Effect Of Laparoscopic Sleeve Gastrectomy Research Articles

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

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. Basis and background: Laparoscopic sleeve gastrectomy has become quite common as a single and definitive treatment for morbid obesity. There are publications regarding the positive short-term outcomes, but long-term outcomes and studies revealing the correlation of ghrelin and LSG are still insufficient. Method: 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. Findings: 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.

Effects of laparoscopic sleeve gastrectomy on the cost of medications and management of type 2 diabetes among patients with obesity in Jeddah, Saudi Arabia: A retrospective study

Abstract Background and Aim: The prevalence of type 2 diabetes mellitus (T2DM) and obesity and the associated direct healthcare costs have been increasing worldwide. Several bariatric surgical procedures, which have successfully resulted in body weight loss, were found to be superior to conservative therapies in managing T2DM. We aimed to assess the effect of laparoscopic sleeve gastrectomy (LSG) on the direct cost of antidiabetic medications among adult T2DM patients in Saudi Arabia. Materials and Methods: Following a retrospective chart review, this study included all adult T2DM patients with a body mass index (BMI) ≥ 35 kg/m2 who underwent LSG between January 2015 and June 2018 at King Abdulaziz Medical City in Jeddah. Patient files were reviewed at baseline, and 6 and 12 months postoperatively. Results: This study included 83 patients (mean age = 44.0 ± 10.9 years; men = 50.6%). BMI significantly decreased (P < 0.001) from the time of surgery (42.7 ± 6.4 kg/m2) to 6 and 12 months postoperatively (32.7 ± 6.2 kg/m2 and 29.7 ± 5.6 kg/m2, respectively), as did the glycosylated hemoglobin values (7.6% ± 1.6%, 6.0% ± 0.9%, and 6.1% ± 1.3%, respectively, P < 0.001). Overall, T2DM patients saved 1479 (95% confidence interval: 1053.75–1904.24) Saudi Riyal on their medications on their first-year post-LSG. Conclusions: LSG was effective in the management of T2DM in patients with obesity. Within 1 year postoperatively, it was associated with significantly improved diabetes control and reduced antidiabetic medication costs.

The Effect of Laparoscopic Sleeve Gastrectomy on Serum Thyroid-Stimulating Hormone Levels in Obese Patients with Overt and Subclinical Hypothyroidism: a 7-Year Retrospective Study.

Inconsistent results were reported by several studies that evaluated the effect of weight loss induced by bariatric surgery on thyroid function panel. This study is aimed at evaluating this effect on thyroid-stimulating hormone (TSH) and thyroid hormone replacement dosages in obese population with overt and subclinical hypothyroidism (SH). A retrospective study was performed on all morbidly obese patients with previous diagnosis of overt and subclinical hypothyroidism who underwent laparoscopic sleeve gastrectomy from October 2009 to January 2017. The correlation between TSH and body mass index (BMI) and the effect of weight loss induced by bariatric surgery on TSH were investigated. The prevalence of overt and SH in morbidly obese patients was 10.8% and 7.2%, respectively. Thirty-six hypothyroid patients and 67 subclinically hypothyroid patients were included in the study. Hypothyroidism improved in 44.5% of patients and completely resolved in 22.2%, and 33.3% experienced no change. Ninety-one percent of SH patients completely resolved, 6% improved, but 3% worsened, with one patient developed hypothyroidism. Both groups achieved a significant decrease in postoperative BMI. A positively statistically significant association was found between BMI and TSH (p < 0.005). Our results favor the effect of laparoscopic sleeve gastrectomy in the obese population with overt and SH as shown by the majority of SH resolution and overt hypothyroidism improvement.

Effects of laparoscopic sleeve gastrectomy on obstetric outcomes within 12 months after surgery.

