To determine the effects imposed by laparoscopic sleeve gastrectomy (LSG) on
obesity-associated co-morbidities.
Patients & Methods: The study included 40 patients, 13 of them were morbid obese and 27 of
them were obese patients. To all of them, pre-operative evaluation for existence and associated
co-morbidities diabetes mellitus, dyslipidemia, hypertension obstructive sleep apnea syndrome,
depression, and anxiety or joint pain. All patients were subjected to through history taking clinical
examination and measurement with laboratory investigations including analysis lipid profile,
HBA1C determination of homeostasis model assessment of insulin resistance (HOMA-IR). All
patients underwent laparoscopic sleeve gastrectomy (LSG), operative time, hospital stay and
intraoperative and postoperative (PO) complications were registered. Postoperative monitoring
included evaluation of the percentage of excess weight loss (% EWL) and the excess of body
mass index loss (% EBMIL) at, 3, 6, 12, 24 months after surgery, the severity of associated comorbidities and HOMA-IR index was evaluated at 6, 12, 24 months after surgery.
Results: All patients were at least obese and had one or more co-morbidities in varied
combination, 23 (57.5%) were type 2 diabetes mellitus on oral antibiotic drug therapy 13 (32.5%)
patients were dyslipidemia, 21 (52.5%) patients were hypertensive, 26 (65%) had obstructive
sleep apnea syndrome, 17 (42.5%) patients had depression anxiety and 27 (67.5%) patients had
knee or hip joint pain. 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 %EWL and %EBMIL. BMI
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. |
