Laparoskopic sleeve gastrektomi'nin kısa ve orta dönem sonuçları, tip 2 diyabet ve hipertansiyona etkileri

Öz

Amaç: Laparoskopik sleeve gastrektomi (LSG) son yıllarda yaygın olarak kullanılan primer bariatrik cerrahi teknik haline gelmiştir. Bu çalışmada, LSG'nin kilo kaybındaki kısa ve orta dönem etkinliğini, eşlik eden tip 2 diyabet ve hipertansiyona (HT) olan etkilerini araştırmayı amaçladık.

Gereç ve Yöntem: Bu retrospektif çalışmaya Ocak 2009 - Aralık 2011 arasında LSG uygulanan ve postoperatif 6. ay, 1. yıl ve 3. yıl takip kayıtlarına ulaşılabilen seksen iki hasta dahil edildi. Ameliyat öncesi boy/kilo değerleri, komorbiditeler, HT ve/veya tip 2 diyabet için ilaç kullanımı ve postoperatif 6. ay, 1. yıl, 3. yıllık ve 5. yıl verilerindeki değişiklikler kaydedildi.

Bulgular: Ameliyat öncesi verilerle karşılaştırıldığında, postoperatif 6. ay, 1. yıl ve 3. yıl takiplerinde vücut kitle indeksindeki (VKİ) azalma istatistiksel olarak anlamlıydı (p=0,0001, her biri için). Üçüncü yılda 1. yıla göre VKİ artışı (p=0,0001), operasyon öncesine göre 3. yılda diyabet ilacı ve antihipertansif ilaç kullanım sıklığında azalma izlendi (p=0,0001, herbiri için).

Sonuç: Morbid obezitenin cerrahi tedavisinde primer tedavi olarak uygulanabilen LSG, düşük mortalite ve morbidite oranları ile çok etkili ve güvenilir bir yöntemdir. Ek olarak, tip 2 diyabet ve HT gibi komorbiditelerde önemli iyileşme sağlar. Orta dönemde biraz kilo alımı olsa da, LSG'nin kısa ve orta dönem sonuçları etkili bir cerrahi teknik olduğunu göstermektedir.

Anahtar Kelimeler

• Sleeve gastrektomi,komorbidite,bariatrik cerrahi,orta ve uzun dönem sonuçlar

Short and midterm results of laparoscopic sleeve gastrectomy and its effects hypertension and type 2 diabetes

Öz

Purpose: Laparoscopic sleeve gastrectomy (LSG) has become a widely used primary bariatric surgical technique in recent years. We aimed to investigate the short and mid-term effectiveness of LSG in weight loss and its effects on comorbid type 2 diabetes and hypertension (HT).

Materials and Methods:  Eighty-two patients who underwent LSG between January 2009 and December 2011 and whose postoperative 6-month, 1-year, and 3-year follow-up records were available were included in this retrospective study. Preoperative height/weight values, comorbidities, using drugs for HT and/or type 2 diabetes, and changes in postoperative 6-month, 1-year, 3-year, and 5-year data were noted.

Results: When we compared with the preoperative data, decrease in body mass index (BMI) at the postoperative 6-month, 1-year, and 3-year follow-ups was statistically significant (p=0.0001, for each). An increase in BMI was observed at 3-year follow-up than at 1-year follow-up (p=0.0001). Decrease in using diabetes medication and antihypertensive drug use was observed at postoperative 3 years compared with the preoperative data (p=0.0001, for each).

Conclusion: LSG, which can be applied as a primary treatment in surgical treatment of morbid obesity, is a very effective and reliable method with low mortality and morbidity rates. In addition, it provides significant improvements in comorbidities such as type 2 diabetes and HT. Although there is some weight gain in the mid-term, the short and mid-term results of LSG showed that it is an effective surgical technique.

Anahtar Kelimeler

• Sleeve gastrectomy,comorbidity,bariatric surgery,short and mid-term results

Kaynakça

1. Antipatis VJ, Gill TP. Obesity as a global problem. In: Björntorp P, ed. International textbook of obesity. Chichester: John Wiley & Sons Ltd, 2001;3-21.
2. Haslam DW, James WP. Obesity. Lancet. 2005;366:1197-1209.
3. Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg 2004;14:1157-1164.
4. Atila K. Morbid obezitenin cerrahi tedavisi. Archives of clinical toxicology. 2014;1:23-27. Turkey.
5. Sanchez SR, Masdevall C, Baltasar A, et al. Short and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish national registry. Obes Surg 2009;19:1203-1210.
6. Menenakos E, Stamou K, Albanopoulos K, Papailiou J, Theodorou D, Leandros E. Laparoscopic sleeve gastrectomy performed with intent to treat morbid obesity: a prospective single-center study of 261 patients with a median follow-up of 1 year. Obes Surg 2010;20:276-282.
7. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as atreatment for the high-risk super-obese patient. Obes Surg 2004;14:492-497.
8. Noah J, Smith A, Birch D, Karmali S. The metabolic effects of laparoscopic sleeve gastrectomy: a review. J Minim Invasive Surg Sci 2013;2:3-7.