To determine the obstetric and neonatal outcomes of pregnant patients having undergone laparoscopic sleeve gastrectomy (LSG) in the previous 12 months. This retrospective and observational study included 144 pregnant women: 48 had pregnancies within 12 months after LSG (Group A), 42 became pregnant more than 1 year after surgery (Group B) and 54 obese pregnant women who had a body mass index (BMI) >30 kg/m2 , were categorized as the control group because they did not undergo surgery (Group C). The participants' early gestational BMI, predelivery BMI and gestational weight gain were determined and the obstetric and neonatal outcomes of the groups were compared. The time interval from surgery to conception was 7.8 ± 3.4 months and 25.8 ± 13.4 months for Groups A and B, respectively (P < 0.01). There were no significant differences in the rates of gestational hypertension, pre-eclampsia, preterm delivery and cesarean section between the groups. The number of patients with gestational diabetes mellitus was significantly higher in Group C than in Groups A and B (P = 0.004). The number of large-for-gestational-age infants was higher in Group C than in Groups A and B (P = 0.046). The number of small-for-gestational-age infants was significantly higher in Group A than in Groups B and C (P = 0.025). Pregnancy within one year after LSG is related to an increased risk of small-for-gestational-age infants. LSG decreases the risk of gestational diabetes mellitus independent of the time interval between surgery and conception.

Impact of Laparoscopic Sleeve Gastrectomy on Obese Patients with Subclinical Hypothyroidism.

Background: This study aims to evaluate the incidence of subclinical hypothyroidism (SCH) among studied obese patients. The effects of laparoscopic sleeve gastrectomy (LSG) and loss of weight on thyroid hormones level and the impact of adding thyroxine treatment is described. Patients and Methods: Obese patients undergoing LSG at the university hospital between June 2016 and January 2018 were included. Weight loss and changes in body mass index (BMI), serum thyroid stimulating hormone (TSH), and FT4 were evaluated. SCH patients were randomly divided into group "A" received thyroxine treatment and group "B" received no treatment. Results: There were 554 patients studied (mean age 41 ± 12 years); the mean preoperative BMI, serum TSH, and FT4 were 45 ± 6.8 kg/m2, 3.91 ± 1 μU/mL, and 1.32 ± 1 ng, respectively. Incidence of SCH was 12.9%. Significant post-LSG decrease in BMI (30.8 ± 4.6 kg/m2) was associated with significant decrease in serum TSH (1.99 ± 1.1 μU/mL) in all patients; changes were more prominent in SCH group and in patients with higher BMI. SCH patients had normalization of mean serum TSH at 12 months post-LSG. Results of groups "A" and "B" were not significantly different. Conclusion: The incidence of SCH was 12.9%. The significant decrease in BMI was associated with a significant decrease in serum TSH after LSG; this was more evident in SCH and in patients with higher BMI. Complete resolution of SCH occurred at 12 months post-LSG. Adding thyroxine treatment in obese SCH patients did not improve outcome and should be reserved to specific clinical and laboratory indications.

Effects of Laparoscopic Sleeve Gastrectomy on Quality of Life Related to Gastroesophageal Reflux Disease.

Purpose: Effects of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) symptoms are controversial. Our aim is to evaluate the effects of LSG on GERD symptoms in obese patients using a validated quality-of-life questionnaire. Methods: Records of 100 patients (median body mass index [BMI] 44.4 kg/m2, range 35-63.6) without hiatal hernia or severe GERD were analyzed. GERD symptoms were evaluated by GERD Health-Related Quality-of-Life (HRQL) questionnaire before and after surgery. Weight loss and comorbidity resolution were recorded. Results: Median GERD-HRQL scores decreased from 7 (range 0-44) to 3 (0-34) (P = .025) (median follow-up 56 months [range 7-136]). GERD-HRQL scores improved in 55 patients and worsened in 21; de novo GERD was observed in 10; no change occurred in 14 patients (differences being statistically significant: P = <.0001). On multilinear regression analysis, total preoperative GERD-HRQL score and postoperative BMI were independent variables for overall postoperative GERD-HRQL score: higher total preoperative GERD-HRQL score was associated with improved postoperative GERD-HRQL scores, whereas higher postoperative BMI was associated with worse total postoperative GERD-HRQL score. Resolution of diabetes, hypertension, and sleep apnea syndrome occurred in 84.4%, 68%, and 89.7% of patients, respectively. Conclusions: In obese patients, although LSG was associated with statistically significantly improved postoperative GERD-HRQL scores at mid-term follow-up in 55% of patients, only preoperative GERD-HRQL score and postoperative BMI were independent predictors of GERD after LSG. Higher overall preoperative GERD-HRQL score was associated with improved postoperative GERD-HRQL score. However, further research is needed to assess how to predict GERD outcome.

