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. |
