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Głuszyńska P, Łukaszewicz A, Diemieszczyk I, Chilmończyk J, Reszeć J, Citko A, Szczerbiński Ł, Krętowski A, Razak Hady H. The Effect of Laparoscopic Sleeve Gastrectomy on the Course of Non-Alcoholic Fatty Liver Disease in Morbidly Obese Patients during One Year of Follow Up. J Clin Med 2023; 12:4122. [PMID: 37373815 DOI: 10.3390/jcm12124122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Morbid obesity co-exists with non-alcoholic fatty liver disease in up to 90% of cases. Laparoscopic sleeve gastrectomy leads to a reduction in body mass and thus may improve the course of non-alcoholic fatty liver disease. The aim of this study was to evaluate the effect of laparoscopic sleeve gastrectomy on the resolution of non-alcoholic fatty liver disease. METHODS The study included 55 patients with non-alcoholic fatty liver disease who underwent laparoscopic sleeve gastrectomy at a tertiary institution. The analysis consisted of preoperative liver biopsy, abdominal ultrasound, weight loss parameters, Non-Alcoholic Fatty Liver Fibrosis Score and selected laboratory parameters. RESULTS Before the surgery, 6 patients were diagnosed with grade 1 liver steatosis, 33 patients with grade 2 and 16 patients with grade 3. One year after the surgery, only 21 patients had features of liver steatosis at ultrasound. All weight loss parameters showed statistically significant changes during the observation; the median percentage of total weight loss was 31.0% (IQR: 27.5; 34.5) with p = 0.0003, the median percentage of excess weight loss was 61.8% (IQR: 52.4; 72.3) with p = 0.0013 and the median percentage of excess body mass index loss was 71.0% (IQR: 61.3; 86.9) with p = 0.0036 12 months after laparoscopic sleeve gastrectomy. The median Non-Alcoholic Fatty Liver Fibrosis Score at baseline was 0.2 (IQR: -0.8; 1.0) and decreased to -1.6 (IQR: -2.4; -0.4) (p < 0.0001). Moderate negative correlations between Non-Alcoholic Fatty Liver Fibrosis Score and percentage of total weight loss (r = -0.434, p < 0.0001), percentage of excess weight loss (r = -0.456, p < 0.0001) and percentage of excess body mass index loss (r = -0.512, p < 0.0001) were found. CONCLUSIONS The study supports the thesis that laparoscopic sleeve gastrectomy is an effective method for treatment of non-alcoholic fatty liver disease in patients with morbid obesity.
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Affiliation(s)
- Paulina Głuszyńska
- Department of General and Endocrine Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Aleksander Łukaszewicz
- Department of General and Endocrine Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Inna Diemieszczyk
- Department of Surgery, Independent Public Health Care Center in Lapy, 18-100 Lapy, Poland
| | - Jan Chilmończyk
- Department of General and Endocrine Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Joanna Reszeć
- Department of Medical Pathomorphology, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Anna Citko
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Łukasz Szczerbiński
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland
- Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Adam Krętowski
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland
- Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Hady Razak Hady
- Department of General and Endocrine Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland
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Głuszyńska P, Diemieszczyk I, Szczerbiński Ł, Krętowski A, Major P, Razak Hady H. Risk Factors for Early and Late Complications after Laparoscopic Sleeve Gastrectomy in One-Year Observation. J Clin Med 2022; 11:jcm11020436. [PMID: 35054132 PMCID: PMC8779692 DOI: 10.3390/jcm11020436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/10/2022] Open
Abstract
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.
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Affiliation(s)
- Paulina Głuszyńska
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, 15-089 Bialystok, Poland; (I.D.); (H.R.H.)
- Correspondence: ; Tel.: +48-85-831-8279
| | - Inna Diemieszczyk
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, 15-089 Bialystok, Poland; (I.D.); (H.R.H.)
| | - Łukasz Szczerbiński
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland; (Ł.S.); (A.K.)
| | - Adam Krętowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland; (Ł.S.); (A.K.)
