Impact of Sleeve Gastrectomy on Weight Loss, Glucose Homeostasis, and Comorbidities in Severely Obese Type 2 Diabetic Subjects

This study was undertaken to assess medium-term effects of laparoscopic sleeve gastrectomy (LSG) on body weight and glucose homeostasis in severely obese type 2 diabetic (T2DM) subjects. Twenty-five obese T2DM subjects (10 M/15 F, age 45 ± 9 years, BMI 48 ± 8 kg/m2, M ± SD) underwent evaluation of anthropometric/clinical parameters and glucose homeostasis before, 3 and 9–15 months after LSG. Mean BMI decreased from 48 ± 8 kg/m2 to 40 ± 9 kg/m2 (P < .001) at 3 months and 34 ± 6 kg/m2 (P < .001) at 9–15 months after surgery. Remission of T2DM (fasting plasma glucose < 126 mg/dL and HbA1c < 6.5% in the absence of hypoglycemic treatment) occurred in all patients but one. There was a remarkable reduction in the percentage of patients requiring antihypertensive and hypolipidemic drugs. Our study shows that LSG is effective in producing a significant and sustained weight loss and improving glucose homeostasis in severely obese T2DM patients

Laparoscopic reinforced sleeve gastrectomy: early results and complications

BACKGROUND: Sleeve gastrectomy (SG) was pioneered as a two-stage intervention for super and super-super obesity to minimize morbidity and mortality; it is employed increasingly as a primary procedure. Early outcomes and integrity of laparoscopic SG (LSG) against leak using a technique incorporating gastric transection-line reinforcement were studied. METHODS: Between 2003 and 2009, 121 patients underwent LSG (16, two-stage; 105, primary). Of the patients, 66% were women, mean age 38.8 ± 10.9 (15.0-64.0), and body mass index (BMI, kg/m(2)) 48.7 ± 9.3 (33.7-74.8). Bovine pericardium (Peri-Strips Dry [PSD]) was used to reinforce the staple line. Parametric and nonparametric tests were used, as appropriate. The paired t test was used to assess change from baseline; bivariate analyses and logistic regression were used to identify preoperative patient characteristics predictive of suboptimal weight loss. RESULTS: Mean operative time was 105 min (95-180), and mean hospitalization was 5.6 days (1-14). There was no mortality. There were 6 (5.0%) complications: 1 intraoperative leak, 1 stricture, 1 trocar-site bleed, 1 renal failure, and 2 wound infections. There were no postoperative staple-line leaks. Following 15 concomitant hiatal hernia operations, 3 (20%) recurred: 1 revised to RYGB and 2 in standby. Two post-LSG hiatal hernias of the two-stage series required revisions because of symptoms. BMI decreased 24.7% at 6 months (n = 55) to 37.5 ± 9.3 (22.2-58.1); %EWL was 48.1 ± 19.3 (15.5-98.9). Twelve-month BMI (n = 41) was 38.4 ± 10.5 (19.3-62.3); %EWL was 51.7 ± 25.0 (8.9-123.3). Forty-eight-month BMI (n = 13) was 35.6 ± 6.8 (24.9-47.5); %EWL was 61.1 ± 12.2 (43.9-82.1) (p 70% of patients who experienced <50% EWL at 6 months. At 2 weeks, 100% of type 2 diabetes patients (n = 23) were off medication (mean HbA(1C), 5.9 ± 0.5%; glycemia, 90.0 ± 19.9 mg/dL (p < 0.01) at 3 months). CONCLUSIONS: Laparoscopic PSD-reinforced LSG as a staged or definitive procedure is safe and effective in the short term and provides rapid type 2 diabetes mellitus reduction with a very low rate of complications

Comparison of Excess Weight Loss and Body Composition Between Diabetic and Non-Diabetic Patients Following Gastic Bypass or Sleeve Gastrectomy

Background Bariatric surgery provides excellent results in term of weight loss and improve associated metabolic disorders such as type 2 diabetes mellitus (T2DM). There is low evidence in literature about changes in body composition in relation to different bariatric procedures and the presence of T2DM. Aim of this study is to evaluate changes in body composition in diabetic obese patients vs. non-diabetic obese patients who underwent different bariatric procedures, Gastric bypass (LRYGB) or Sleeve Gastrectomy (SG). Methods the Body composition of obese patients eligible to surgery was evaluated by bioelectrical impedence analysis (Tanita BC 418-MA) before and 1-year after surgery. A variation test was used to analyze results (BMI and body composition). Results 46 patients underwent bariatric procedures: 20 patients LRYGB and 26 patients SG. 21 patients preoperatively suffered from T2DM and 25 did not. Data concerning BMI and body composition were collected at baseline and 1- year follow-up in four subgroups of patients: obese non-diabetic patients (group 1) and obese diabetic patients (group 2) who underwent LRYGB, obese non-diabetic patients (group 3) and obese diabetic patients (group 4) who underwent Sleeve gastrectomy. At 1-year follow-up, fat mass and fat-free mass differences in percentage were statistically significant in each subgroup. There were no statistically significant differences as regards BMI, fat mass and fat-free mass percentages between subgroups 1 and 2 as there were, in contrast, between group 3 and 4. Conclusions bariatric surgery can induce good results in term of weight loss, reduction of fat mass as well as fat-free mass improvement. Obese diabetic patients submitted to Sleeve Gastrectomy have a worse improvement of fat mass and free-fat mass compared to non diabetic patients submitted to the same procedure