The Effects of Laparoscopic Sleeve Gastrectomy on the Parameters of Leptin Resistance in Obesity.

Obesity is a growing public health problem worldwide. Bariatric surgical procedures achieve the most sustainable and efficacious outcomes in the treatment of morbid obesity. However, little is known about the underlying molecular pathways modulated by these surgical interventions. Since leptin resistance is implicated in the pathogenesis of obesity, we herein report the effects of laparoscopic sleeve gastrectomy (LSG) on the serum levels of leptin and leptin receptor, in addition to its overall effect on leptin resistance. This was an interventional and follow-up clinical study. In the first part, patients attending the general surgery outpatient clinics at our university hospital were first stratified according to their Body-Mass Index (BMI) into cases (n = 38) with BMI ≥ 35 who were scheduled to undergo LSG, and controls (n = 75) with a normal BMI. Serum leptin and leptin receptor levels were measured by sandwich ELISA technique. A leptin resistance index was estimated by adjusting leptin to BMI ratio to leptin receptor concentration. In the second part of the study, cases who underwent LSG were followed up one year postoperatively to assess their BMI and serum leptin and leptin receptor levels. Leptin to BMI ratio was significantly higher, while serum leptin receptor was significantly lower, in obese patients compared to controls. This translated into a significantly higher leptin resistance index in obese patients. LSG resulted in a significant reduction of BMI, leptin to BMI ratio, and leptin resistance index, as it significantly increased leptin receptor levels. In conclusion, LSG showed significant decrease in leptin resistance in obese patients after one year. Further studies are needed to determine the clinical impact of this finding on LSG outcomes.

Effect of laparoscopic sleeve gastrectomy on blood sugar and blood pressure

Background: Surgery is one and may be the most effective method to treat obesity. In the last decade, Laparoscopic Sleeve Gastrectomy is perceived to be less invasive, technically simple, less morbid and more popular form of bariatric surgery.&#x0D; Objectives: This study aims to assess the effect of Laparoscopic Sleeve Gastrectomy on Fasting Blood Glucose Levels and Blood Pressure.&#x0D; Methods: A prospective controlled study in which 50 obese patients were involved, 36 of patients have hypertension and type 2 diabetes mellitus , 7 patients have type 2 diabetes mellitus only, and 7 patients don’t have hypertension or type 2 diabetes. All patients were submitted to Laparoscopic Sleeve Gastrectomy at Al-Kindy Teaching Hospital between October 2014 and October 2016.&#x0D; Results: Forty five of patients were females, while five were males . Mean age was 34 years, mean height 159 cm mean pre Laparoscopic Sleeve Gastrectomy weight was 121kg. Mean post- Laparoscopic Sleeve Gastrectomy weight was 82kg. Mean weight loss outcome at 1 year follow-up is 32.23% of total body weight. . Preoperative initial mean value of fasting blood glucose was 157.4 mg/dL and the declining occurred at 12 months after Laparoscopic Sleeve Gastrectomy was 97 mg/dL . The hypertension remission rates 1 year after Laparoscopic Sleeve Gastrectomy ranges up to 54% of total number of patients and 75% of those with Hypertension.&#x0D; Conclusions: Laparoscopic Sleeve Gastrectomy has an effect in improving Fasting Blood Glucose Levels and Blood Pressure.

The Effects of Laparoscopic Sleeve Gastrectomy on Metabolic Syndrome

Purpose: Obesity is an important component of metabolic syndrome. In this study, we aim to research the effect of laparoscopic sleeve gastrectomy (LSG) on metabolic syndrome. Methods: A total of 16...

