Page 6 - World Journal of Laparoscopic Surgery

Shailesh Kumar et al
12th weeks respectively. All these observations were feeling of satiety earlier. Ghrelin, a hunger-regulating
analyzed and found statistically significant (p < 0.05) peptide hormone, produced by P/D1 cells that are found
(Table 1 and Graph 1). mainly in the fundus of the stomach are removed, thus
reducing plasma ghrelin levels and, subsequently, the
DISCUSSION feeling of hunger. Ghrelin regulation is also disturbed
World Health Organization reveals in its report that following the sleeve gastrectomy. In a prospective study of
obesity is one of the most common, yet among the most 20 patients, the effects of LSG on immediate and 6-month
neglected public health problems in both developed and postoperative ghrelin levels were compared with those
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developing countries. Obesity is strongly associated of laparoscopic adjustable gastric banding. The LSG
with other comorbidity including diabetes, hypertension, patients showed a significant decrease in plasma ghrelin
dyslipidemia, cardiovascular disease, and some cancers. 24 levels on day 1, which remained low throughout 6 months.
There is a growing consensus that bariatric surgery is In a prospective double-blind study of 32 patients, LSG
the predominant treatment option available for the man- resulted in a marked reduction in fasting ghrelin levels and
agement of morbid obesity and its associated comorbidi- significant suppression after a meal, which was not seen
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ties. Diet therapy, medical treatment, exercise, and yogas after RYGB. Furthermore, appetite was also reduced to a
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are relatively ineffective in treating morbid obesity in the greater extent after LSG. Laparoscopic sleeve gastrectomy
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long term. Recently, the LSG has emerged as a stand- was also reported to have a hindgut effect with increasing
alone procedure for the treatment of morbid obesity, and levels of glucagon-like peptide-1 and peptide YY due to the
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unlike the Roux-en-Y gastric bypass (RYGB), the LSG does increased transit time after LSG.
not bypass the foregut. 26,27 Laparoscopic Sleeve Gastrectomy Efficacy Profile
The mechanisms of action of LSG are probably mechan-
ical restriction and hormonal modulation. It reduces the Early safety and efficacy of LSG was examined prospec-
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size of the gastric reservoir to 60 to 100 mL, permitting the tively by Mognol and colleagues. Mean operative time
intake of only small amounts of food and imparting a was 120 (90–150) minutes and the average length of stay

Table 1: Correlation of weight and BMI with postoperative period after LSG
Duration Sample size Parameter Mean ± SD Min–Max p-value
0 Week 60 Weight (kg) 111.03 ± 8.78 100–130
BMI 43.68 ± 3.75 37.63–56.44
1st Week 60 Weight (kg) 109 ± 8.23 98–126 <0.0005
BMI 42.9 ± 3.52 37.63–55.55 <0.0005
2nd Week 60 Weight (kg) 107.2 ± 7.88 97–124 <0.0005
BMI 42.09 ± 3.26 37.26–53.33 <0.0005
4th Week 60 Weight (kg) 103.37 ± 7.81 94–120 <0.0005
BMI 40.55 ± 3.14 36.13–51.11 <0.0005
12th Week 60 Weight (kg) 96.63 ± 7.06 84–112 <0.0005
BMI 38.01 ± 2.31 34.62–44.44 <0.0005

Graph 1: Weight and BMI trends following LSG Graph 2: Percentage of EWL trend with postoperative period
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