To Compare the Weight and Metabolic Parameters Before and After Laparoscopic Sleeve Gastrectomy in 74 Bariatric Patients

PRABHDEEP NAIN, MS, SATPAL VIRK, MCh, ASHISH AHUJA, MS, HARISH MATTA, MS. DAYANAND MEDICAL COLLEGE & HOSPITAL, LUDHIANA, INDIA

INTRODUCTION
Laparoscopic sleeve gastrectomy was a part of staged operation for super-obese patients, but with the advent of more restrictive sleeve gastrectomy it could become a single stage procedure in carefully selected patient subset. Various studies have shown that weight loss has been in range of 55% to 70% of the excess body weight. We have studied this procedure over 74 patients .

MATERIAL AND METHOD
A prospective study of 74 morbidly obese patients who underwent laparoscopically sleeve gastrectomy between January 2007 to August 2009. The inclusion criteria were Body Mass Index ( BMI ) more than 40 without comorbidity or more than 35 with comorbidity. Patients were medically fit to undergo laparoscopic major surgery . They were followed up at six and twelve months. We recorded the weight, fasting blood sugar( FBS ) , Lipid profile , Sodium (Na ) , Potassium ( K) , Calcium (Ca ) , Magnesium ( Mg ) , Uric Acid and blood pressure. We performed laparoscopic sleeve gastrectomy over 32-F bougie. Intra-operative methylene blue dye test and post-operative gastrograffin test was done at day one in all patients.
RESULTS
The results of laparoscopic sleeve gastrectomy on 74 morbidly obese patients (BMI average 45.2 kg/m²) showed ; weight loss at 6 months and 12 months, 56% and 72% excess weight loss .Mean weight loss was 28.2kg at 1 year & BMI loss of average patient 10% .Improvement in diabetis control was observed in 72% at 6 months and 78% at 1 year.
Hypertension showed improvement in 80% patients at 1 year. Resolution of dyslipidemia was observed at 62% at 1 year. The other metabolic parameters studied namely Na, K, Mg, Ca and uric acid levels did not show any significant change at 1 year interval.
The procedure had failure in 5 patients ; who did not show significant weight loss. 1 patient had postoperative leak from gastro-esophgeal junction which was managed conservatively . 3 patients required postoperative ventilatory support for 2 days. 2 patients developed features of pulmonary embolism despite on low molecular weight heparin they improved conservatively.
CONCLUSION
The more restrictive sleeve gastrectomy could become a single stage operation for most morbid obese patients. Any failure following laparoscopic sleeve gastrectomy may require re-sleeve or conversion to Roux-en-Y gastric bypass.
Patients who underwent laparoscopic sleeve gastrectomy achieved a mean excess weight loss at 6 & 12 months post-operatively, of 56% and 72% respectively. The effect on metabolic syndrome namely the blood sugar levels measured by fasting blood sugar at six months and twelve months showed improvement in 72 % and 78 % . Hypertension showed improvement in 80 % patients at one year. Lipid profile showed improvement in 62% at one year. Other metabolic parameters studied were the same at one year interval.