Effect of Laparoscopic Sleeve Gastrectomy on Static and Dynamic Measures of Glucose Homeostasis and Incretin Hormone Response 4-Years Post-Operatively

IntroductionThere is limited literature available on the long-term effect of bariatric surgery especially laparoscopic sleeve gastrectomy (LSG) on the incretin hormone response.AimOur primary aim was to investigate changes in glucose metabolism and incretin hormone responses in participants with impaired glucose regulation approximately 4 years after LSG. The secondary aim was to examine the long-term incretin hormone changes of biliopancreatic diversion (BPD).MethodA non-randomised prospective study comprising of 10 participants undergoing LSG and 6 participants undergoing BPD. Serial measurements of glucose, insulin, C-peptide, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were performed during an oral glucose tolerance test pre-operatively and 1 month, 6 months and at approximately 4–7 years post-operatively. Area under the curve (AUC) was examined at 60 and 120 min.ResultsIn the LSG group, a significant reduction in 2-h plasma glucose (2 h PG), HbA1c and HOMA-IR was observed at 4 years. Compared with pre-operative levels, significant increases in post-glucose GLP-1 secretion were observed at 1 and 6 months, but not maintained at 4 years. A linear increase was seen in post-glucose GIP response at 1 month and 6 months and 4 years. Within the BPD group, a reduction in HbA1c along with an increase GLP-1 response was observed at 7 years.ConclusionAn increase in GLP-1 response was not preserved at 4 years, but a significant increase in GIP response was observed along with improved glycaemic control following LSG.

The Effect of Laparoscopic Sleeve Gastrectomy on Nonalcoholic Fatty Liver Disease.

Obesity is associated with nonalcoholic fatty liver disease which is one of the most common causes of chronic liver disease. FibroScan is a noninvasive tool for liver stiffness measurement and controlled attenuation parameter to evaluate liver steatosis and fibrosis. We aimed to demonstrate the effect of laparoscopic sleeve gastrectomy on liver steatosis and fibrosis. Of the 120 consecutive patients screened, 72 were enrolled in this study. FibroScan M probe and XL probe were used for the evaluation of liver steatosis and fibrosis. Fifty-two patients (72.2%) were female individuals and 20 (27.8%) were male individuals; the mean age was 37.9±10.4 years. Percentage of excess weight loss was significant at the third and sixth months: 57.2±18.3 (P<0.05) and 81.4±24.6 (P<0.05), respectively. Mean preoperative controlled attenuation parameter and liver stiffness measurement values were 309.2±68.7 dB/m and 7.5±5.0 kPa, respectively, and significantly declined to 217.4±56.4 dB/m and 5.6±2.5 kPa, respectively, at sixth postoperative month (P<0.001 and <0.01, respectively). These results suggest that laparoscopic sleeve gastrectomy is associated with significant improvement in liver steatosis and fibrosis. Bariatric surgery has a beneficial effect on nonalcoholic fatty liver disease in morbidly obese patients.

2077-P: Effect of Laparoscopic Sleeve Gastrectomy on Sex Hormone Level and Ovarian Volume in Female Obesity with PCOS

Objective: This study was designed to examine changes in body fat distribution after laparoscopic sleeve gastrectomy (LSG) and to confirm whether these changes are correlated with increased testosterone. Methods: A retrospective study was performed in 51 obese female patients with BMI 30-45 kg/m2 who underwent LSG from Shanghai Tenth People’s Hospital, 38 of whom were PCOS patients. The anthropometric indexes, sex hormone and ovarian volume of ultrasound examinations include both sides ovarian volume, mean ovarian volume (MOV) and maximal ovarian volume (MaxOV) were observed preoperative and follow-up at 3 and 6 months after LSG. The metabolic indexes and ovarian volume were compared before and after surgery. Results: Compared with preoperative, PCOS patients' weight, BMI, waist circumference and hip circumference were significantly lower at 3 and 6 months after operation (P&amp;lt;0.05). Percentage of excess body weight loss(%EWL) for 3 months and 6 months after LSG was 56.32% and 75.98%. TT and cFT showed a downward trend at 3 and 6 months after surgery while SHBG showed an upward trend (P&amp;lt;0.05). Both sides ovary volume and MOV, MaxOV all decreased at 6 months after LSG, but there was no statistically significant difference compared to baseline. Compared with patients without PCOS, the preoperative MOV, MaxOV, and left ovary volume were significantly larger (P&amp;lt;0.05). At 6 months after surgery, the MOV, MaxOV, left ovary volume and right ovarian volume of PCOS and non-PCOS patients were all reduced. The differences in MOV, MaxOV, left ovary volume and right ovarian volume were no longer statistically significant between the two groups. Conclusions: TT and cFT decreased and SHBG increased significantly after LSG. MOV shrinked at 6 months after LSG and was no longer different from non-PCOS patients. LSG is not only an important treatment for weight loss, but also improve PCOS and its clinical symptoms effectively in severe obese women. Disclosure J. Gao: None. M. Zhang: None. C. Zhu: None. X. Wang: None. F. Mei: None. S. Qu: None. Funding National Natural Science Foundation of China (81601269)

Temporal effects of laparoscopic sleeve gastrectomy on adipokines, inflammation, and oxidative stress in patients with impaired glucose homeostasis.

