Improved Obesity Reduction and Co-morbidity Resolution in Patients Treated with 40-French Bougie Versus 50-French Bougie Four Years after Laparoscopic Sleeve Gastrectomy. Analysis of 294 Patients

Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, Australia.
Obesity Surgery (Impact Factor: 3.74). 08/2011; 22(1):97-104. DOI: 10.1007/s11695-011-0493-z
Source: PubMed

ABSTRACT We compared percent excess body mass index loss (%EBMIL) and resolution of dyslipidaemia, hypertension, and type 2 diabetes mellitus in the 4 years following laparoscopic sleeve gastrectomy (LSG) between patients calibrated with a 40-French (40F) or a 50-French (50F) bougie.
We conducted a longitudinal retrospective descriptive study of routinely collected pre- and post-surgical data from 294 patients who underwent LSG at a single surgical centre (50F--n = 106, 40F--n = 185). Obesity measurements were taken prior to surgery and at regular intervals until 48 months post-surgery. Co-morbidity resolution was also assessed across the 48-month observation period. Multivariate regression modelling was used to control analyses for baseline obesity and sociodemographic variables.
At 48 months post-surgery mean (±SD) %EBMIL was 60.2 ± 27.6% and 45.4 ± 38.4% for those treated with the 40F and 50F bougie, respectively. After controlling for sociodemographic variables and baseline excess weight, mean %EBMIL was 15.5% greater with a 40F bougie compared with a 50F bougie at the end of follow-up. The likelihood of dyslipidaemia resolution within 48 months post-LSG was 19.0 times greater (p = 0.006), hypertension resolution 3.6 times greater (p = 0.005) and type 2 diabetes mellitus resolution 5.2 times greater (p = 0.034) by 4 years post-surgery in patients treated with the 40F bougie compared with a 50F bougie.
Improved obesity reduction and resolution of dyslipidaemia, hypertension and type 2 diabetes mellitus is experienced during the 4 years following surgery by patients treated with a 40F bougie compared with the 50F. These findings remain when controlling for potential confounding clinical and sociodemographic factors.

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    ABSTRACT: Sleeve gastrectomy constitutes an effective surgical procedure for the treatment of morbid obesity in humans and rodents with diet-induced obesity. The aim of the present study was to establish the effects of sleeve gastrectomy on weight loss and cardiovascular parameters in genetically obese (fa/fa) Zucker rats. Eleven-week-old male obese (fa/fa) (n = 20) Zucker rats were assigned to three alternative procedures (sham operation, sleeve gastrectomy, or pair-fed to the amount of food eaten by sleeve-gastrectomized animals) and compared with lean Zucker (Fa/Fa) rats (n = 9). Systolic (SBP), diastolic (DBP), and mean (MBP) blood pressure values as well as heart rate (HR) were recorded in conscious, resting animals by non-invasive tail-cuff plethysmography before and 3 weeks after the surgical interventions. Sleeve-gastrectomized rats experienced a reduction in body weight (P < 0.01), total adiposity amounts (P < 0.001), together with an increased excess weight loss (%EWL) (P < 0.05) compared with sham-operated and pair-fed animals 3 weeks after the surgical interventions. Rats with sleeve gastrectomy exhibited reduced (P < 0.01) blood pressure values (ΔSBP = -11 ± 8 mmHg; ΔDBP = -6 ± 4 mmHg; ΔMBP = -8 ± 6 mmHg) compared with the control group, but no changes were observed in HR (P = 0.560). Sham-operated and pair-fed groups did not alter their cardiovascular variables. Our findings provide evidence of the beneficial effects of sleeve gastrectomy on blood pressure values in addition to the weight loss in obese (fa/fa) Zucker rats independently of surgical trauma and food intake reduction.
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