of obesity has increased exponentially in recent decades, being one of the diseases that most affects global health. It is a chronic disease associated with multiple comorbidities, which lead to a decrease in life expectancy and quality of life. It requires a multidisciplinary approach by a specialized medical team. Obesity can be treated with conservative or with surgical treatments that will depend on the characteristics of the patient.

OBJECTIVE/METHODOLOGY

The referenced surgery can be performed using different surgical techniques that are analyzed in the present work through an exhaustive narrative bibliographic review in the PubMed and Cochrane databases, as well as in UpToDate.

RESULTS

Currently, those most used are restrictive techniques, specifically vertical gastrectomy and mixed techniques, with gastric bypass being the "gold standard".

CONCLUSIONS

In order to choose one technique or another, the characteristics of each patient and the experience of the surgical team must be taken into account.

Higher HOMA-IR index is associated with increased excess weight loss in patients with BMI≥35kg/m2 after vertical gastrectomy

INTRODUCTION

Bariatric surgery is considered the most effective treatment for severe obesity. However, it is not clear if patients with diabetes mellitus or insulin resistance have the same response than patients without those conditions. Our objective was to evaluate association between pre-surgical HOMA-IR index and percentage of excess weight loss (EWL%) one year after bariatric surgery using sleeve gastrectomy.

METHODS

Retrospective cohort including patients ≥18 years old with BMI≥35kg/m², who underwent primary sleeve gastrectomy between 2014-2017 at the Avendaño Medical Center, Peru. Only patients with Type 2 Diabetes, Hypertension, or Dyslipidemia were included. EWL% ≥60% one year after surgery was considered satisfactory. Crude and adjusted Lineal and Poisson regression with robustness was used to assess statistical associations with EWL%.

RESULTS

Ninety-one patients were included with a median of 34 years, and 57.1% were women. 85.7% had insulin resistance as per HOMA-IR. One year after surgery, 76.9% had a satisfactory EWL%. The lineal model showed .29% less EWL% per each extra year of life (P=.019), and .93% more EWL% per each extra HOMA-IR point (P=.004). The adjusted Poisson model showed 2% lower risk of having a satisfactory EWL% per each additional year of life (P=.050), and 2% more chance of success per each additional HOMA-IR point (P=.038).

CONCLUSIONS

There was association between a higher pre-surgical HOMA-IR index and increased EWL% one year after surgery. It is possible that insulin resistance does not affect negatively sleeve gastrectomy outcomes.