Bariatric surgery is an effective treatment for morbid obesity and metabolic dysfunction. The aim of this work was to examine the early temporal effects of laparoscopic sleeve gastrectomy (LSG) on adipokines (adiponectin, leptin), inflammatory cytokines (interleukin-6, C-reactive protein, interleukin-10), and global plasma measures of oxidative stress (thiobarbituric acid reactive substances and total antioxidant status) in a sample of 55 participants preoperatively, and 1 and 6 months postoperatively. The focus was on a sample of patients with impaired glucose tolerance and type 2 diabetes, which is associated with increased low-grade systemic inflammation and oxidative stress. University hospital, United Kingdom. This was a prospective study comprising 55 participants with impaired glucose homeostasis and type 2 diabetes undergoing LSG (mean body mass index 50.4 kg/m2, mean glycated hemoglobin 7.4%). Serial measurements of the above markers were made preoperatively, 1 and 6 months postoperatively (43 had measurable cytokines and oxidative stress at 1- and 6-mo follow-up). We observed a significant reduction in interleukin-6, C-reactive protein, leptin, and thiobarbituric acid reactive substances, along with an increase in adiponectin 6 months postoperatively. To our knowledge the effects of LSG on inflammatory cytokines and plasma markers of oxidative stress have not been examined temporally in a sizeable sample of participants who have undergone LSG. This present study supports the role of LSG for the treatment of the proinflammatory and pro-oxidant status associated with obesity-related glucose dysregulation.

The Effect of Laparoscopic Sleeve Gastrectomy on Serum Lipids

Background:morbid obesity is a growing health problem in the modern world and affects almost 20% of the population. Obesity associates with increased morbidity and mortality, one of which is dyslipidemia. Bariatric surgery is the only known method to induce significant weight loss and prevent its regain in morbidly obese patients. Aim of the work: the aim of this work was to evaluate the effect of laparoscopic sleeve gastrectomy on serum lipids (Cholesterol - TG - LDL - HDL) and analysis of these data and compare with other results from different centers, institutes all over the world. Methods: our study was a retrospective study on 20 patients hospitalized in General Surgery department of Al-zhraa University hospital who underwent laparoscopic sleeve gastrectomy in order to treat morbid obesity from August 2018 to February 2019. Results: In our study 3 month after LSG we observed significant changes in lipid profile parameters including significant decrease in total cholesterol, TG, LDL and significant increase in HDL. Conclusion: our retrospective study shows that LSG is very good bariatric procedure with excellent results on short term follow up regarding body weight reduction, BMI. Three months after operation improve metabolism and lipid profile was accompanied by decrease in Total Cholesterol, Triglyceride and LDL cholesterol and increase in HDL cholesterol change in significant way

Laparoskopik sleeve gastrektomi sonrası grelin, leptin ve insülin düzeylerindeki değişiklikler

Aim: The objective of this study was to evaluate the effects of laparoscopic sleeve gastrectomy (LSG), performed upon patients with morbid obesity, on weight loss and recovery of comorbid diseases as well as on metabolic and hormonal mechanisms by comparing pre and postoperative hormone levels.Materials and Methods: 38 patients having undergone LSG between May 2013 and May 2014 were included in the study. In this prospective study, patients’ demographic data and associated diseases; weight loss; pre and post-operative insulin levels in addition to pre and post-operative leptin and ghrelin levels in the eighth weeks were compared.Results: Of 38 patients included in the study there were 32 (84.2%) females and 6 (15.8%) males. Median leptin level was 11.16 ng/mL in the preoperative blood sample, whereas postoperative hormone level in the eighth week was 4.39 ng/mL. When ghrelin levels were examined; preoperative median was 25.72 pg/mL, whereas postoperative hormone level was 14.16 pg/mL in the eighth week. Preoperative median body mass index was determined to be 44.27 and post-operative median was observed to be 36.6 in the eighth week. No mortality was observed.Conclusion: Today LSG has become a unique surgical technique in the treatment of morbid obesity due to its efficiency in obtaining weight loss and its feasible complication rates. After reviewing the results of our study; we believe this surgical technique does not only provide continuity in weight loss by restrictive changes but at the same time by metabolic ones, too.

