Impact of Laparoscopic Sleeve Gastrectomy on Obesity-associated comorbidities: A two-year follow-up prospective study
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Objectives: To determine the effects imposed by laparoscopic sleeve gastrectomy (LSG) on obesity-associated co-morbidities. Patients & Methods: The study included 40 patients; 13 morbid obese and 27 obese patients. All patients were evaluated preoperatively for existence and severity of co-morbidities and determination of Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). All patients underwent LSG; operative time, hospital stay, and intraoperative and postoperative (P0) complications were registered. Postoperative monitoring included evaluation of the percentage of excess weight loss (%EWL) and the percentage of excess body mass index loss (%EBMIL) at 3. 6. 12 and 24 months after surgery; the frequency of associated co-morbidities and HOMA-IR index was evaluated at 6, 12 and 24 months after surgery. Results: Mean operative time was 157.8±17 minutes and mean duration of hospital stay was 5.5±0.9 days. No conversion to open surgery. All patients showed progressive weight loss throughout the follow-up period with progressively increasing VOEWL and %EBMIL. BM1 strata showed significant progressive change throughout follow-up period; 27 women were overweight and only 13 women were obese. All obesity-associated co-morbidities showed progressive improvement or resolution. At end of follow-up, 7 patients still had co-morbidities, 9 patients had improved co-morbidities and 24 patients had resolved co-morbidities with an improvement and resolution rates of 22.5% and 60%, respectively and only 11 co-morbidities were recorded at end of follow-up in various combinations in the 7 non-responders. Preoperatively, all patients were insulin resistant; however, at the end of follow-up period HOMA-IR index of all patients was within the non-resistant range. Conclusion: Bariatric surgery effectively improves obesity-associated co-morbidities and could be considered as non-pharmacological therapeutic modality for these co-morbidities. Laparoscopic gastric sleeve is a safe and effective appropriate surgical procedure for morbidly obese patients with associated co-morbidities.