Success of laparoscopic sleeve resection of the stomach in the treatmnent of obesity ant metabolic syndrome in patients with a body mass index greater above and below 50 kg/m2

[S. S. Putnik]

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Uvod: Laparoskopska rukavna resekcija želuca (LSG) danas se izvodi kao najčešća hirurška procedura kod pacijenata sa gojaznošću i metaboličkim sindromom. Od vrednosti indeksa telesne mase (BMI) zavisi preoperativna priprema, intraoperativni i postoperativni tok, kao i uspešnost lečenja. Metod: Retrospektivna kohortna studija, koja obuhvata pacijente operisane LSG od 2008 do 2020 godine sa periodom praćenja do 12 godina. Pacijenti su podeljeni u dve grupe: sa inicijalnim BMI<50 kg/m2 i inicijalnim BMI≥50 kg/m2 . Podaci o pacijentima prikupljeni su uvidom u istorije bolesti, operativne protokole i putem telefonskog intervjua. Postoperativni uspeh se definiše kao ukupni gubitak težine (%TWL) preko 20% i utvrđeni gubitak telesne težine (%EWL) i gubitak viška indeksa telesne mase (%EBMIL) preko 50% najmanje godinu dana nakon operacije. Rezultati: Studija je obuhvatila 257 pacijenata sa početnim BMI od 31,2 do 86,6 kg/m2 . Praćenjem TWL, EWLi EBMIL utvrđeno je da je LSG uspešna u kratkoročnom, srednjeročnom i dugoročnom periodu. U odnosu na posmatrane grupe operacija je uspešna kod svih pacijenata, ali sa lošijim rezultatom kod pacijenata sa BMI≥50 kg/m2 u periodu koji je veći od pet godina. Od postoperativnih komplikacija najčešće su bile intraoperativne 28,9%, kasne 8,2% i rane 7,1% slučajeva. Logističkom regresijom je utvrđeno da hipertenzija povećava šansu za pojavu intraoperativnih komplikacija 12 puta, a šećerna bolest 2 puta. Zaključak: LSG je uspešna kao barijatrijska procedura u lečenju gojaznosti. U odnosu na EBMIL i EWL, LSG daje bolje rezultate u lečenju gojaznosti kod pacijenata sa BMI manjim od 50 kg/m2 . Pored redukcije telesne težine LSG dovodi i do izlečenja/poboljšanja dislipidemije, hipertenzije i šećerne bolesti, ali i drugih komorbiditeta.

Introduction: Laparoscopic sleeve gastrectomy (LSG) is now performed as most common surgical procedure in patients with obesity and metabolic syndrome. Preoperative preparation, intraoperative and postoperative course and success of treatment depend on the body mass index (BMI) value. Methods: Retrospective cohort study including patients who underwent LSG surgery between 2008 and 2020, with a follow-up period of up to 12 years. Patients were divided into two groups: those with an initial BMI less than 50 kg/m2 and those with an initial BMI greater than or equal to 50 kg/m2 . Patient data were collected from medical history, surgical protocols and telephone interviews. Postoperative success is defined as total weight loss (%TWL) over 20% and determined body weight loss (%EWL) and excess body mass index loss (%EBMIL) over 50% at least one year after surgery. Results: The study included 257 patients with initial BMI ranging from 31.2 to 86.6 kg/m2 . According TWL, EWLi EBMIL, LSG proved successful in short-, medium- and long-term follow-up periods. Compared to the observed groups surgery was successful in all patients, but with a worse outcome in the patients with a BMI≥50 kg/m2 at a period of more than five years. Of the postoperative complications, the most common intraoperative was 28.9%, late 8.2% and early in 7.1% of cases. Logistic regression showed that hypertension increased the risk of intraoperative complications by 12 times and diabetes by 2 times. Conclusion: LSG is a successful bariatric procedure in the treatment of obesity. Compared with EBMIL and EWL, LSG provides better results in the treatment of obesity in patients with BMI less than 50 kg/m2 . In addition to reducing body weight, LSG also leads to cure/improvement of dyslipidemia, hypertension, and diabetes, as well as other comorbidities.

rukavna resekcija želuca, gojaznost, metabolički sindrom, indeks telesne mase.

sleeve resection of the stomach, obesity, metabolic syndrome, body mass index

616-089(043.3)

Laparoskopska hirurgija - Želudac

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