Impact of Pyloric Injection of Magnesium Sulfate-Lidocaine Mixture on Postoperative Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: a Randomized-Controlled Trial.

One of the most common adverse effects of laparoscopic sleeve gastrectomy (LSG) is postoperative nausea and vomiting (PONV). The present study aimed to assess the impact of local injection of a mixture of magnesium sulfate and lidocaine into the pylorus on gastric intraluminal pressure (ILP) and PONV after LSG. Patients with morbid obesity who underwent LSG were randomly allocated to one of two equal groups: treatment group (pyloric injection of a mixture of magnesium sulfate and lidocaine) and control group (pyloric injection of normal saline). PONV and antiemetic requirements were recorded at 6 and 24h postoperatively. Seventy patients (63 female) with a mean age of 34.6 ± 9.9years were included. The mean preoperative and postoperative gastric ILP was comparable in the two groups. The pyloric injection of magnesium sulfate-lidocaine mixture resulted in 31% reduction in the mean gastric ILP (19.4 ± 4.7mmHg before injection to 13.4 ± 4.1mmHg after injection, p < 0.0001). Pyloric injection of saline did not result in significant change in ILP (19.9 ± 4.9 vs 20.3 ± 5.1mmHg). Of the treatment group patients, 17.1% had significant PONV at 6h compared to 91.4% of control group patients (p < 0.0001). At 24h, none of the treatment group patients had significant PONV versus 40% of the control group patients (p < 0.0001). Pyloric injection of magnesium sulfate-lidocaine mixture during LSG resulted in lower incidence of PONV and less use of antiemetic medications in the first 24h after LSG without being associated with higher complication rate.

Preserving β-cell function is the major determinant of diabetes remission following laparoscopic sleeve gastrectomy in Japanese obese diabetic patients

Laparoscopic sleeve gastrectomy has been proven effective in treating obesity-associated type 2 diabetes mellitus (T2DM). However, reports of the effect of laparoscopic sleeve gastrectomy on glucose metabolism in Japanese obese patients with T2DM are rare. The aim of this study was to evaluate the effects of laparoscopic sleeve gastrectomy on glucose tolerance in Japanese obese patients with T2DM, and to analyze factors influencing diabetes remission after surgery. This was a retrospective analysis of data for 24 consecutive patients with T2DM who underwent laparoscopic sleeve gastrectomy. We investigated weight loss and its impact on T2DM 1 year postoperatively. We also compared baseline characteristics and postoperative factors between patients who achieved diabetes remission and patients without remission. Mean body weight loss and percent total weight loss were 23.9 kg and 23.3%, respectively. Mean hemoglobin A1c levels dropped from 7.3 ± 0.3% to 6.1 ± 0.2%, and 18 patients (75%) achieved diabetes remission 1 year postoperatively. Patients achieving remission had significantly lower hemoglobin A1c levels (p = 0.026), higher fasting C-peptide values (p < 0.001), shorter diabetes duration (p < 0.001), lower insulin requirement (p = 0.002), and higher area under the insulin response curve (p < 0.001) and insulinogenic index (p < 0.001) during oral glucose tolerance testing. In conclusion, laparoscopic sleeve gastrectomy is an effective treatment for Japanese obese patients with T2DM. Preserving insulin secretion is the major determinant of diabetes remission.

The Effect of Laparoscopic Sleeve Gastrectomy on Obesity and Obesity-related Disease : the Results of 10 Initial Cases.