Clinical Efficacy of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass in Obese Type 2 Diabetic Patients: a Retrospective Comparison.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are performed in patients with obesity and type 2 diabetes mellitus (T2DM). The aim of this study is to evaluate retrospectively the clinical efficacy of RYGB and SG in two groups of obese T2DM patients. METHODS: From the hospital database, we extracted the clinical records of 31 obese T2DM patients, of whom 15 (7 F/8 M) had undergone laparoscopic SG (LSG) and 16 (7 F/9 M) laparoscopic RYGB (LRYGB) in the period 2005-2008. The groups were comparable for age (range 33-59 years) and BMI (range 38-57 kg/m(2)). LRYGB alimentary limb was 150 cm, and biliopancreatic limb was 150 cm from the Treitz ligament. LSG vertical transection was calibrated on a 40-Fr orogastric bougie. Data were analysed at 6, 12 and 18-24 months with reference to weight loss and remission of comorbidities. RESULTS: The reduction in body weight was comparable in the two groups. At 18-24 months the percent BMI reduction was 29 ± 8 and 33 ± 11 % in LSG and LRYGB, respectively. Percent excess weight loss was 53 ± 16 and 52 ± 19 % in LSG and LRYGB, respectively. Thirteen patients in LSG and 14 patients in LRYGB discontinued their hypoglycaemic medications. Five (55 %) patients in LSG and eight (89 %) in LRYGB discontinued antihypertensive drugs. Three out of five patients in LSG and one out of two patients in LRYGB withdrew lipid-lowering agents. CONCLUSIONS: LSG and LRYGB are equally effective in terms of weight loss and remission of obesity-related comorbidities. Controlled long-term comparisons are needed to establish the optimal procedure in relation to patients' characteristics

LAPAROSCOPIC SLEEVE GASTRECTOMY: LONG-TERM OUTCOMES ON WEIGHT LOSS, GERD AND DIABETES

Background: Laparoscopic Sleeve Gastrectomy (LSG) is an effective and relatively safe bariatric procedure, but long-term results are still rare. Our aim was to evaluate the efficacy of LSG on weight loss, gastroesophageal reflux symptoms and Type 2 Diabetes. Methods: Medical records of all 105 patients undergoing SG at our Institution between 2006 and 2009 were retrospectively examined. Long-term outcomes were analyzed in terms of BMI, %TWL, %EWL, comorbidities resolution and revisional surgery. According to the preoperative BMI, patients were divided in two groups: Group 1 (n=61) BMI<50kg/m2 and Group 2 (n=44) BMI≥50Kg/m2. We considered as surgical success the achievement of a BMI<35kg/m2 for Group 1 and of a BMI<40kg/m2 for group 2. Results: Group 1 (72% female, mean age 39.9 years old) presented a mean preoperative BMI of 41.2±4.7kg/m2 and Group 2 (52% female, mean age 38.5 years old) a BMI of 57.2±3.6kg/m2 . No difference was found in the preoperative prevalence of hypertension, dyslipidemia, T2DM, GERD symptoms between the two groups. The follow-up rate was 94.2% after 5 years (n=99). At 5th year, Group 1 showed a mean BMI 30.1±4.8kg/m2 , a %TWL of 26.6±10, and %EWL of 58.4±21.8. Group 2 had a mean BMI of 37.8±8.3kg/m2 , %TWL 33.4±12.9, %EWL 53.9±22.4. Surgical success was achieved in 85% of patients of Group 1 and 63% of patients of Group 2. Comorbidities improved considerably: resolution of hypertension was achieved in 64% of patients, of dyslipidemia in 69% of patients, resolution (complete or partial) of T2DM in 90% of patients. At 5 years of follow-up, diabetic patients showed a significantly lower weight loss when compared to non-diabetic patients (%EWL: 44±19, p=0.007 vs non-diabetic subjects). GERD symptoms improved in 73.3% of patients of Group 1 and in 44.4% of patients of Group 2, with a new onset of GERD in 15% of patients of Group 1 and 7.7% of patients of Group 2. Nine patients (9,1%) underwent revisional surgery for poor weight loss outcomes or severe GERD symptoms. Conclusion: SG is an effective procedure in terms of weight loss outcomes and remission of comorbidities, more evident in patients with a preoperative BMI<50kg/m2. Although a second procedure can be required for poor weight loss outcomes or persistence of GERD symptoms