Laparoscopic sleeve gastrectomy could Adjust the hyperandrogenic milieu And help induction of ovulation in Infertile morbidly obese PCOS women
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Objectives: The present study aimed to evaluate the surgical safety and feasibility of laparoscopic sleeve gastrectomy (LSG) and its applicability as a line of management of infertile polycystic ovary syndrome (PCOS) women. Patients & Methods: The study included 23 infertile PCOS women with mean age of 29.4±2.1 years and mean preoperative body mass index (BMI) of 38.9±2 kg/m2. Twelve women had primary infertility and eleven women had secondary infertility. All patients underwent transvaginal ultrasonographic (TVU) examination and measurements of body weight (BW), height and BMI was calculated. Fasting serum testosterone and steroid hormone binding-globulin (SHBG) level were estimated and free androgen index (FM) was calculated. All patients underwent LSG and operative time, hospital stay, and surgery-related and co-morbidities related complications were registered. Body weight and BM!, hormonal assay and FM were evaluated at 3 and 6- months but ovulation was monitored monthly. Results: All patients passed smoothly without intraoperative complications or conversion to open procedure with a mean operative time was 155±11.2 minutes and mean duration of hospital stay was 3.1±0.9 days. Three patients were re-admitted; two diabetic patients developed wound infection and the 3"I patient had a severe asthmatic attack, all responded to conservative treatment. There was significant progressive BW reduction with a progressive increase of percentage of excess weight loss (VDEWL) and %EBMIL at 6 months after surgery compared to percentages reported at 3 months after surgery. Sixteen women developed regular ovulatory cycles for a success rate of 69.6% and a positive significant correlation with the %EBMIL. Amelioration of androgenism was evident with significantly lower serum testosterone and higher SHBG with significant decrease of FAL Conclusion: PCOS is a frequent association with obesity and bariatric surgery may be considered as an effective management for amelioration of hyperandrogenemic milieu with subsequent ovulation induction success rate of 69.6%. LSG is a safe procedure with high %EBMIL approaching 47% and could be considered an appropriate therapeutic line for such patients.