Page 3 - World Journal of Laparoscopic Surgery

WJOL S
WJOLS

10.5005/jp-journals-10033-1301
Short- and Long-term Effects of LSG on Body Weight and Glucose Homeostasis in Diabetic Patients
ReSeaRch aRticLe

Short- and Long-term Effects of Laparoscopic Sleeve

Gastrectomy on Body Weight and Glucose
Homeostasis in Diabetic Patients

1 Mohamed Abdelmohsen, Hazem Badr
2

ABSTRACT Source of support: Nil
Introduction: Laparoscopic sleeve gastrectomy (LSG) is Conflict of interest: None
being performed more frequently and is currently very “trendy”
among laparoscopic surgeons involved in bariatric surgery.
Laparoscopic sleeve gastrectomy is associated with a marked INTRODUCTION
reduction of ghrelin secretion, which is produced by the gastric Obesity is defined as body mass index (BMI) > 30 kg/m .
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fundus involved in mealtime hunger regulation, and it is also
known to extend several diabetogenic effects. Obesity is increasing in prevalence worldwide with
economic costs. Obesity and its complications lead to
Aim: The aim of this study is to assess the short- and long-
term effects of LSG on body weight and glucose homeostasis other significant costs, such as missed days of work and
in morbidly obese diabetic patients. a decrease in life expectancy. 1
Materials and methods: This is a prospective study that was Body mass index is considered to represent the most
conducted on 40 diabetic patients randomly selected suffering practical measure of a person’s adiposity. It is calculated
from morbid obesity that had type II diabetes mellitus (T2DM). by dividing the weight in kilograms by the height in
Patients were managed by LSG in AL-Zahraa Hospital, Faculty meters squared (kg/m ). Bariatric surgical procedures
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of Medicine for girls, Al-Azhar University, from January 2012
to December 2015, to assess the short- and long-term effects affect weight loss through two fundamental mechanisms:
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of the procedure on glucose homeostasis. Malabsorption and restriction. Selection and follow-up
Results: The study was conducted on 40 patients of morbid should be carried out by a team including surgeon, inter-
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obesity that had T2DM. The preoperative mean fasting blood nist, dietitian, and psychiatrist. Success includes weight
glucose (FBG) level was 209.3 ± 36.6 (156–299) mg/dL and loss of 25% or more, absence of major complications, and
postoperatively was 172.5 ± 29 (130–250) mg/dL, 125.6 ± 16.7
(99–169) mg/dL, 111.7 ± 20.9 (77–167) mg/dL, 105 ± 18.3 reversal of obesity-related diseases like type II diabetes
(73–137) mg/dL, and 102.9 ± 21 (70–145) mg/dL at 1 day and mellitus (T2DM) and sleep apnea. Best results occur with
3, 6, 9, and 12 months respectively. Postoperatively, the FBG gastric bypass and biliopancreatic diversion. Late weight
levels were improved with significant declining at 1 day (p < 0.001), regain was common with horizontal gastroplasty and is
3 months (p < 0.001), and 6 months (p < 0.004) but nonsignificant
declining at 9 months (p < 0.25) and 12 months (p = 1). more common after vertical banded gastroplasty than
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gastric bypass. Some surgeons advocate that a staged
Conclusion: Laparoscopic sleeve gastrectomy is an effective
surgical treatment for most severely or morbidly obese patients procedure is performed in which a sleeve gastrectomy
with DM. Weight loss is effective treatment for patients with (SG) is performed initially. Later, once some weight loss
these medical problems. The SG is associated with a high rate is achieved a completion gastrectomy is combined with
of resolution of T2DM at 12 months after surgery in severely a Roux reconstruction. The laparoscopic sleeve gastrec-
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obese patients with T2DM.
tomy (LSG) is being performed more frequently and is
Keywords: Body mass index, Laparoscopic sleeve gastrec- currently very “trendy” among laparoscopic surgeons
tomy, Morbid obesity, Type II diabetes mellitus.
How to cite this article: Abdelmohsen M, Badr H. Short- and involved in bariatric surgery. The LSG is not a new
Long-term Effects of Laparoscopic Sleeve Gastrectomy on Body operation, as it is the restrictive part of a more complex
Weight and Glucose Homeostasis in Diabetic Patients. World malabsorptive bariatric procedure. 6
J Lap Surg 2017;10(2):45-50. Nutritional deficiencies can occur after gastric bypass.
Deficiency of iron (6–52%), folate (22–63%), and vitamin
B12 (3–37%) is common postoperatively and contributes
1 Assistant Lecturer, Consultant
2
1 Department of Surgery, Al-Sabah Hospital, Kuwait, Kingdom to the development of anemia found in up to 54% of
of Saudi Arabia patients. Increased bone resorption after gastric bypass
2 Department of Surgery, Al-Azhar University, Cairo, Egypt has also been demonstrated and patients should be coun-
Corresponding Author: Mohamed Abdelmohsen, Assistant seled regarding this potential problem. Routine supple-
Lecturer, Department of Surgery, Al-Sabah Hospital, Kuwait mentation with iron, vitamin B12, folate, and calcium
Kingdom of Saudi Arabia, Phone: +0096560463440, e-mail: following gastric bypass will prevent the majority of
mohsenroom@yahoo.com
these deficiencies. In SG, avoiding the intestinal bypass
World Journal of Laparoscopic Surgery, May-August 2017;10(2):45-50 45