Carolyn Graham, MD, MBT1, Noah Switzer, MD2, Richdeep Gill, MD, PhD, FRCSC1, Estifanos Debru, MD, FRCSC1, Neal Church, MD, FRCSC1, Philip Mitchell, MD, PhD, FRCSC1, Artan Reso, MD, FRCSC1. 1University of Calgary, 2University of Alberta
INTRODUCITON: Bariatric surgery has been shown to be a safe and dramatic management strategy for patients struggling with severe obesity and the metabolic syndrome, including hypertension. Buchwald et al. reported hypertension resolution rates in 67.1% and improvement in 78.5% following aggregate bariatric surgery. The laparoscopic sleeve gastrectomy (LSG) is becoming more recognized as a primary bariatric surgery, but it lacks long-term outcome data to solidify its reputation. Our aim is to establish the long-term efficacy of the laparoscopic sleeve gastrectomy on hypertension outcomes.
METHODS AND PROCEDURES: Two independent reviewers performaed a comprehensive literature search through Medline, Embase, Scopus, Web of Science, Dare, Cochrane library, and HTA database. The search terms used were broad: sleeve gastrectomy AND hypertension OR blood pressure. Adult patients (>18 years) undergoing LSG with follow-up hypertension outcome results of at least 5 years were included. Revisional surgeries were excluded from this review. Using the Newcastle-Ottawa scale (NOS), studies were graded on their quality.
RESULTS: Fourteen studies were included in this systematic review, which included 3550 subjects in total. All studies reviewed using the NOS received a score of "good". The mean age was 41.1 + 10.7 years . Mean pre-operative BMI and weight was 47.7 + 8.83 kg/m2 and 272.8 + 48.4 lb respectively. The pre-operative prevalence of hypertension was 36.5% (95% CI 23.6 – 49.5%), which dropped to 14.79% (95% CI -3.86 – 33.4%) at approximately 5 years follow-up. Hypertension resolved in 62.17% (95% CI 43.8 – 80.5%) of patients and improved in 35.7% (95% CI 11.2 – 60.3%), at a mean of 5.35 years follow-up.
CONCLUSION: From our systematic review, it appears that the LSG is an effective long-term metabolic strategy for patients with hypertension. It would be interesting to further investigate the overall effect and cost reduction on our healthcare system with improvement in patient comorbidities such as hypertension.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85559
Program Number: S040
Presentation Session: Bariatrics 2 Session
Presentation Type: Podium