Midterm Impact of Sleeve Gastrectomy, Calibrated with a 50-Fr Bougie, on Weight Loss, Glucose Homeostasis, Lipid Profiles, and Comorbidities in Morbidly Obese Patients

ArticleinThe American surgeon 78(9):969-74 · September 2012with15 Reads
Source: PubMed
Bariatric surgery has been shown to be effective in achieving and maintaining weight change and reducing obesity-related comorbidities. Recent reports have shown that sleeve gastrectomy could have similar resolution rates of the metabolic syndrome than Roux-Y bypass after a short-term follow-up of 1 year. Most surgeons calibrate the sleeve with 32-Fr to 40-Fr bougies. There is little mid- and long-term information available about the evolution of these comorbidities with this procedure and with calibration of the sleeve with a 50-Fr bougie. A retrospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy, calibrated with a 50-Fr bougie, as bariatric procedure between October 2007 and September 2009 was performed. Mean excessive body mass index loss was 76.9 per cent after 1 year and 79.9 per cent after 2 years. After surgery, 83.3 per cent of patients with Type 2 diabetes mellitus discontinued their hypoglycemic medication at 1 month. All the patients with hypertension discontinued antihypertensive drugs at 6 months. One hundred per cent of patients with hypertriglyceridemia discontinued their hypolipidemic drugs at 3 months. Glucose levels decreased significantly 3 months after surgery (mean reduction of 24.7 mg/dL; 95% confidence interval [CI], 8.8 to 40.7; P = 0.003). Triglyceride levels decreased 3 months after surgery (mean reduction of 54.4 mg/dL; 95% CI, 22.8 to 86.1; P = 0.004). High-density lipoprotein (HDL) cholesterol increased significantly after 12 months (increase of 16.7 mg/dL; 95% CI, 11.7 to 21.7; P < 0.001). The changes observed were maintained 24 months after surgery. Sleeve gastrectomy, calibrated with a 50-Fr bougie, significantly reduced glucose and triglyceride levels and the cardiovascular risk predictor triglyceride/HDL ratio and increased HDL levels after surgery and maintained them under normal ranges for at least 2 years.
    • "This reasoning comports with our rationale for the use of TGL/HDL ratio as a screening tool to predict success with dose reductions of anti-diabetic medications. Prior studies have also shown TGL/HDL ratio to positively correlate with adiposity, and its decrease proportional to magnitude of weight loss [12,13]. Further, 75% of our patients were using lipid lowering medications at baseline (Table 1). "
    [Show abstract] [Hide abstract] ABSTRACT: Intentional weight loss, by reducing insulin resistance, results in both better glycemic control and decreased need for anti-diabetic medications. However, not everyone who is successful with weight loss is able to reduce anti-diabetic medication use. In this retrospective cohort study, we assessed the predictive accuracy of baseline triglyceride (TGL)/HDL ratio, a marker of insulin resistance, to screen patients for success in reducing anti-diabetic medication use with weight loss. Case records of 121 overweight and obese attendees at two outpatient weight management centers were analyzed. The weight loss intervention consisted of a calorie-restricted diet (~1000Kcal/day deficit), a behavior modification plan, and a plan for increasing physical activity. Mean period of follow-up was 12.5 ± 3.5 months. By study exit, mean weight loss and mean HbA1c% reduction were 15.4 ± 5.5 kgs and 0.5 ± 0.2% respectively. 81 (67%) in the study cohort achieved at least 1 dose reduction of any anti-diabetic medication. Tests for predictive accuracy of baseline TGL/HDL ratio ≤ 3 to determine success with dose reductions of anti-diabetic medications showed a sensitivity, specificity, positive predictive value, negative predictive value, area under the curve, likelihood ratio (LR) + and LR-of 81, 83, 90, 70, 78, 4.8 and 0.2, respectively. Reproducibility of TGL/HDL ratio was acceptable. TGL/HDL ratio shows promise as an effective screening tool to determine success with dose reductions of anti-diabetic medications. The results of our study may inform the conduct of a systematic review using data from prior weight loss trials.
