Laparoskopik sleeve gastrektomi ve intragastrik balon uygulaması: Morbid obes hastalarda erken dönem sonuçlarımız

Year 2017, Volume: 2 Issue: 2, 35 - 38, 15.08.2017

Hacı Çaycı Umut Eren Erdogdu

https://doi.org/10.25000/acem.324199

Cited By: 3

Abstract

Amaç: Morbid obes hastalarda kilo verilmesi için endoskopik intragastrik balon uygulaması (İGB) ve bariatrik cerrahi yöntemlerinden biri olan laparoskopik sleeve gastrektomi (LSG) yaygın olarak kullanılmaktadır. Çalışmamızda morbid obes hastalarda LSG ve İGB uygulanması sonuçlarımızın değerlendirilmesi amaçlanmıştır.

Yöntemler: Morbid Obesite (Vücut Kitle İndeksi-VKİ ≥40 kg/m2) nedeniyle aynı dönemde tedavi edilen ve 12 aylık takip dönemini tamamlayan 119 hastanın verileri retrospektif olarak değerlendirildi. Çalışmada İGB uygulanan 20 hasta ve LSG yapılan 99 hasta yer aldı. Hastaların demografik verileri, yandaş hastalık, preoperatif ve postoperatif 12. ayda kilo ve VKİ verileri, verilen fazla kilo ve yüzdeleri, verilen fazla VKİ ve yüzdeleri kaydedilip gruplar karşılaştırıldı.

Bulgular: LSG ve İGB grupları arasında preoperatif kilo açısından istatiksel anlamlı farklılık olduğu görüldü (sırasıyla 124,3 ± 17 ve 145,5 ± 24,7; p<0,001). Postoperatif 12. ayda ölçülen kilo değerlendirildiğinde İGB grubunda ortalama 119,2 ±28,5 kg ve LSG grubunda 78,9 ± 12,9 kg saptandı (p<0,001). İGB grubundaki hastaların 12.ay sonunda ortalama 26,3 ±12,8 kg kilo verdiği, LSG grubundaki hastalarında 45,35 ±12,2 kg kilo verdiği görüldü (p<0,001). Postoperatif 12. ayda saptanan verilen fazla kilo yüzdesi İGB grubunda 33,42 ±9,2%, LSG grubunda 67,68 ±14,9% saptandı (p‹0,001). Postoperatif 12.ayda saptanan verilen fazla VKİ yüzdesi açısından İGB grubunda 41 ±17,3%, LSG grubunda 81,48  ±18,8% saptandı (p<0,001).

Sonuç: Morbid obes hastalarda endoskopik İGB uygulaması cerrahiye uygun olmayan veya cerrahi tedaviyi tercih etmeyen hastalarda etkin ve güvenli bir tedavi seçeneği olarak tercih edilebilir. 

Keywords

Morbid obesite, laparoskopik sleeve gastrektomi

Laparoscopic sleeve gastrectomy versus endoscopical intra-gastric balloon placement: early results of morbidly obese patients

Abstract

Aim: Endoscopic intra-gastric balloon (IGB) placement and laparoscopic sleeve gastrectomy (LSG) are widely used treatment modalities for weight loss in patients with morbid obesity. The aim of our study was to evaluate the results of these two methods in patients with morbid obesity.

Material and Methods: The data of 119 patients who were treated during the same time period for morbid obesity (Body Mass Index (BMI) ≥40 kg/m2) and completed a 12-month follow-up period were evaluated retrospectively. The study comprised twenty patients who underwent IGB placement and 99 LSG patients. Patients from these two groups were compared according to their demographic data; rate of comorbidity; weight and BMI changes both preoperatively and postoperatively at the 12 months; excess weight loss (EWL); and excess BMI loss (EBL).

Results: Evaluation of postoperative 12th month weights showed a mean weight of 119.2 ±28.5 kg in the IGB group and 78.9 ±12.9 kg in the LSG group (p<0.001). The patients in the IGB group had lost 26.3 ±12.8 kg by the end of the 12th month, while patients in the LSG group had lost 45.35 ±12.2 kg (p<0.001). EWL recorded at the postoperative 12th month was 33.42 ±9.2 % in the IGB group and 67.68 ±14.9 % in the LSG group (p<0.001); EBL% at the postoperative 12th month was 41 ±17.3% in the IGB group and 81.48 ±18.8% in the LSG group (p<0.001). 

Conclusion: In patients with morbid obesity, endoscopic IGB placement may still be preferred as an effective and safe alternative in patients who decline or are unsuitable for surgery.

