Obezite için laparoskopik sleeve gastrektomi’nin 4 yıllık uzun dönem metabolik, ghrelin seviyesi ve komorbidite değişimi üzerine etkileri ve sonuçları

Amaç: Laparoskopik Sleeve Gastrektemi’nin (LSG) orta ve uzun dönem etkilerini, pre-op ve post-op uzun dönem (4 yıl) ghrelin düzeylerinin karşılaştırılması, hastaların LSG sonrası uzun dönemde tekrar kilo alıp almadıkları, obeziteye eşlik eden komorbiditelerin değişimini araştırmaktır. Gereç ve yöntem: Pamukkale Üniversitesi Genel Cerrahi Anabilim Dalı’nda morbid obezite tanısı ile cerrahi için seçilen, işlem öncesi ghrelin düzeylerine bakılan toplam 34 hastada, Ocak 2009 ve Aralık 2011 tarihleri arasında obezite tedavisi olarak LSG uygulandı. Hastaların ameliyattan sonra 1. ay, 3. ay, 6. ay, 12. ay ve daha sonrasında yıllık kontrolleri yapıldı. En sonunda, post-op 4. yılda hastalarla iletişim kurulup son kontrol ve tetkikleri için çağrıldı. Bulgular: Çalışma kapsamına alınan 34 hastanın pre-op ağırlık ortalaması 132,93±19,25 kg iken, post-op 4. yıl 83±13,90 kg oldu. Ameliyat esnasında ortalama BMİ: 49,8±7,3 kg/m2 idi. LSG ameliyatı sonrası 4. yıl sonunda BMİ: 29,18±5,6 kg/m2 olarak bulundu. Çalışmaya dahil edilen hastalarda pre-op ghrelin değeri 672±143 pg/ ml iken, post-op 4.yıl ghrelin değeri 164±43 pg/ml oldu. Pre-op ve post-op 4. yıl değerleri arasındaki fark istatistiksel olarak anlamlıydı. Çalışma grubundaki hiçbir hastada, majör komplikasyon ya da takip süresince mortalite izlenmedi. Sonuç: LSG sonrası ghrelin düzeyi, midenin fundus ve gövdesinin rezeksiyonu nedeniyle azaltılarak karbonhidrat ve yağ tüketimini düşürür. LSG ile obezite tedavisi Tip 2 DM ve HT gibi komorbiditelerin semptomlarını azaltarak hastaların sağlık durumları üzerinde doğrudan yararlı etkiye sahiptir. Elde ettiğimiz verilere göre, LSG morbid obezitenin tedavisinde emniyetli ve etkin bir yöntemdir, uzun dönemli olumlu metabolik etkilere sahiptir, yaşam kalitesi ve konforunu artırıcı bir prosedürdür.

Effects and results of laparoscopic sleeve gastrectomy for obesity on 4-year long-term metabolic, ghrelin level and comorbidity change

Purpose: The aim of this study is to investigate the moderate and long-term effects of Laparoscopic Sleeve Gastrectomy (LSG), the comparison of pre-op and post-op long-term (4 years) ghrelin levels, whether patients have gained weight again after LSG or not, and the change of the comorbidities accompanying obesity. Material and methods: LSG was administered as an obesity treatment between January 2009 and December 2011 in a total of 34 patients selected for surgery with the diagnosis of morbid obesity, whose pre-treatment ghrelin levels were measured, at Pamukkale University Department of General Surgery. 1st month, 3rd month, 6th month, 12th month and then annual controls of the patients after the surgery were conducted. Finally, patients were contacted in the post-op 4th year and they were called for their final control and examinations. Results: The mean pre-op weight of the 34 patients included in the study was 132.93±19.25 kg, whereas the mean weight in the post-op 4th year was 83±13.90 kg. During the surgery, mean BMI: was 49.8±7.3 kg/m2. At the end of 4th year after the LSG surgery, BMI: was found as 29.18±5.6 kg/m2. While the pre-op ghrelin value of the patients included in the study was 672±143 pg/ml, their post-op 4th year ghrelin value became 164±43 pg/ ml. The difference between the pre-op and post-op 4th year was statistically significant. None of the patients in the study group had any major complications or mortality during follow-up. Conclusions: The ghrelin level after LSG gradually reduces the carbohydrate and fat consumption due to the resection of the fundus and the body of the stomach. Obesity therapy with LSG has a direct beneficial effect on the health status of the patients by reducing the symptoms of the comorbidities such as Type 2 DM and HT. According to the findings, LSG is a safe and effective method in the treatment of morbid obesity, has long-term positive metabolic effects, and is a procedure that increases the quality of life and comfort.

