Hasan ÇANTAY, Mehmet Fatih EROL, Hacı Murat ÇAYCI, Umut Eren ERDOĞDU, Evren DİLEKTAŞLI, Gözde DOĞAN, Yurdakul DENİZ FIRAT, Nejdet Deniz TİHAN, Hüseyin Ayhan KAYAOĞLU

Laparoskopik Sleeve Gastrektomi ve Roux-En-Y Gastrik Bypass Sonrası Kilo Verme ve Beslenme Parametrelerinin Ara Dönem Karşılaştırması

Amaç: Obezite tedavisinde sleeve gastrektomide restriktif, Roux- En-Y Gastrik Bypass yönteminde ise malabsorbtif etkiler ön plandadır. Çalışmamızda LSG ve LRYGB grubundaki hastalarımızın preoperatif ve postoperatif dönemdeki kilo ve nutrisyonel parametrelerinin karşılaştırılması amaçlanmıştır. Materyal ve Metot: 2012–2017 yılları arasında Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesinde Genel cerrahi kliniğinde morbid obezite (Body Mass Index-BMI ≥40 kg/m2) nedeniyle, bariatrik cerrahi uygulanan ve altı aylık takip dönemini tamamlayan toplam 110 hastanın verileri retrospektif olarak değerlendirildi. Hastalar uygulanan yönteme göre iki gruba ayrıldı (LSG ve LRYGB). LSG grubunda 65, LRYGB grubunda 45 hasta yer aldı. Gruplarda yer alan hastaların demografik özellikleri, preoperatif ve postoperatif dönemdeki kilo, BMI, demir ve demir bağlama kapasitesi, ferritin, vitamin B12, folik asit, hemoglobin, 25-hidroksi vitamin D ve MCV düzeyleri kaydedilip karşılaştırıldı. Bulgular: Gruplar arasında hastaların ameliyat öncesi ve sonrası kilo ve BMI değerleri ve ameliyat sonrası 6. ayda kaybedilen kg değerleri açısından anlamlı fark bulunamadı (p>0,05). Ameliyat öncesi bütün parametreler her iki ameliyat grubu arasında benzerken, ameliyat sonrası 6. ayda LRYGB grubunda serum demir ve MCV değerlerindeki düşüş istatistiksel olarak anlamlı bulundu (sırasıyla, p=0,014, p=0,031). Sonuç: Sonuç olarak, erken dönem sonuçları itibari ile LSG ve LRYGB ameliyatları benzer sonuçlara ve başarı oranlarına sahip etkili cerrahi metodlar olarak kabul edilebilir. Bariatrik cerrahi sonrası gastrik bypass uygulanan hastalarda erken dönemde demir eksikliği ve buna bağlı semptomlar sleeve gastrektomiye göre daha sık görülebilir.

Anahtar Kelimeler:

sleeve gastrektomi;, gastrik bypass;, laparoskopi;, bariatrik cerrahi;, vitamin eksikliği

