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

Yıl 2020, Cilt: 13 Sayı: 1, 193 - 198, 21.01.2020

Onur Kılıç , Asli Mete Onur Birsen

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

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.

Öz

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.

 

Anahtar Kelimeler

Laparoscopic sleeve gastrectomy, morbid obesity, ghrelin, comorbidity

Kaynakça

• 1. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2015.
• 2. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC public health. 2009;9(1):88.
• 3. Arias E, Martínez PR, Li VKM, Szomstein S, Rosenthal RJ. Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obesity surgery. 2009;19(5):544-8.
• 4. Menenakos E, Stamou KM, 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. Obesity surgery. 2010;20(3):276-82.
• 5. Gumbs AA, Gagner M, Dakin G, Pomp A. Sleeve gastrectomy for morbid obesity. Obesity Surgery. 2007;17(7):962-9.
• 6. Müller TD, Nogueiras R, Andermann ML, Andrews ZB, Anker S, Argente J, et al. Ghrelin. Molecular metabolism. 2015;4(6):437-60.
• 7. Sato T, Ida T, Nakamura Y, Shiimura Y, Kangawa K, Kojima M. Physiological roles of ghrelin on obesity. Obesity research & clinical practice. 2014;8(5):e405-e13.
• 8. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obesity surgery. 1998;8(3):267-82.
• 9. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obesity surgery. 2004;14(4):492.
• 10. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obesity surgery. 2013;23(4):427-36.
• 11. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Annals of surgery. 2010;252(2):319-24.
• 12. Gadiot RP, Biter LU, van Mil S, Zengerink HF, Apers J, Mannaerts GH. Long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results. Obesity surgery. 2017;27(1):59-63.
• 13. Lee W-J, Ser K-H, Chong K, Lee Y-C, Chen S-C, Tsou J-J, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion. Surgery. 2010;147(5):664-9.
• 14. Abbatini F, Capoccia D, Casella G, Coccia F, Leonetti F, Basso N. Type 2 diabetes in obese patients with body mass index of 30–35 kg/m 2: sleeve gastrectomy versus medical treatment. Surgery for Obesity and Related Diseases. 2012;8(1):20-4.
• 15. Sarkhosh K, Birch DW, Shi X, Gill RS, Karmali S. The impact of sleeve gastrectomy on hypertension: a systematic review. Obesity surgery. 2012;22(5):832-7.16. Beckman LM, Beckman TR, Earthman CP. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass procedure: a review. Journal of the American Dietetic Association. 2010;110(4):571-84.
• 17. Kotidis EV, Koliakos G, Papavramidis TS, Papavramidis ST. The effect of biliopancreatic diversion with pylorus-preserving sleeve gastrectomy and duodenal switch on fasting serum ghrelin, leptin and adiponectin levels: is there a hormonal contribution to the weight-reducing effect of this procedure? Obesity surgery. 2006;16(5):554-9.
• 18. Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Annals of surgery. 2008;247(3):401-7.
• 19. Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, Gfrerer L, Ludvik B, Zacherl J, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obesity surgery. 2010;20(5):535-40.