Laparoscopic Sleeve Gastrectomy induces Weight Reduction, reduces Plasma Ghrelin levels and improves Insulin Sensitivity in Non-diabetic Obese Patients
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Objectives: To evaluate short-term outcome of laparoscopic sleeve gastrectomy (LSG) in terms of changes of body weight (BW), insulin resistance (IR) and plasma ghrelin levels in non-diabetic obese patients. Patients & Methods: The study included 33 patients with body mass index (BMI)>30 kg/m2, normo-glycemia and no associated comorbidities. All patients underwent determination of BW and BMI and estimation of fasting blood glucose (FBG), plasma insulin (FPI) and plasma ghrelin level and calculation of Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) preoperatively and at 3 and 6 postoperative (PO) months. All patients underwent LSG and collected surgical data included operative time, time till l st oral intake, duration of PO hospital stay and frequency and type of complications. Results: All surgeries passed smoothly without intraoperative complications or conversion to open procedure within a mean operative time of 150.8±25 minutes. Mean duration till is' oral intake and PO hospital stay was 2.6±0.5 and 5.1±1.5 days, respectively. All patients showed progressive BW loss with significantly lower weight at 3- and 6- m PO compared to preoperative BW. Percentage of excess weight loss (%EWL) at 6-m PO was significantly higher compared to 3-m PO °/oEWL. All patients showed steady progressive significant decrease of their FBG, FPI and plasma ghrelin levels with significant reduction of HOMA-IR index. Percentage of EWL showed a positive significant correlation with the percentage of decrease of HOMA-IR at 3-m PO, and with the percentage of decrease of plasma ghrelin level at 6-m PO. Conclusion: LSG is feasible and easy to perform with acceptable surgical outcome. LSG induced progressive significant EWL through a combination of improved insulin sensitivity and utilization of glucose during the early PO phase and reduction of plasma ghrelin concentration with subsequent appetite suppression and decreased food intake during the late PO phase.