PDF

___

1. Craig MH, Margaret D, Cheryl D. Fryar CL. Ogden. Prevalence of Obesity Among Adults and Youth: United States, 2015– 2016. National Center for Health Statistics 2017;288.
2. Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond)2008;32(9):1431–7.
3. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA 2014;311:74– 86.
4. Noah J, Smith A, Birch D, Karmali S. The Metabolic Effects of Laparoscopic Sleeve Gastrectomy: A Review. J Minim Invasive Surg Sci 2013;2(3):3–7.
5. Sarela AI, Dexter SP, O’Kane M, Menon A, McMahon MJ. Long-term follow-up after laparoscopic sleeve gastrectomy:8–9- year results. Surg Obes Relat Dis 2012;8:679–84.
6. Cayci HM, Erdogdu UE, Karaman K, Budak E, Taymur İ, Buyukuysal C. Does Weight Gain During the Operation Wait Time Have an Impact on weight Loss After Laparoscopic Sleeve Gastrectomy?. Obes Surg 2017;27:338–42.
7. Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: A prospective, double blind study. Ann Surg 2008;247:401–7.
8. Cottam DR, Atkinson J, Anderson A, Grace B, Fisher B. A casecontrolled matched-pair cohort study of laparoscopic Rouxen- Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up. Obes Surg 2006;16:534–40.
9. Iannelli A, Anty R, Schneck AS, Tran A, Gugenheim J. Inflammation, insulin resistance, lipid disturbances, anthropometrics, and metabolic syndrome in morbidly obese patients: A case control study comparing laparoscopic RouxenY gastric bypass and laparoscopic sleeve gastrectomy. Surgery 2011;149:364–70.
10. Khwaja HA, Bonanomi G. Bariatric Surgery: Techniques, Outcome and Complications. Current Anaesthesia & Critical Care 2010;21:31–38.
11. Barth M, Jenson C. Postoperative nursing care of gastric bypass patients. American Journal of Critical Care 2006;15(4):378– 88.
12. Campos GM, Rabl C, Roll GR, Peeva S, Prado K, Smith J et al. Better Weight Loss, Resolution of Diabetes, and Quality of Life for Laparoscopic Gastric Bypass vs Banding. Arch Surg 2011;146:149–55.
13. Vijgen GH, Schouten R, Bouvy ND, Greve JW. Salvage banding for failed Roux-en-Y gastric bypass. Surg Obes Relat Dis 2012;86:803–8.
14. Gilbert EW, Wolfe BM. Bariatric surgery for the management of obesity: state of the field. Plast Reconstr Surg 2012;130:948– 54.
15. Henkel DS, Mora-Pinzon M, Remington PL, Jolles SA, Voils CI, Gould JC et al. Trends in the prevalence of severe obesity and bariatric surgery access: a state-level analysis from 2011 to 2014. J Laparo endosc Adv Surg Tech A 2017;27(7):669–75.
16. Lee WJ, Pok EH, Almulaifi A, Tsou JJ, Ser KH, Lee YC. Medium Term Results of Laparoscopic Sleeve Gastrectomy: a Matched Comparison with Gastric Bypass. Obes Surg 2015;25:1431–38.
17. Herron D, Roohipour R. Complications of Roux-en-Y gastric bypass and sleeve gastrectomy. Abdom Imaging 2012;37:712– 8.
18. Buchwald H, Avidor Y, Braunwald E. Bariatric surgery: a systematic review and metaanalysis. Journal of the American Medical Association 2004;292(14):1724–37.
19. Sjöström L, Lindroos A, Peltonen M, Torgerson J, Bouchard C, Carlsson B et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. The New Eng J Medicine 2004;351(26):2683–93.
20. Vidal P, Ramón JM, Goday A, Benaiges D, Trillo L, Parri A et al. Laparoscopic Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy as a Definitive Surgical Procedure for Morbid. Obesity. Mid-Term Results. Obes Surg 2013;23:292–9.
21. Leyba JL, Aulestia SN, Llopis SN. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity: a prospective study of 117 patients. Obes Surg 2011;21:212–6.
22. Parmar CD, Mahawar KK. One Anastomosis (Mini) Gastric Bypass Is Now an Established Bariatric Procedure: a Systematic Review of 12, 807 Patients. Obes Surg 2018;28(9):2956–67.
23. Miller NG, Wright BN. Mineral malnutrition following bariatric surgery. American Society for Nutrition. Adv. Nut 2013;4(5):506–17.
24. Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)-a prospective study. Obes Surg 2010;20:447–53.
25. Menenakos E, Stamou K, Albanopoulos K, Papailiou J, Theodorou D, Leandros E. Laparoscopic Sleeve Gastrectomy Performed with Intent to Treat Morbid Obesity: A Prospective Single-Center Study of 261 Patients with a Median Follow-up of 1 Year. Obes Surg 2010;20:276–82.
26. Üstün BY, Köksal E. Obesity and anesthesia. Journal of Experimental and Clinical Medicine 2013;30:15–23.
27. Herron D, Roohipour R. Complications of Roux-en-Y gastric bypass and sleeve gastrectomy. Abdom Imaging 2012;37:712– 8.
28. Al Harakeh AB. Complications of laparoscopic Roux-en-Y gastric bypass. Surg Clin North Am 2011;91:1225–37.
29. Mierzyńska MJ, Ostrowska L, Hady HR, Dadan J. Assessment of dietary habits, nutritional status and blood biochemical parameters in patients prepared for bariatric surgery: a preliminary study. Video surgery Mini inv 2012;7(3):156–65.