Page 13 - World Journal of Laparoscopic Surgery

Bariatric Surgery and Obesity
(p = 0.488) at 4 weeks (mean: 287.70 ± 70.87 mg/dL) when Effect on Biochemical Parameters
compared with preoperative levels (mean: 305.47 ± 76.81 mg/dL) Laparoscopic sleeve gastrectomy has been shown to reduce
and a significant improvement (p = 0.030) at 3 months (mean: comorbidities and mortality in patients with morbid obesity and
250.88 ± 63.08 mg/dL). Serum HDL levels showed an improvement most significantly to ameliorate or resolve type II DM. Much of the
(p = 0.067) at 4 weeks (mean: 29 ± 5.91 mg/dL) when compared improvement has been related to the excess weight loss after surgery.
with preoperative levels (mean: 25.23 ± 5.70 mg/dL) and a highly However, some effects appear to be independent from weight loss.
significant improvement (p = 0.0001) at 3 months (mean: 38.94 ± In our study, there was a significant reduction in the levels of
8.16 mg/dL). Serum LDL levels showed a decreasing trend (p = 0.711) HbA1c at 4 weeks and 3 months postoperatively in diabetic patients
at 4 weeks (mean: 94.41 ± 38.23 mg/dL) when compared with with mean HbA1c at 4 weeks and 3 months being 6.71% and 5.57%,
preoperative levels (mean: 99.47 ± 40.88 mg/dL) and a further fall respectively, when compared with the mean preoperative value
in levels (p = 0.304) at 3 months (mean: 86 ± 34.08 mg/dL). Serum of 7.14%.
VLDL levels showed a slight decrease at 4 weeks (mean: 35.82 ± Todkar et al. also showed a decrease in HbA1c levels after LSG.
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14.79 mg/dL) which was not statistically significant (p = 0.790) when This also proves that LSG has a significant role in improvement and
compared with preoperative levels (mean: 37.23 ± 15.91 mg/dL), and remission of diabetes.
this trend was consistent at 3 months (mean: 32.47 ± 11.87 mg/dL) The achievement of normoglycemia after bariatric procedures
but again not statistically significant (p = 0.330). results from multiple changes that occur postoperatively such as
dIscussIon control of diet/dietary modifications, decreased plasma ghrelin
levels, which, in turn, leads to an increase in maximal capacity
Success or failure of any weight-reducing technique is measured by of glucose-induced insulin release by the islet cells. Other
the extent by which body weight is reduced, which is an important causes of normoglycemia include loss of weight, reduction of
parameter of a study. In our study, mean weight loss following body fat, and the release of gastrointestinal hormones. These
bariatric surgery at 4 weeks and 3 months was 8.47 and 22.29 kg, hormones further interfere with the function of pancreatic
respectively. Out of 17 patients, 16 patients had lost more than β-cells (incretins).
25% of the excess weight at 3 months following surgery with Dyslipidemia is a recognized cardiovascular risk factor in
mean percentage of excess weight loss (%EWL) at 4 weeks and 3 obese patients. In our study, there was a significant decrease in
months being 12.96 and 36.11%, respectively. There was a significant serum cholesterol and serum triglycerides levels at 3 months with
decrease in BMI at 3 months following LSG in our study group with a significant improvement in serum HDL levels. Serum LDL and
2
mean BMI at 4 weeks and 3 months being 43.95 and 38.67 kg/m serum VLDL levels also showed a decreasing trend, however not
2
when compared with the preoperative values of 46.67 kg/m . statistically significant in this study, citing further follow-up to 1–2
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Similar results were found by Alagna et al. at mean 12 ± 1 years. Five dyslipidemic patients achieved normal serum cholesterol
months postsurgery, the patients showed a significant decrease levels (<240 mg/dL) within 3 months of surgery and thus showed a
in weight, from 132.1 ± 36.9 kg before surgery to 93.5 ± 20 kg (p < resolution of dyslipidemia. A study done by Chowbey et al. showed
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0.0001), and BMI, from 47.3 ± 13.1 kg/m before surgery to 33.5 ± similar results with the resolution of dyslipidemia in 34% of the
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7 kg/m (p < 0.0001). patients with a significant decrease in mean cholesterol and LDL
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Omana et al. found the same results when studied men levels 6 months after LSG. Todkar et al. conducted a study on 20
undergoing surgery lost weight; the %EWL was 61.48% (confidence dyslipidemic patients who underwent LSG. Parameters like serum
interval: 47.3875–75.5725). cholesterol, triglycerides, and LDL levels showed a marked increase
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Similarly, mean weight loss observed by Bastounis et al. in in HDL levels. A significant decrease in serum cholesterol, LDL,
their study was 70 ± 10 kg for men. The mean body weight and and serum triglyceride levels with an increase in serum HDL levels
BMI 12 months after vertical banded gastroplasty were 109 ± 20.5 following sleeve gastrectomy in 130 obese patients undergoing
2
kg and 34.7 ± 6.5 kg/m , respectively. LSG was documented by Hady et al. 26
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Chowbey et al. reported the Indian experience of‘ 75 patients
who underwent LSG for the treatment of morbid obesity. There was Effect on Anthropometric Parameters
a steady rise in %EWL from 31.2% at 3 months to 52.3% at 6 months, In our study, mean waist circumference of 17 obese patients was
59.13% at 1 year, and 65% at 2 years. 132.94 ± 13.64 cm preoperatively. Postoperatively at 4 week, the
An important reason for reduction in BMI and %EWL is due to mean waist circumference decreased to 126.47 ± 13.24 cm, but waist
effect of LSG on gastric emptying time. The time required for half of circumference showed a significant decrease/reduction at 3 months
the solid meal to leave the stomach (T ) gets significantly altered following surgery with the mean values falling down to 106.93 ±
1/2
following LSG, indicating that the stomach empties solid foods 10.84 cm. There was a decrease in waist-to-hip ratio at 4 weeks
rapidly and possibly incompletely processed into the duodenum. postoperatively, from mean preoperative value of 1.06 ± 0.06 cm
Excision of the fundus and absence of receptive relaxation, as well to mean values of 1.05 ± 0.06 cm and a further significant decrease
as alterations in the contractile activity in the proximal stomach, are to 0.98 ± 0.05 cm at 3 months, respectively. This signifies that LSG
possible explanations for the decreased T . Laparoscopic sleeve as a sole bariatric procedure decreases the risk of central obesity.
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gastrectomy thus induces weight loss by reducing food intake, In our study, there is no significant change in hip circumference of
accelerated gastric emptying, and delivery of nutrients to the small the patients.
intestine early in the eating cycle which activates small intestine In a study conducted by Hady et al., similar findings were
satiety inducing chemoreceptors that modify food ingestion documented in a clinical report which got published in 2012. After
periodicity, inhibit glucagon secretion, and reduce bowel motility 1 year of the surgery, waist circumference in women decreased
and thus reducing appetite and food intake. Postprandial satiety is from 122.8 ± 18.4 cm to 89 ± 8.2 cm and in men from 134.2 ±
provoked with significantly less food than preoperatively. 27.6 cm to 106 ± 9.66 cm. 27

World Journal of Laparoscopic Surgery, Volume 12 Issue 3 (September–December 2019) 99