Laparoskopik Sleeve Gastrektominin Kan Basıncı Üzerine Erken Dönem Etkisi

Amaç: Laparoskopik Sleeve Gastrektomi (LSG)obezite tedavisinde etkinliğini göstermiştir. Güncel olarak en sık yapılan bariatrik bir prosedür olarak popülerlik kazanmıştır. Tip 2 diabets mellitüs ve hiprtansiyon regülasyonunda birinci yıl olumlu sonuçları bildirilmiştir. Bu çalışmada LSG’ nin postoperatif erken dönemde kan basıncı (KB) üzerine etkisini araştırmayı amaçladık.Gereç ve Yöntemler: Ocak 2017 ile Şubat 2018 arasında, LSG yapılan ardışık 148 hasta hipertansiyon (HT) analizi bakımından retrospektif olarak derlendi. KB ölçümleri, hastalara otomatik bir makine aracılığıyla preoperatif ve postoperatif 1, 6, 12, 24 ve 36.saatlerde hastane yatışı sırasında standart koşullar altında yapıldı. Preoperatif laboratuvar değerlendirmesi; tam kan sayımı, metabolik panel ve lipit profilini içerdi.Bulgular: Dışlanma kriterleri ve ulaşılamayan laboratuvar sonuçları nedeniyle 100 hastanın verisi analiz edildi. Çalışmaya dahil edilen hastaların 63’ü kadın, 37’si erkekti. Yaş ortalaması 38 yıl (18-61), hastanede yatış ortalaması 4,3 gün ve ortalama vücut kütle indeksi (BKİ) 47 kg/m2 (40-75) olarak saptandı. Preoperatif HT olan 44 hastanın 28’si ve normotansif olan 56 hastadan 21’i antihipertansif ilaç kullanıyordu. Preoperatif sistolik kan basıncı 143,4±23,98 ve diyastolik kan basıncı 84,76±16,46 mm Hg iken, postoperatif 36. saattesırasıyla 130,29±18,23 ve 76,69±13,02 olarak saptandı. Üç günlük takip sonrası sistolik KB (13 mm Hg) ve diyastolik KB (8 mm Hg)ölçümlerinde erken olarak görülen düşüş istatistiksel olarak anlamlı saptandı (p <0,001).Sonuç: LSG’nin önemli kilo kaybına ulaşılmadan önce kan basıncında erken dönemde azalmaya neden olduğunu göstermektedir. Bunedenle, gözlenen değişiklikler için kilo kaybından bağımsız hormonal bir mekanizma ile olabileceğini düşündürür.

Anahtar Kelimeler:

Sleeve gastrektomi, postoperatif takip, hipertansiyon

Early Effects of Laparoscopic Sleeve Gastrectomy on Blood Pressures

Aim: Laparoscopic Sleeve Gastrectomy (LSG) has shown its effectiveness in the treatment of obesity. It has recently gained popularity as the most frequent bariatric procedure. The positive results of the first year in the regulation of type 2 diabetes mellitus and hypotension have been reported. In this study, we aimed to investigate the effect of LSG on blood pressure (BP) in the early postoperative period.Material and Methods: Between January 2017 and February 2018, 148 consecutive patients who underwent LSG were retrospectively compiled for hypertension (HT) analysis. BP measurements were carried out to patients under standard conditions during hospital stay at the 1st, 6th, 12th, 24th and 36th hours preoperatively and postoperatively via an automated machine. Preoperative laboratory evaluation included complete blood count, metabolic panel and lipid profile.Results: Data of 100 patients were analyzed due to the exclusion criteria and inaccessible laboratory results. Of the patients included in the study, 63 were female and 37 were male. The average age was 38 years (18-61), the mean hospitalization was 4.3 days, and the averagebody mass index (BMI) was 47 kg/m2 (40-75). 28 of 44 patients with preoperative HT and 21 of 56 patients who were normotensive were using antihypertensive drugs. Preoperative systolic blood pressure was 143.4±23.98 and diastolic blood pressure was 84.76±16.46 mm Hg, while it was respectively 130.29±18.23 and 76.69±13.02 at the 36th hours postoperatively. After three days of follow-up, an early decrease in systolic BP (13 mm Hg) and diastolic BP (8 mm Hg) measurements were found to be statistically significant (p<0.001).Conclusion: This study shows that LSG causes an early decrease in blood pressure before significant weight loss is achieved. Therefore, it suggests that for the observed changes, there may be with a hormonal mechanism independent of weight loss.

Keywords:

Sleeve gastrectomy, Postoperative follow-up, Hypertension,

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Referans1- Buchwald H, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292: 1724-1737. Referans 2- Flores L, et al. Hypertension remission 1 year after bariatric surgery: predictive factors. Surg Obes Relat Dis 2014; 10: 661-665. Referans 3-Tritsch AM, et al. A retrospective review of the medical management of hypertension and diabetes mellitus following sleeve gastrectomy. Obes Surg 2015; 25: 642-647. Referans 4- Halperin F, et al. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. JAMA Surg 2014; 149: 716-726. Referans 5- Benaiges D, et al. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis 2011; 7: 575-580. Referans 6- Mikhail N, et al. Obesity and hyper tension. Prog Cardiovasc Dis 1999; 42: 39-58. Referans 7- Ahmed AR, et al. Laparoscopic Roux-en-Y gastric bypass and its early effect on blood pressure. Obes Surg 2009; 19: 845-849. 8- Pories WJ, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995; 222: 339-350. Referans 9- Chobanian AV, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC report. JAMA 2003; 289: 2560-2572. Referans 10- Samson R, et al. Effect of sleeve gastrectomy on hypertension. J Am Soc Hypertens 2018; 12: 19-25. Referans 11- Sarkhosh K, et al. The impact of sleeve gastrectomy on hypertension: a systematic review. Obes Surg 2012; 22: 832-837. Referans 12- Magee CJ, et al. Laparoscopic sleeve gastrectomy for high-risk patients: weight loss and comorbidity improvement--short-term results. Obes Surg 2011; 21: 547-550. Referans 13- Segal JB, et al. Prompt reduction in use of medications for comorbid conditions after bariatric surgery. Obes Surg 2009; 19: 1646-1656. Referans 14- Reisin E, et al. Cardiovascular changes after weight reduction in obesity hypertension. Ann Intern Med 1983; 98: 315-319. Referans 15- Michell AR, et al. Regulation of renal function by the gastrointestinal tract: potential role of gut-derived peptides and hormones. Annu Rev Physiol 2008; 70: 379-403. Referans 16- le Roux CW, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg 2007; 246: 780-785. Referans 17- Fenske WK, et al. Effect of bariatric surgeryinduced weight loss on renal and systemic inflammation and blood pressure: a 12-month prospective study. Surg Obes Relat Dis. 2013; 9: 559-568. Referans 18- Seravalle G, et al. Long-term sympathoinhibitory effects of surgically induced weight loss in severe obese patients. Hypertension 2014; 64: 431-437. Referans 19- McGavigan AK, et al. Vertical sleeve gastrectomy reduces blood pressure and hypothalamic endoplasmic reticulum stress in mice. Dis Model Mech 2017; 10: 235-243.