Introduction : The number of patients who undergo laparoscopic sleeve gastrectomy (LSG) has been increasing. Department of Surgery, Tokushima University performed the first LSG in 2013. The aim of this study was to report the results of the initial ten cases who underwent a LSG. Patients and methods : Ten obese patients : five males and five females ; age range from thirty-three years to fifty-six years (mean age 42.2 years) ; mean body mass index (BMI) 50.3 ; five with diabetes ; nine with hypertension (HT) ; four with hyperlipidemia (HL) ; eight with sleep apnea syndrome (SAS) who underwent LSG were enrolled in this study. The data was analyzed retrospectively and included short- and long-term outcomes. Results : There were no post-operative complications in this study. The %EWL at three and six months and one year post-operative were 44.2%, 50.2% and 48.6% respectively. In three months post-operative the non-alcoholic fatty liver (NAFLD) and non-alcoholic steatohepatitis (NASH) had improved transaminase (AST/ALT), liver to spleen ratio in plain CT value. Improvements were also evident in the obesity-related diseases : diabetes 80% (4/5) ; HT 67% (6/9) ; HL 75% (3/4) ; and SAS 88% (7/8). Conclusion : LSG is a promising option for the treatment of morbid obesity and obesity-related diseases. J. Med. Invest. 66 : 289-292, August, 2019.

SHORT TERM EFFECT OF LAPAROSCOPIC SLEEVE GASTRECTOMY ON CLINICAL, RENAL PARAMETERS AND URINARY NGAL LEVELS IN DIABETIC AND NON DIABETIC OBESITY.

Although diseases such as diabetes, hypertension, obstructive sleep apnea and hyperlipidemia are clearly documented as obesity associated diseases, it is not well-known whether obesity causes renal pathologies. The aim of the present study was to evaluate the effect of weight loss following laparoscopic sleeve gastrectomy on clinical, renal parameters and urinary Neutrophil gelatinase-associated lipocalin (NGAL) levels in diabetic and non-diabetic obese patients. Nineteen morbidly obese patients (10 diabetic and 9 non diabetic) who underwent laparoscopic sleeve gastrectomy were evaluated clinically (anthropometric measurements) and biochemically before surgery and at 6 months from surgery. Significant decreases in weight, BMI, FPG, PPG and HbA1c levels were observed in the diabetic group when the baseline and 6th month parameters of the patients were compared. There was also a significant decrease in SBP and DBP. At 6th month following laparoscopic sleeve gastrectomy, renal parameters such as creatinine, mAlb/creatinine, NGAL/creatinine did not differ in the diabetic group. In the nondiabetic group, serum creatinine levels were significantly decreased, but other renal parameters such as mAlb/creatinine and NGAL/creatinine were not significantly different. Our findings revealed significant decreases in weight, body mass index and glycemic parameters after sleeve gastrectomy in diabetic and non-diabetic patients, while no significant alteration was noted in renal functions, urinary NGAL and microalbumin levels.

The Effects of Laparoscopic Sleeve Gastrectomy on Glucose Metabolism in Patients with a Body Mass Index below 35 kg/m².

Objectives:The prevalence of obesity and its associated comorbidities are increasing all over the world. Laparoscopic sleeve gastrectomy has become the most common bariatric surgery in the world today, especially in the treatment of Type 2 diabetes mellitus, which is one of the effective surgical methods. The present study aims to investigate the effects on glucose metabolism in patients following laparoscopic sleeve gastrectomy.Methods:In this study, the files of 174 patients who had laparoscopic sleeve gastrectomy with a body mass index between 30-35kg/m2 between March 2013 and September 2019 were analyzed retrospectively. Patients were evaluated by a multidisciplinary team in the preoperative period. Patients who met the criteria for laparoscopic sleeve gastrectomy were operated according to American Metabolic and Bariatric Surgeons criteria. Demographic data, body mass index, insulin, glycosylated hemoglobin (HbA1c), glucose, homeostasis model insulin resistance (HOMA-IR) values were recorded. The patients were followed up with visits to the outpatient clinic scheduled for 1-3-6 and 12 months postoperatively.Results:The mean age of the 174 patients who underwent laparoscopic sleeve gastrectomy was 39.57±9.40, and the mean body mass index was 32.70±2.65. 149 patients (85.6%) were female. The mean hospital stay was 3.1±0.7 days. When glucose, HbA1c, HOMAR-IR and insulin values of the patients were examined, it was observed that the decrease was statistically significant at 12 months follow-up. There was a significant decrease in body mass index compared to the preoperative period.Conclusion:Laparoscopic sleeve gastrectomy is an effective surgery on glucose metabolism in patients with a body mass index of 30-35kg/m2.