9. Nocca D, Guillaume F, Noel P, et al. Impact of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on HbA1c blood level and pharmacological treatment of type 2 diabetes mellitus in severe or morbidly obese patients. Results of a multicenter prospective study at 1 year. Obes Surg 2011;21:738-743.
10. Zhou D, Jiang X, Ding W, et al. Impact of bariatric surgery on ghrelin and obestatin levels in obesity or type 2 diabetes mellitus rat model. J Diabetes Res 2014;2014:569435.
11. Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg 2008;12:662-667.
12. Park JY, Song D, Kim YJ. Clinical experience of weight loss surgery in morbidly obese Korean adolescents. Yonsei Med J 2014;55:1366-1372.
13. Alvarenga ES, Lo Menzo E, Szomstein S, Rosenthal RJ. Safety and efficacy of 1020 consecutive laparoscopic sleeve gasterctomies performed as a primary treatment modality for morbid obesity. A single-center experience from the metabolic and bariatric surgical accreditation quality and improvement program. Surg Endosc 2016;30:2673-2678.
14. Noel P, Nedelcu M, Eddbali I, Manos T, Gagner M. What are the long-term results 8 years after sleeve gastrectomy? Surg Obes Relat Dis 2017;13:1110-1115.
15. Dudric V, Constantea N, Crisan D, et al. Laparoscopic sleeve gastrectomy: short and mid-term outcome. HVM Bioflux 2016;8:171-175.
16. Greenspan SF, Gardner DG. Basic and clinical endocrinology. 7th ed. NewYork: McGraw-Hill, 2004.
17. Dunitz M, Kopelman PG. The management of obesity and related disorders. 1st ed. London, 2001.
18. The trials of hypertension prevention collaborative research group. Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The trials of hypertension prevention, phase II. Arch Intern Med 1997;157:657-667.
19. Sarkhosh K, Birch DW, Shi X, Gill RS, Karmali S. The impact of sleeve gastrectomy on hypertension: a systematic review. Obes Surg 2012;22:832-837.
20. Leonetti F, Capoccia D, Coccia F, et al. Obesity, type 2 diabetes mellitus, and other comorbidities: a prospective cohort study of laparoscopic sleeve gastrectomy vs medical treatment. Arch Surg 2012;147:694-700.
21. Slater BJ, Bellatorre N, Eisenberg D. Early postoperative outcomes and medication cost savings after laparoscopic sleeve gastrectomy in morbidly obese patients with type 2 diabetes. J Obes 2011;2011:350523.
22. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012;26;366:1567-1576.
23. Shah PS, Todkar JS, Shah SS. Effectiveness of laparoscopic sleeve gastrectomy on glycemic control in obese Indians with type 2 diabetes mellitus. Surg Obes Relat Dis 2010;6:138-141.
24. Casella G, Abbatini F, Calì B, Capoccia D, Leonetti F, Basso N. Ten-year duration of type 2 diabetes as prognostic factor for remission after sleeve gastrectomy. Surg Obes Relat Dis 2011;7:697-702.
25. Hoogerboord M, Wiebe S, Klassen D, Ransom T, Lawlor D, Ellsmere J. Laparoscopic sleeve gastrectomy: perioperative outcomes, weight loss and impact on type 2 diabetes mellitus over 2 years. Can J Surg 2014;57:101-105.
26. Gill RS, Birch DW, Shi X, Sharma AM, Karmali S. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis 2010;6:707-713.
27. Roslin MS, Dudiy Y, Weiskopf J, Damani T, Shah P. Comparison between RYGB, DS, and VSG effect on glucose homeostasis. Obes Surg 2012;22:1281-1286.
28. Juodeikis Ž, Brimas G. Long-term results after sleeve gastrectomy: a systematic review. Surg Obes Relat Dis 2017;13:693-699.
29. Makary MA, Clark JM, Shore AD, et al. Medication utilization and annual health care costs in patients with type 2 diabetes mellitus before and after bariatric surgery. Arch Surg 2010;145:726-731.