Keywords

Morbid obesity, laparoscopic sleeve gastrectomy

References

• 1. ProspectiveStudies Collaboration, Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009;373 (9669):1083–96.
• 2. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of comorbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009;9:88.
• 3. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA 2014;311:74-86.
• 4. ASGE/ASMBS Task Force on Endoscopic Bariatric Therapy, Ginsberg GG, Chand B, Cote GA, Dallal RM, Edmundowicz SA, Nguyen NT, et al. A pathway to endoscopic bariatric therapies. Gastrointest Endosc 2011;74:943-53.
• 5. Poobalan AS, Aucott LS, Smith WC, Avenell A, Jung R, Broom J. Long-term weight loss effects on all cause mortality in overweight/ obese populations. Obes Rev 2007;8:503-13.
• 6. Mathus-Vliegen EM. Endoscopic treatment: the past, the present and the future. Best Pract Res Clin Gastroenterol 2014;28:685-702.
• 7. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013;23:427–36.
• 8. Adams TD, Davidson LE, Litwin SE, Kolotkin RL, LaMonte MJ, Pendleton RC, et al.Health benefits of gastric bypass surgery after 6 years. Jama 2012;308:1122–31.
• 9. Sarela AI, Dexter SP, O’Kane M, Menon A, McMahon MJ. Long-term follow-up after laparoscopic sleeve gastrectomy: 8–9-year results. Surg Obes Relat Dis 2012;8:679-84.
• 10. Cayci HM, Erdogdu UE, Karaman K, Budak E, Taymur İ, Buyukuysal C. Does Weight Gain During the Operation Wait Time Have an Impact on weight Loss After Laparoscopic Sleeve Gastrectomy?. Obes Surg 2017;27:338-42.
• 11. Gleysteen JJ. A history of intragastric balloons. Surg Obes Relat Dis 2016;12:430-5.
• 12. Genco A, Bruni T, Doldi SB, Forestieri P, Marino M, Busetto L, et al. BioEnterics Intragastric Balloon: the Italian experience with 2.515 patients. Obes Surg 2005;15:1161-4.
• 13. Göttig S, Daskalakis M, Weiner S, Weiner RA. Analysis of safety and efficacy of intragastric balloon in extremely obese patients. Obes Surg 2009;19:677–83.
• 14. Coskun H, Bostanci O, Dilege E, Bozbora A. BioEnterics intragastric balloon: clinical outcomes of the first 100 patients – a Turkish experience. Obes Surg 2008;18:1154–6.
• 15. Mui WL, Ng EK, Tsung BY, Lam CH, Yung MY. Impact on obesity-related illnesses and quality of life following intragastric balloon. Obes Surg 2010;20:1128-32.
• 16. Imaz I, Martínez-Cervell C, García-Alvarez EE, Sendra-Gutiérrez JM, González-Enríquez J. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg 2008;18:841-6.
• 17. Casazza K, Fontaine KR, Astrup A, Birch LL, Brown AW, Bohan Brown MM, et al. Myths, presumptions, and facts about obesity. N Engl J Med 2013;368:446–54.
• 18. Dumonceau JM. Evidence-based review of the Bioenterics intragastric balloon for weight loss. Obes Surg 2008;18:1611-7.
• 19. Machytka E, Klvana P, Kornbluth A, Peikin S, Mathus-Vliegen LE, Gostout C, et al. Adjustable intragastric balloons: a 12-month pilot trial in endoscopic weight loss management. Obes Surg 2011;21:1499-507.
• 20. ASGE Bariatric Endoscopy Task Force; ASGE Technology Committee, Abu Dayyeh BK, Edmundowicz SA, Jonnalagadda S, Kumar N, Larsen M, Sullivan S, et al. Endoscopic bariatric therapies. Gastrointest Endosc 2015;81:1073-86.
• 21. Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg 2014;149:275-87.
• 22. Benaiges D, Más-Lorenzo A, Goday A, Ramon JM, Chillarón JJ, Pedro-Botet J, et al. Laparoscopic sleeve gastrectomy: More than a restrictive bariatric surgery procedure? World J Gastroenterol 2015;21:11804-14.
• 23. Özgüç H, Narmanlı M, Duman E. Treatment of sleeve gastrectomy leak with an endoscopic stent. Ulus Cerrahi Derg 2014;30:169-72.
• 24. Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 2013;27:240-45.
• 25. Rosenthal RJ; International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 2012;8:8-19.
• 26. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012;366:1567–76.
• 27. Peterli R, Steinert RE, Woelnerhanssen B, Peters T, Christoffel-Courtin C, Gass M, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg 2012;22:740–8.
• 28. Lee WJ, Chong K, Ser KH, Lee YC, Chen SC, Chen JC, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg 2011;146:143–8.