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

Year 2020, Volume: 13 Issue: 1, 193 - 198, 21.01.2020

Onur Kılıç , Asli Mete Onur Birsen

https://doi.org/10.31362/patd.601112

Abstract

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.

Keywords

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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