Page 35 - World Journal of Laparoscopic Surgery

WJOLS

Obesity-related Metabolic Comorbidities Remission in Postbariatric Surgery Patients
procedures proved equally effective in the resolution of of the surgery defines a patient’s total or partial remis-
comorbidities and the weight loss. 13 sion. 22-24 A Swedish study showed more benefits with the
This change, both in weight and comorbidities, bypass, although it is worth mentioning that this study
directly impacts mortality, with a decrease between 29 did not include the gastric sleeve. 13
and 40% and with improvements in terms of life expec- Bariatric surgery has proved to be the most effective
25
14
tancy. We know that obesity accounts for between 2 treatment in management of metabolic syndrome. A
and 7% of the overall health costs of a country, which can decrease of more than 50% of the patient’s excess weight
translate, in the USA, into 100 billions of dollars each year. has a significant impact on the resolution of this pathol-
Bariatric surgery is a cost-effective method to decrease ogy and the type of surgery undertaken does not affect
the costs related to the management of obesity. 15,16 this result; in our cohort, there was a loss of 30% of the
A factor that affects patient outcome is the different patient’s excess weight in the 1st month, leading to a
processes of authorization of the insurers. Flanagan significant improvement of their metabolic syndrome.
17
et al performed a study comparing the mortality of During the year of the patients’ follow-up, a resolu-
patients whose insurers, after being approved by the tion of their metabolic symptoms was found in 92% of

multidisciplinary group, either approved or denied patients. 21,22 The inability of patients to attend their
the procedure. The study showed that the mortality of the follow-up appointments was one of the difficulties of this
control group was 6% compared with the study group, study; monitoring and follow-up of patients for 1 year or
favoring bariatric surgery for the resolution of the patients’ more is hampered by insurers.
comorbidities and increasing their life expectancy. In terms of pharmacoeconomics, this indicates that
This same analysis was done in Europe; in France, there is a decrease of up to 82% of the costs associated
there was a decline of 5% in terms of the overall cost with the management and treatment of comorbidities
for the patients operated on during the first 2 years of secondary to obesity, in relation to the overall cost of the
postbariatric surgery, which has a positive impact on the surgery; this is small with regards to the social impact
reduction of their medical expenses and the number of this brings to the patient. 16
medical visits. 18
As to whether there were any differences in the meta- CONCLUSION
bolic impact and the type of surgery for weight reduction, Bariatric surgery is an excellent tool for the management
11
Zhang et al showed that both have a positive impact of metabolic disease, as our study showed a resolution
on weight reduction and improving the patient’s comor- of up to 92% and a weight decrease of more than 70%,
bidities. The results obtained for the two different types which is consistent with previously published studies.
of surgeries were not very different from one another, The impact of these results on the patient is translated
although it is known that the sleeve type of surgery is into an improvement in the quality of their daily lives
considered a better option for the management of diabe- (such as their working conditions). It also produces
tes; it has been shown that there are particular benefits in a positive impact in terms of reduction in the use of
terms of the resolution of type II diabetes with this type health services, both medication usage and medical
19
of surgery. This type of surgery has also been shown visits. This translates to savings of millions of pesos in
to produce improvement in the patients’ total choles- health care costs. It is very important to bear in mind
terol and their LDL, although the sleeve type of surgery that a change of habits, in patients, is fundamental in
improves the patients’ triglycerides and increases their order to achieve these results and to keep their weight
levels of HDL. 19,20 down in the long-term.
Hepatic steatosis is a disease frequently found in
patients with morbid obesity and is one of the main causes REFERENCES
of chronic liver disease, such as steatohepatitis, chronic
inflammation, cirrhosis, and eventually hepatocellular 1. Yaghoubian A, Tolan A, Stabile BE, Kaji AH, Belzberg G,
carcinoma. Hepatic steatosis makes up part of the metabolic Mun E, Zane R. Laparoscopic Roux-en-Y gastric bypass and
sleeve gastrectomy achieve comparable weight loss at 1 year.
diseases that are related to insulin resistance. Currently, the Am Surg 2012 Dec;78(12):1325-1328.
use of ultrasonography has facilitated the early diagnosis 2. Deitel M. Overweight and obesity worldwide now estimated
of this pathology, but it is clear that a decrease of 50% EWL to involve 1.7 billion people. Obes Surg 2003 Jun;13(3):329-330.
leads to the resolution of this pathology. 21 3. Monteforte MJ, Turkelson CM. Bariatric surgery for morbid
In a meta-analysis, Buchwald showed that remission obesity. Obes Surg 2000 Oct;10(5):391-401.
of hypertension is not dependent on the type of proce- 4. Sussenbach SP, Padoin AV, Silva EN, Benzano D, Pufal MA,
Barhouch AS, Chatkin R, Ramos RJ, Balestro A, Mottin CC.
dure, but rather that the number of antihypertensive Economic benefits of bariatric surgery. Obes Surg 2012
drugs a patient was taking before or around the time Feb;22(2):266-270.
World Journal of Laparoscopic Surgery, January-April 2017;10(1):30-34 33