    Full-text · Article · Jul 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Bariatric surgery is the most effective treatment for achieving a significant weight loss. Morbidities present a significant reduction after bariatric surgery, but it may also result in several health complications, related to nutritional deficiencies, including bone metabolism. Several studies have reported a decrease in bone mineral density (BMD), but most of them referring to malabsorptive procedures. Restrictive procedures do not imply changes in gastrointestinal anatomy, so that one may expect fewer metabolic disturbances. Methods: We performed a retrospective observational study of all morbidly obese patients undergoing LSG between 2008 and 2011 at our institution. Bone densitometry was performed before surgery and 1 and 2 years after the intervention. Body size measurements, analytical variables and densitometric values in the lumbar spine (BMD, t score and z score) were investigated. Results: Forty-two patients were included, 39 females and 3 males. Mean BMI was 51.21 kg/m(2). Mean excessive BMI loss was 79.9 % after 1 year and 80.6 % after 2 years. Mean BMD values for spine increased progressively, reaching statistical significance at 1 and at 2 years. Percentage of BMD increase was 5.7 % at 1 year and 7.9 % at 2 years. An inverse correlation was observed between BMD increase and parathyroid hormone (PTH) decrease and a direct correlation between BMD and vitamin D increase. Conclusion: Bone mineral density showed a progressive increase during the first and second year after sleeve gastrectomy. BMD changes are not associated with weight loss, but showed a direct correlation with vitamin D and an inverse correlation with PTH levels.
    Article · Jan 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Obesity and diabetes usually co-exist. Obesity surgery seems to offer solutions for both. The objective of this study was to show the effect of obesity surgery on the diabetic profile. Data on obesity surgery in Germany (2005-2011) were collected from the Institute of Quality Assurance at the research university. Follow-up of the diabetic profile at 1, 2, and up to 6 years after surgery was done. Among 17,670 patients, 5,506 (31.2%) were diabetics. Follow-up was accomplished in 87.4%, 82.5%, and 68.9% of eligible patients at 1, 2, and up to 6 years, respectively, after surgery. Of the study participants, 38.2% were insulin-treated (IT) patients and 61.8% were noninsulin-treated patients (NIT). Of the patients' procedures, 2878 (52.3%) Roux-en-Y gastric bypasses (RYGB), 1711 (31.1%) sleeve gastrectomies (SG), 679 (12.3%) laparoscopic adjustable gastric bands (LAGB), 165 (3%) biliopancreatic diversions with duodenal switch (BPD/DS), and 68 (1.3%) biliopancreatic diversions (BPD) were performed. Female gender percentage and mean body mass index (BMI) were significantly higher in the RYGB and LAGB groups. Mean age was significantly higher in BPD/DS group. At 1 year, remission/improvement (RI) percentage was 83.5%, 82.5%, 67.8%, 93.4%, and 84.8% after RYGB, SG, LAGB, BPD, and BPD/DS, respectively. At 2 years, RI% was 84.9%, 79.5%, 67.7%, 94.5%, and 90.9% after RYGB, SG, LAGB, BPD, and BPD/DS, respectively. At late follow-up, RI% was 83.2%, 59.5%, 58.9%, 100%, and 86.4% after RYGB, SG, LAGB, BPD, and BPD/DS, respectively. IT patients showed insignificantly higher RI% than NIT patients at all follow-up points. Malabsorptive procedures (RYGB, BPD, and BPD/DS) showed a significantly higher RI% than restrictive procedures (LAGB and SG) at late follow-up. Obesity surgery has promising antidiabetic efficacy, especially in IT patients. Malabsorptive procedures show higher, gradually descending, but durable antidiabetic efficacy.
    Article · Jul 2013
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