Obezite için laparoskopik sleeve gastrektemi’nin 4 yıllık uzun dönem metabolik, ghrelin seviyesi ve komorbidite değişimi üzerine etkileri ve sonuçları.

Öz

Amaç: Laparoskopik Sleeve Gastrektemi’nin (LSG) orta ve uzun dönem etkilerini, pre-op ve post-op uzun dönem (4 yıl) ghrelin düzeylerinin karşılaştırılması, hastaların LSG sonrası uzun dönemde tekrar kilo alıp almadıkları, obeziteye eşlik eden komorbiditelerin değişimini araştırmaktır.

Dayanak ve arka plan: Laparoskopik sleeve gastrektomi, morbid obezite için tek ve nihai tedavi olarak oldukça yaygın yapılmaya başlanmıştır.  Olumlu kısa vadeli sonuçları içeren yayınlar mevcut, ancak uzun vadeli sonuçlar ve ghrelin ile LSG’nin ilişkisini ortaya koyan çalışmalar hala yetersiz.

Yöntem: Pamukkale Üniversitesi Genel Cerrahi Anabilim Dalı’nda morbid obezite tanısı ile cerrahi için seçilen, işlem öncesi ghrelin düzeylerine bakılan toplam 34 hastada, Ocak 2009 ve Aralık 2011 tarihleri arasında obezite tedavisi olarak LSG uygulandı. Hastaların ameliyattan sonra 1. ay, 3. ay, 6. ay, 12. ay ve daha sonrasında yıllık kontrolleri yapıldı. En sonunda, post-op 4. yılda hastalarla iletişim kurulup son kontrol ve tetkikleri için çağrıldı.

Bulgular: Çalışma kapsamına alınan 34 hastanın pre-op ağırlık ortalaması 132.93±19.25 kg iken, post-op 4. yıl 83±13.90 kg oldu. Ameliyat esnasında ortalama BMİ: 49.8±7.3 kg/m2 idi. LSG ameliyatı sonrası 4. yıl sonunda BMİ: 29.18±5.6 kg/m2 olarak bulundu. Çalışmaya dahil edilen hastalarda pre-op ghrelin değeri 672±143 pg/ml iken, post-op 4.yıl ghrelin değeri 164±43 pg/ml oldu. Pre-op ve post-op 4. yıl değerleri arasındaki fark istatistiksel olarak anlamlıydı. Çalışma grubundaki hiçbir hastada, majör komplikasyon ya da takip süresince mortalite izlenmedi.

Sonuç: LSG sonrası ghrelin düzeyi, midenin fundus ve gövdesinin rezeksiyonu nedeniyle azaltılarak karbonhidrat ve yağ tüketimini düşürür. LSG ile obezite tedavisi Tip 2 DM ve HT gibi komorbiditelerin semptomlarını azaltarak hastaların sağlık durumları üzerinde doğrudan yararlı etkiye sahiptir. Elde ettiğimiz verilere göre, LSG morbid obezitenin tedavisinde emniyetli ve etkin bir yöntemdir, uzun dönemli olumlu metabolik etkilere sahiptir, yaşam kalitesi ve konforunu artırıcı bir prosedürdür.

Anahtar Kelimeler

• Laparoskopik sleeve gastrektomi,morbid obezite,girelin,komorbidite

Effects and results of laparoscopic sleeve gastrectomy for obesity on 4-year long-term metabolic, ghrelin level and comorbidity change.

Abstract

Purpose: The aim of this study is to investigate the moderate and long-term effects of Laparoscopic Sleeve Gastrectomy (LSG), the comparison of pre-op and post-op long-term (4 years) ghrelin levels, whether patients have gained weight again after LSG or not, and the change of the comorbidities accompanying obesity.

Basis and background: Laparoscopic sleeve gastrectomy has become quite common as a single and definitive treatment for morbid obesity.  There are publications regarding the positive short-term outcomes, but long-term outcomes and studies revealing the correlation of ghrelin and LSG are still insufficient.

Method: LSG was administered as an obesity treatment between January 2009 and December 2011 in a total of 34 patients selected for surgery with the diagnosis of morbid obesity, whose pre-treatment ghrelin levels were measured, at Pamukkale University Department of General Surgery. 1st month, 3rd month, 6th month, 12th month and then annual controls of the patients after the surgery were conducted. Finally, patients were contacted in the post-op 4th year and they were called for their final control and examinations.

Findings: The mean pre-op weight of the 34 patients included in the study was 132.93±19.25 kg, whereas the mean weight in the post-op 4th year was 83±13.90 kg. During the surgery, mean BMI: was 49.8±7.3 kg/m2. At the end of 4th year after the LSG surgery, BMI: was found as 29.18±5.6 kg/m2. While the pre-op ghrelin value of the patients included in the study was 672±143 pg/ml, their post-op 4th year ghrelin value became 164±43 pg/ml. The difference between the pre-op and post-op 4th year was statistically significant. None of the patients in the study group had any major complications or mortality during follow-up.

Conclusions: The ghrelin level after LSG gradually reduces the carbohydrate and fat consumption due to the resection of the fundus and the body of the stomach. Obesity therapy with LSG has a direct beneficial effect on the health status of the patients by reducing the symptoms of the comorbidities such as Type 2 DM and HT. According to the findings, LSG is a safe and effective method in the treatment of morbid obesity, has long-term positive metabolic effects, and is a procedure that increases the quality of life and comfort.

 

Keywords

• Laparoscopic sleeve gastrectomy,morbid obesity,ghrelin,comorbidity

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