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Hady Razak Hady
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, 15-089 Bialystok, Poland; (I.D.); (H.R.H.)
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Diemieszczyk I, Woźniewska P, Gołaszewski P, Drygalski K, Nadolny K, Ładny JR, Razak Hady H. Does weight loss after laparoscopic sleeve gastrectomy contribute to reduction in blood pressure? Pol Arch Intern Med 2021; 131:693-700. [PMID: 34075736 DOI: 10.20452/pamw.16023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Obesity‑related hypertension is a life threatening medical condition that significantly increases the risk of cardiovascular diseases and premature mortality. Effective treatment of obesity may be achieved by laparoscopic sleeve gastrectomy (LSG). This surgical method contributes not only to sustained weight loss but also to normalization of blood pressure. OBJECTIVES To evaluate the effect of weight loss after LSG on partial or full control of blood pressure. PATIENTS AND METHODS A retrospective analysis of medical and clinical data of 305 patients who had undergone LSG was performed. The bariatric effect of LSG was assessed by calculating percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and percentage of excess BMI loss (%EBMIL). Blood pressure status after surgery was categorized as partial or full hypertension resolution. RESULTS A total of 143 patients (46.9%) were diagnosed with hypertension preoperatively with median (IQR) hypertension duration of 7.52 (1.88-13.16) years. Hypertensive patients were older (49 vs 38.5 years) and had higher prevalence of coexisting diseases (type 2 diabetes, dyslipidemia, and obstructive sleep apnea) than patients with normal blood pressure. During 1‑year follow up, 90 patients (63%) used lower doses of antihypertensive medications and 33 patients (23%) discontinued the therapy. Twelve months after the surgery, median (IQR) %TWL in the control group was 32.5% (28.1%-37.7%), while in the hypertensive group, 29.1% (25.9%-33.6%) (P <0.001); %EWL was 62.9% (53%-74.6%) and 54.8% (47.4%-68.2%), respectively (P = 0.001), and %EBMIL 73.9% (59.5%-91.2%) and 63% (55%-80.5%), respectively (P = 0.002). CONCLUSIONS Laparoscopic sleeve gastrectomy is an effective method for the treatment of obesity‑ related hypertension. However, weight loss induced by LSG does not affect the blood pressure status after the surgery.
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Affiliation(s)
- Inna Diemieszczyk
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, Białystok, Poland
| | - Paulina Woźniewska
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, Białystok, Poland.
| | - Piotr Gołaszewski
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, Białystok, Poland
| | - Krzysztof Drygalski
- Clinical Research Center, Medical University of Bialystok, Białystok, Poland
| | - Klaudiusz Nadolny
- Department of Emergency Medical Service, Higher School of Strategic Planning, University of Dabrowa Gornicza, Dąbrowa Górnicza, Poland
| | - Jerzy R Ładny
- Department of Emergency Medicine, Medical University of Bialystok, Białystok, Poland
| | - Hady Razak Hady
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, Białystok, Poland
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Wysocki M, Małczak P, Wierdak M, Walędziak M, Hady HR, Diemieszczyk I, Proczko-Stepaniak M, Szymański M, Dowgiałło-Wnukiewicz N, Szeliga J, Pędziwiatr M, Major P. Utility of Inflammatory Markers in Detection of Perioperative Morbidity After Laparoscopic Sleeve Gastrectomy, Laparoscopic Roux-en-Y Gastric Bypass, and One-Anastomosis Gastric Bypass-Multicenter Study. Obes Surg 2021; 30:2971-2979. [PMID: 32347517 PMCID: PMC7305064 DOI: 10.1007/s11695-020-04636-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The most commonly performed bariatric operations are laparoscopic sleeve gastrectomy (LSG) and bypass surgeries (laparoscopic one-anastomosis gastric bypass (OAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB)), and predicting perioperative morbidity is crucial for early, safe patient discharge. We aimed to determine whether C-reactive protein (CRP) and white blood count (WBC) measured on the first postoperative day predicts perioperative morbidity in the first 30-days after LSG and bypass surgeries. Methods We retrospectively analyzed data for 1400 patients who underwent bariatric surgery in seven bariatric centers from 2014 to 2018. Patients were divided into a complicated group (patients with postoperative complications) and a non-complicated group. We also performed separate analyses for LSG and bypass surgeries. Results Patients were 929 women (66%) and 471 men (34%) with a median age of 42 years (range, 35–51 years); 1192 patients underwent LSG (85%), 120 underwent LRYGB (9%), and 80 underwent OAGB (6%). We performed ROC analyses to set cut-off points, followed by multivariate logistic regressions. CRP > 33.32 mg/L increased the odds ratio (OR) of perioperative complications after LSG 2.27 times, while WBC > 12.15 × 103/μL on postoperative day 1 was associated with a 3.34-times greater or of developing complications. WBC > 13.78 × 103/μL was associated with a 13.34-times higher or of perioperative morbidity in patients undergoing bypass surgeries. Conclusion Even slightly elevated CRP and WBC on postoperative day 1 should alert surgeons to the potential risk of perioperative morbidity.
