Laparoscopic Sleeve Gastrectomy: An Efficacious Management of Metabolic Syndrome in the Morbidly Obese.

Joslin Cheverie, MD, FRCSC, Garth R Jacobsen, MD, FACS, Bryan J Sandler, MD, FACS, Juan S Barajas-Gamboa, MD, Manuel Valero, MD, Alisa M Coker, MD, C. Aitor Macias, MD, MPH, Mark A Talamini, MD, FACS, Eduardo Grunvald, MD, Santiago Horgan, MD, FACS

UCSD Center for the Future of Surgery

Introduction

The objective of this study is to evaluate weight loss, resolution of diabetes, and remission of obesity related co-morbidities following laparoscopic sleeve gastrectomy (LSG) in morbidly obese diabetic patients.

Methods

Under IRB approval, a retrospective review of all diabetic patients who underwent LSG was performed. Inclusion criteria included age >18, BMI > 30 , and presence of diabetes with proven biochemistry and/or ongoing medical treatment. Multidisciplinary preoperative assessment involving medical, surgical, psychiatric, and dietary evaluations was completed. Patient demographics, weight, BMI, glycosylated hemoglobin level, fasting blood glucose, insulin requirements, oral hypoglycemics, antihypertensive medications, lipid profiles, and arthritis prevalence were obtained both pre- and post-operatively. Outcome measures included resolution of diabetes, extent of weight loss, percent of excess weight loss (%EWL), percent BMI loss (%BMI loss), complications, mortality, and duration of follow-up.

Results

Fifty-five obese, diabetic patients underwent LSG between
August 2007 and July 2012. Female to male ratio was 2.24:1. Initial age, weight, and BMI averaged 53 years, 310 lbs, and 50 kg/m2, respectively. Mean operative time was 113 mins (74-269). Preoperative duration of disease with respect to DM was 8.24 (0.5-30) years. Average preoperative HgA1C level was 10.4 mmol/mol (5.6-11.8), which dropped to 6.33 (5.1-9.3), 6 (5-6.8), and 6.1 (4.9-9.3) mmol/mol at 1, 6, and 12 months respectively. The mean initial fasting blood glucose level was 167 mg/dL (105-287), and at 1, 6, and 12 months this level was 106 mg/dL (75-157), 99 mg/dL (68-159), and 102 mg/dL (73-170) accordingly. One patient (1.8%) was on insulin alone, 53 patients (96%) were on oral anti-hyperglycemics, and 14 patients (25.5%) were on a combination of both. At 1 month, 28 patients (51%) were off all diabetic medications, and this increased to 37 (67%) and 39 (71%) patients at 6 and 12 months. Mean weight at 1, 6, and 12 months was 265, 238, and 227 lbs, respectively. The %EWL was 27%, 42%, 48% and %BMI loss was 14.3%, 23.1%, 26.3% at these intervals. Hypertension was present in 41 patients (75%) who required an average of 1.5 (1-4) oral medications for treatment. Hypertension prevalence decreased to 24 patients (25%) at 6 months. Hypertriglyceridemia was noted preoperatively with a mean of 193 mg/dL (71-467); average 6-month postoperative triglyceride level was 127 mg/dL (68-336). Preoperative LDL, HDL, and total cholesterol levels were 96 mg/dL (42-187), 43 mg/dL (19-76), and 180 mg/dL (99-308); postoperative measurements were 94 mg/dL (45-164), 48 mg/dL (9-76), and 165 mg/dL (107-274) respectively. Post operative complications and mortality were 0%.

Conclusions

LSG as a primary surgical treatment in obese diabetic patients maintains metabolically desirable outcomes over time. Weight loss, glucose homeostasis, and resolution of obesity-related co-morbidities in combination with zero surgical complications or mortalities supports LSG as a stand-alone procedure for metabolic syndrome.


Session: Podium Presentation

Program Number: S011

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