Impact oflaparoscopic sleeve gastrectomy on obesity-associated co-morbidities:A two-year follow-up prospective study

Abstract

Objectives: To determine the effects imposed by laparoscopic sleeve gastrectomy (LSG) on obesity-associated co-morbidities. Patients & methods: The study included 40 patients; 13 morbid obese and 27 obese patients. All patients were evaluated preoperatively for existence and severity of co-morbidities and determination of Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). All patients underwent LSG; operative time, hospital stay, and intraoperative and postoperative (PO) complications were registered. Postoperative monitoring included evaluation of the percentage of excess weight loss (roEWL)and the percentage of excess body mass index loss (roEBMIL) at 3, 6, 12 and 24 months after surgery; the frequency of associated co-morbidities and HOMA­ IR index was evaluated at 6, 12 and 24 months after surgery. Results: Mean operative time was 157.8±17 minutes and mean duration of hospital stay was 5.5±0.9 days. No conversion to open surgery. All patients showed progressive weight loss throughout the follow-up period with progressively increasing roEWL and roEBMIL. BMI strata showed significant progressive change throughout follow-up period; 27 women were overweight and only 13 women were obese. All obesity-associated co-morbidities showed progressive improvement or resolution. At end of follow-up, 7 patients still had co-morbidities, 9 patients had improved co-morbidities and 24 patients had resolved co-morbidities with an improvement and resolution rates of22.5% and 60%, respectively and only 11 co-morbidities were recorded at end of follow-up in various combinations in the 7 non-responders. Preoperatively, all patients were insulin resistant; however, at the end of follow-up period HOMA-IR index of all patients was within the non-resistant range. Conclusion: Bariatric surgery effectively improves obesity-associated co-morbidities and could be considered as non-pharmacological therapeutic modality for these co-morbidities. Laparoscopic gastric sleeve is a safe and effective appropriate surgical procedure for morbidly obese patients with associated co-morbidities.