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Affiliation(s)
- Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Hady Razak Hady
- First Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Inna Diemieszczyk
- First Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Szymański
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Jacek Szeliga
- Department of General, Gastroenterological, and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, Torun, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland.
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Diemieszczyk I, Głuszyńska P, Wojciak PA, Ładny JR, Razak Hady H. METABOLIC SYNDROME. ETIOLOGY AND PATHOGENESIS. Wiad Lek 2021; 74:2510-2515. [PMID: 34897013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The aim of the study was to assess the impact of individual components of the metabolic syndrome on the human body, taking into account their etiology and pathogenesis. This article is analytical analysis of scientific and medical literature basing on aspects of the etiology and pathogenesis of the metabolic syndrome. The key role in the pathogenesis of the metabolic syndrome is played by insulin resistance, which may be a result of lifestyle conditions (low physical activity, overweight or obesity) or genetic background. A certain role in the pathogenesis of the metabolic syndrome is also attributed to disorders of the hypothalamic-pituitary-adrenal axis in the form of increased cortisol control, which may initiate the development of abdominal obesity, insulin resistance, hypertension and dyslipidemia. Aforementioned factors (environmental, hormonal and genetic) lead to excessive fat tissue gathering. The excess of abdominal fat tissue - abdominal obesity - leads to insulin resistance, the concentration of which causes body mass gain. Such mechanism is dangerous for our health and may lead to the occurrence of type 2 diabetes and premature development of atherosclerosis with all its consequences such as atherosclerotic cardiovascular diseases including coronary artery disease.
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Affiliation(s)
- Inna Diemieszczyk
- 1ST DEPARTMENT OF GENERAL AND ENDOCRINE SURGERY, UNIVERSITY HOSPITAL OF BIALYSTOK, BIALYSTOK, POLAND
| | - Paulina Głuszyńska
- 1ST DEPARTMENT OF GENERAL AND ENDOCRINE SURGERY, UNIVERSITY HOSPITAL OF BIALYSTOK, BIALYSTOK, POLAND
| | | | - Jerzy Robert Ładny
- 1ST DEPARTMENT OF GENERAL AND ENDOCRINE SURGERY, UNIVERSITY HOSPITAL OF BIALYSTOK, BIALYSTOK, POLAND
| | - Hady Razak Hady
- 1ST DEPARTMENT OF GENERAL AND ENDOCRINE SURGERY, UNIVERSITY HOSPITAL OF BIALYSTOK, BIALYSTOK, POLAND
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Woźniewska P, Diemieszczyk I, Groth D, Szczerbiński Ł, Choromańska B, Błachnio-Zabielska A, Krętowski A, Hady HR. The influence of patient's age on metabolic and bariatric results of laparoscopic sleeve gastrectomy in 2-year observation. BMC Surg 2020; 20:323. [PMID: 33298009 PMCID: PMC7727122 DOI: 10.1186/s12893-020-00989-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 11/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background The incidence of obesity has been constantly growing and bariatric procedures are considered to be the most effective treatment solution for morbidly obese patients. The results of laparoscopic sleeve gastrectomy (LSG) may differ depending on patient’s age, gender, preoperative body mass index (BMI) and physical activity. Methods The aim of this study was to evaluate age-related differences in the outcome of LSG in terms of weight loss parameters, lipid and carbohydrate profile. The retrospective