PDF

___

Ogden CL, Carroll M, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014: US Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics; 2015;1-8.
Nakatani T, Kim HJ, Kaburagi Y, Yasuda K, Ezaki O. A low fish oil inhibits SREBP-1 proteolytic cascade, while a high-fish-oil feeding decreases SREBP-1 mRNA in mice liver: relationship to anti-obesity. J Lipid Res 2003;44:369-379. https://doi.org/10.1194/jlr.M200289- JLR200
Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009;9:88. https:// doi.org/10.1186/1471-2458-9-88
Arias E, Martínez PR, Ka Ming Li V, Szomstein S, Rosenthal RJ. Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obes Surg 2009;19:544-548. https://doi.org/10.1007/ s11695-009-9818-6
Menenakos E, Stamou KM, 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;20:276-282. https://doi.org/10.1007/s11695-009- 9918-3
Gumbs AA, Gagner M, Dakin G, Pomp A. Sleeve gastrectomy for morbid obesity. Obes Surg 2007;17:962-969.
Müller TD, Nogueiras R, Andermann ML, et al. Ghrelin. Mol Metab 2015;4:437-460. https://doi.org/10.1016/j. molmet.2015.03.005
Sato T, Ida T, Nakamura Y, Shiimura Y, Kangawa K, Kojima M. Physiological roles of ghrelin on obesity. Obes Res Clin Pract 2014;8:405-413. https://doi. org/10.1016/j.orcp.2013.10.002
Eriksson J, Lindström J, Tuomilehto J. Potential for the prevention of type 2 diabetes. British Medical Bulletin. 2001;60:183-99.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403. https://doi.org/10.1056/ NEJMoa012512
Rizzello M, Abbatini F, Casella G, et al. Early postoperative insulin-resistance changes after sleeve gastrectomy. Obes Surg 2010;20:50-55. https://doi. org/10.1007/s11695-009-0017-2
Basso N, Capoccia D, Rizzello M, et al. First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis. Surg Endosc 2011;25:3540-3550. https://doi.org/10.1007/s00464- 011-1755-5
Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg 1998;8:267-282. https:// doi.org/10.1381/096089298765554476
Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk superobese patient. Obes Surg 2004;14:492-497 https://doi. org/10.1381/096089204323013479
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013;23:427-436. https:// doi.org/10.1007/s11695-012-0864-0
Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 2010;252:319-324. https://doi.org/10.1097/ SLA.0b013e3181e90b31
Hodge A, Dowse G, Gareeboo H, Tuomilehto J, Alberti K, Zimmet P. Incidence, increasing prevalence, and predictors of change in obesity and fat distribution over 5 years in the rapidly developing population of Mauritius. Int J Obes Relat Metab Disord 1996;20:137- 146.
Gadiot RP, Biter LU, van Mil S, Zengerink HF, Apers J, Mannaerts GH. Long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results. Obes Surg 2017;27:59-63. https://doi. org/10.1007/s11695-016-2235-8
Lee WJ, Ser KH, Chong K, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion. Surgery 2010;147:664-669. https://doi.org/10.1016/j. surg.2009.10.059
Abbatini F, Capoccia D, Casella G, Coccia F, Leonetti F, Basso N. Type 2 diabetes in obese patients with body mass index of 30-35 kg/m 2: sleeve gastrectomy versus medical treatment. Surg Obes Relat Dis 2012;8:20-24. https://doi.org/10.1016/j.soard.2011.06.015
Sarkhosh K, Birch DW, Shi X, Gill RS, Karmali S. The impact of sleeve gastrectomy on hypertension: a systematic review. Obes Surg 2012;22:832-837. https://doi.org/10.1007/s11695-012-0615-2
Beckman LM, Beckman TR, Earthman CP. Changes in gastrointestinal hormones and leptin after Rouxen-Y gastric bypass procedure: a review. J Am Diet Assoc 2010;110:571-584. https://doi.org/10.1016/j. jada.2009.12.023
Kotidis EV, Koliakos G, Papavramidis TS, Papavramidis ST. The effect of biliopancreatic diversion with pyloruspreserving sleeve gastrectomy and duodenal switch on fasting serum ghrelin, leptin and adiponectin levels: is there a hormonal contribution to the weight-reducing effect of this procedure? Obes Surg 2006;16:554- 559. https://doi.org/10.1381/096089206776944940
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;247:401-407. https://doi.org/10.1097/ SLA.0b013e318156f012
Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5 year results for weight loss and ghrelin. Obes Surg 2010;20:535-540. https://doi.org/10.1007/ s11695-009-0066-6