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

Abstract

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.

Amelioration of Diabetes Mellitus Type II after Sleeve Gastrectomy—Data on Nationwide Survey on Quality Assurance in Bariatric Surgery in Germany

“…Ruiz-Tovar et al noticed that 83.3% of patients discontinued their hypoglycemic medications within one month after SG. These findings were maintained for 24 months after surgery [18]. In this survey, a more or less stationary RI% was noticed at midterm follow up intervals of 2 years after SG, where RI% dropped slightly to 79.5%.…”

The Role of Plasma Triglyceride/High‐Density Lipoprotein Cholesterol Ratio to Predict New Cardiovascular Events in Essential Hypertensive Patients

“…Both inflammation and high levels of visceral fat have been associated with metabolic disturbances including insulin resistance, dyslipidemia, and hypertension . In addition, TGL/HDL ratio positively correlates with adiposity, and the magnitude of weight loss is proportional with the decrease of TGL/HDL ratio . All these mechanisms may link the relationship between high TG/HDL‐C ratios with worse outcomes.…”

Middle Term Impact of Sleeve Gastrectomy on Major Cardiovascular Risk Factors in a Group of Romanian Obese Patients

“…The control mechanisms of metabolic surgery are unclear, but it is likely that the surgery resets metabolic parameters in a balanced way, such that energy intake and expenditure are optimized. Among the various surgical procedures laparoscopic sleeve gastrectomy (LSG) was proven to obtain significant reduction in glucose, triglyceride levels, triglycerides/HDL ratio and increased HDL levels and these changes were maintained under normal ranges for at least two years after surgery (10).…”