analysis of 555 patients who had undergone LSG was performed to compare the metabolic outcomes of surgery in individuals < 45 and ≥ 45 years old. Evaluation of weight loss parameters along with selected laboratory data was performed to demonstrate the results of LSG in 2 years follow-up. Results Overall, 238 males and 317 females (43%/57%) with median age of 43 years and median preoperative BMI of 46.41 (42.06–51.02) kg/m2 were analyzed. Patients in both groups presented significant weight loss at 24 months after the surgery with comparable percentage of total weight loss (40.95% in < 45 years old group and 40.44% in ≥ 45 years old group). The percentage of excess weight loss (78.52% vs. 74.53%) and percentage of excess BMI loss (91.95% vs. 88.01%) were higher in patients < 45 years old. However, the differences were not statistically significant (p = 0.662, p = 0.788 respectively). Patients under 45 years old experienced faster decrease in fasting glucose level that was observed after only 3 months (109 mg/dl to 95 mg/dl in < 45 years old group vs. 103.5 mg/dl to 99.5 mg/dl in ≥ 45 years old group, p < 0.001). Both groups presented improvement of lipid parameters during the observation. However, patients < 45 years old achieved lower values of LDL at 3 and 12 months follow-up (115 mg/dl vs. 126 mg/dl, p = 0.010; 114.8 mg/dl vs. 122 mg/dl, p = 0.002). Younger group of patients also showed superior improvement of triglycerides level. Conclusions LSG results in significant weight loss in all patients regardless age. In turn, superior and faster improvement in lipid and carbohydrate profile is achieved in patients under 45 years old.
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Affiliation(s)
- Paulina Woźniewska
- 1St Department of General and Endocrine Surgery, Medical University of Bialystok, ul. Marii Skłodowskiej-Curie 24A, 15-276, Bialystok, Poland.
| | - Inna Diemieszczyk
- 1St Department of General and Endocrine Surgery, Medical University of Bialystok, ul. Marii Skłodowskiej-Curie 24A, 15-276, Bialystok, Poland
| | - Dawid Groth
- Eastern Center of the Burns Treatment and Reconstructive Surgery, Independent Public Health Care Center in Łeczna, Łęczna, Poland
| | - Łukasz Szczerbiński
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Barbara Choromańska
- 1St Department of General and Endocrine Surgery, Medical University of Bialystok, ul. Marii Skłodowskiej-Curie 24A, 15-276, Bialystok, Poland
| | | | - Adam Krętowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Hady Razak Hady
- 1St Department of General and Endocrine Surgery, Medical University of Bialystok, ul. Marii Skłodowskiej-Curie 24A, 15-276, Bialystok, Poland
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Hady HR, Olszewska M, Czerniawski M, Groth D, Diemieszczyk I, Pawluszewicz P, Kretowski A, Ladny JR, Dadan J. Different surgical approaches in laparoscopic sleeve gastrectomy and their influence on metabolic syndrome: A retrospective study. Medicine (Baltimore) 2018; 97:e9699. [PMID: 29369197 PMCID: PMC5794381 DOI: 10.1097/md.0000000000009699] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/13/2017] [Accepted: 01/02/2018] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Dawid Groth
- 1st Department of General and Endocrinological Surgery
| | | | | | - Adam Kretowski
- Department of Endocrinology, Diabetology and Internal Medicine
| | - Jerzy Robert Ladny
- Department of Emergency Medicine and Disasters, Medical University of Bialystok, Bialystok, Podlaskie, Poland
| | - Jacek Dadan
- 1st Department of General and Endocrinological Surgery
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