Page 16 - World Journal of Laparoscopic Surgery

Comparative Study of the Effect of Various Bariatric Surgery Methods
nonsurgical group, baseline AST levels increased up to 36.20%, 12 The Chi-squared test showed that mini-gastric bypass surgery
months after surgery. Therefore, the highest decrease in patients’ significantly reduced grade III fatty liver 12 months after surgery
AST was observed in the gastric sleeve group with 34.95%. compared to before. While 21.6% of patients in this group had
According to Kolmogorov–Smirnov test, ALT had a normal grade III fatty liver, 12 months after surgery, the percentage of these
distribution in all four groups (p >0.05). The results of ANOVA test patients decreased to zero. In other words, it led to a 21.6% reduction
showed a significant difference in the mean ALT of patients in in patients with grade III fatty liver. On the other hand, the rate of
different groups before and after surgery. Mean ALT in patients patients with low-risk or grade I fatty liver increased from 32.8 to
significantly decreased from 19.58 to 18.9% in the gastric sleeve 91.2%, 12 months after mini-gastric bypass surgery. In other words,
group 12 months after surgery compared to before surgery it increased 58.4% of patients with grade I fatty liver.
(p = 0.017). The percentage of ALT reduction was 19.58, 18.9 in The Chi-squared test showed that RY gastric bypass surgery
patients 12 months after surgery compared to before surgery in significantly reduced grade III fatty liver 12 months after surgery
the gastric sleeve and mini-gastric bypass groups, respectively. The compared to before. While 17.5% of patients in this group had
ALT levels in patients receiving RY gastric bypass surgery decreased grade III fatty liver, 12 months after surgery, this percentage
by 15.18%, 12 months after surgery compared to before surgery. decreased to zero. In other words, it reduced 17.5% of patients with
However, in the nonsurgical group, baseline ALT levels increased grade III fatty liver. On the other hand, the rate of patients with low-
up to 12.51%, 12 months after surgery compared to before surgery. risk or grade I fatty liver increased from 39.8 to 100.0%, 12 months
Therefore, the highest decrease in patients’ AST was observed in after RY gastric bypass surgery. In other words, it increased 61.0%
the gastric sleeve group with 19.58%. of patients with grade I fatty liver.
Chi-squared test showed that gastric sleeve surgery significantly While 16.9% of patients in this group had grade III fatty liver
reduced NSF score 12 months after surgery compared to before at the beginning of the study, 12 months later the percentage
surgery. While 27.6% of patients in this group were considered increased to 58%. In other words, it led to an increase of 41.1% in
high-risk, 12 months after surgery, the percentage of these people patients with grade III fatty liver. On the other hand, the rate of
decreased to 13.8%. In other words, it reduced 13.8% of high-risk patients with low-risk or grade I fatty liver decreased from 34.9 to
patients with NSF (or NSF above 0.67). On the other hand, the rate 12.7% after 12 months. In other words, it resulted in a reduction of
of patients with low-risk or NSF below −1.5 after 6 months and 12 22.0% of patients with grade I fatty liver in this group.
months of gastric sleeve surgery increased from 13.8 to 81.4%. In
other words, it resulted in an increase of 67.6% of patients with NSF
in the low-risk or normal range. dIscussIon
Chi-squared test showed that mini-gastric bypass surgery Since NAFLD is the most common chronic liver disease, proper
significantly reduced the NSF score 12 months after surgery treatment can prevent its complications, such as cirrhosis or liver
compared to before. While 33.6% of patients in this group were fibrosis. Although diet, exercise, and weight loss are the main
considered high-risk at the beginning of the study, this percentage treatment options for NAFLD, diet and exercise for weight loss in
decreased to 9.1%, 12 months after surgery. In other words, it patients with morbid obesity have little success. For this reason,
resulted in a 24.5% reduction in patients with NSF in the high-risk today, a variety of surgical methods for weight loss and thus
range (or NSF above 0.67). On the other hand, the rate of patients prevention of liver complications is being studied. Therefore, further
with low-risk or NSF lower than −1.5, 12 months after mini-gastric studies are necessary because few studies have been conducted
bypass surgery increased from 11.0% at the beginning of the study on the effect of obesity surgery as the most effective and lasting
to 76.6%. In other words, it resulted in a 65% increase in patients method of weight loss in these patients on the improvement of
with NSF in the low-risk or normal range. NAFLD, and research suggests increased liver fibrosis after obesity
Chi-square test showed that RY gastric bypass surgery surgery. The background shows there are no significant studies
significantly reduced the NSF score 12 months after surgery comparing the effects of different types of obesity surgery on fatty
compared to before. While 26.1% of patients in this group were liver. Therefore, we examined the effect of three types of obesity
considered high-risk at the beginning of the study, this percentage surgery methods (including gastric sleeve, mini-gastric bypass, and
decreased to 6.5%, 12 months after surgery. In other words, it RY gastric bypass) on liver enzymes and grading of NAFLD based on
reduced 19.6% of patients with NSF in the high-risk range (or NSF ultrasound in 900 adult and pediatric patients. In this study, most
above 0.67). On the other hand, the rate of patients with low-risk patients in all four groups were of female gender. The patients
or NSF below −1.5 after 12 months of RY gastric bypass surgery underwent follow-up at the beginning of the study and then 6 and
increased from 10.0% at the beginning of the study to 84.4%. In 12 months after surgery. The results of our study showed that all
other words, it resulted in an increase of 74.4% of patients with NSF three types of surgery had a significant effect on BMI reduction 6
in the low-risk or normal range. and 12 months after the surgery, such that the rate of BMI reduction
The Chi-squared test showed that a significant increase was in patients were 33.53%, 34.95%, and 32.77%, respectively, in gastric
observed in the percentage of high-risk patients during follow-up. groups sleeve, mini-gastric bypass and RY gastric bypass12 months
While 16.2% of patients in this group were considered high-risk at after surgery compared to before. Therefore, the highest decrease
the beginning of the study, 12 months after surgery, this percentage in patients’ BMI was observed in the mini-gastric bypass group
increased to 54.7%. In other words, it increased 38.5% of patients with 34.95%. Conversely, in the control group, a 6.2% increase in
with NSF in the high-risk range (or NSF above 0.67). On the other patients’ BMI was observed 12 months after follow-up. These results
hand, the rate of patients with low-risk or NSF below −1.5 decreased indicated that all three of these surgeries had a significant effect
from 24.0% at the beginning of the study to 9.3% after 12 months. on reducing the BMI of obese patients.
In other words, it resulted in a reduction of 14.7% of patients with The results of our study also showed that all three types
NSF in the low-risk or normal range. of surgery significantly reduced AST and ALT enzymes 6 and

112 World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)