Publication: Bariyatrik Metabolik Cerrahinin Metabolik Sendrom Bileşenleri Üzerine Etkilerinin Araştırılması
Abstract
GİRİŞ: Obezite, küresel boyutta insan sağlığını olumsuz etkileyen bir salgındır. Obezite ve obeziteye eşlik eden komorbiditeler yaşam kalitesini bozan ve hatta insan hayatını tehdit eden ciddi hastalıklardır. Günümüzde obezite tedavisinde sürdürülebilir kilo kaybını sağlayan en etkin yöntem bariyatrik cerrahi prosedürleridir. AMAÇ: Bariyatrik/metabolik cerrahi yöntemlerinin metabolik sendrom bileşenlerinden abdominal obezite, insülin rezistansı/diyabetes mellitüs, hipertansiyon, hiperlipidemi/dislipidemi, obstruktif uyku apnesi/obeziteye bağlı astım ve hipotiroidi üzerine tedavi edici etkisini değerlendirmeyi hedefledik. Bariyatrik cerrahi sonrası komplikasyonları, hastaların tekrar kilo alıp almadıklarını ve bariyatrik cerrahinin kısa, orta ve uzun dönem etkilerini araştırmayı planladık. HASTALAR VE YÖNTEM: Aralık 2012 - Ocak 2020 tarihleri arasında, Ondokuz Mayıs Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'nda, obezite tanısıyla bariyatrik/metabolik cerrahi uygulanan ameliyat sonrası en az 3 ayını tamamlamış hastalar retrospektif olarak incelendi. Operasyon sonrası 3. ay, 6. ay, 1. yıl, 2. yıl ve 3. yıl kontrolleri yapılan 561 hasta, çalışmaya dahil edildi. Hastane veri tabanı, e-nabız ve hasta dosyaları tarandı. Bilgileri eksik olan hastalar ile iletişime geçildi ve veriler kayıt altına alındı. Bariyatrik cerrahinin metabolik sendrom bileşenleri üzerine etkilerini kısmi ve tam remisyon olarak son takibindeki durumuna göre değerlerlerildi. Her hastalık için kısmi iyileşme kriterleri belirlendi. Verilerin analizinde istatistik yazılım programı (SPSS Version 22.0 Armonk, NY: IBM Corp.) kullanıldı. BULGULAR: Morbid obezite tanısı ile Ondokuz Mayıs Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'nda LSG ve MGB uygulanan hastaların, metabolik sendrom bileşenlerinin operasyon öncesi ve sonrası değerlendirildiği çalışmada elde edilen sonuçlar ortaya kondu. LSG uygulanan 516 hastada ve MGB uygulanan 45 hastada operasyon öncesine göre 3. ay, 6. ay, 1. yıl ve 2. yıl kontrolünde VKİ'de düşüş ve EWL(%) değerlerinde yükselme gözlendi. LSG uygulanan hastaların 3. yıl kontrolünde hastaların geri kilo aldığı, bu yüzden 2.yıla göre VKİ'nde artma ve EWL(%) değerlerinde düşme olduğu gözlendi. MGB uygulanan hastalarda ise 3.yılda VKİ'nde düşüş devam ederken EWL(%) değerlerinde yükselme oldu. Bariyatrik/metabolik cerrahi yöntemleri obeziteye eşlik eden metabolik sendrom bileşenlerinden ır/dm, ht, hl/dl, osas, hipotiroidi gibi komorbiditelerde anlamlı düzelme sağlamaktadır. Operasyon öncesine göre, LSG sonrası dm %92,86; ht %89,23; hl/dl %75,70; osas %97,62; hipotiroidi %73,08 oranında iyileşme sağlamıştır. Operasyon öncesine göre, MGB sonrası dm %100; ht %88; hl/dl %82,36; osas %90; hipotiroidi %66,67 oranında iyileşme sağlamıştır. Metabolik sendrom bileşenlerinin takip süresindeki değişimi incelendiğinde dm kısmi iyileşme oranlarının %5,1'den %18,5'e arttığı; tam iyileşme oranlarının %92,3'den %55,6'ya düştüğü gözlendi. Takip süresi uzadıkça tam iyileşme gösteren hasta oranı azalmaktadır (p=0,0001). Diğer parametreler için takip süresinde değişiklik olmadığı gözlendi. LSG ve MGB uygulanan hastalarımızda takip süresince mortalite izlenmedi. Majör komplikasyon olarak kaçak sadece LSG grubunda olup, oran %0,2'dir. Her iki cerrahi tipi için minör komplikasyon oranları benzerdi. ÇIKARIMLAR: Bariyatrik/metabolik cerrahi prosedürü olarak LSG, düşük morbidite ve mortalite oranları ile güvenilir bir şekilde uygulanmaktadır. LSG'nin metabolik sendrom bileşenleri üzerine tedavi edici etkisi güçlü bir şekilde ortaya konmuştur. Ancak bariyatrik/metabolik cerrahi sonrası diyabetes mellitüs remisyonu ve sürdürülebilir kilo kaybı değerlendirildiğinde, MGB uzun dönemde daha etkin olarak karşımıza çıkmaktadır. Bariyatrik/metabolik cerrahi yöntemi yaş ve ek hastalıkların varlığı başta olmak üzere hastaya ait kriterler göz önünde bulundurularak tercih edilmelidir. ANAHTAR KELİMELER: Bariyatrik/metabolik cerrahi, obezite, metabolik sendrom
BACKGROUND: Obesity is an epidemic that negatively affects human health globally. Comorbidities that accompany obesity and obesity are serious diseases that impair quality of life and even threaten human life. Today, bariatric surgery procedures are the most effective method to achieve sustainable weight loss in the treatment of obesity. OBJECTIVE: We aimed to evaluate the therapeutic effect of bariatric / metabolic surgery methods on abdominal obesity, insulin resistance / diabetes mellitus, hypertension, hyperlipidemia / dyslipidemia, obstructive sleep apnea / obesity-related asthma and hypothyroidism. We planned to investigate complications after bariatric surgery, whether patients gain weight again and the short, medium and long-term effects of bariatric surgery. PATIENTS AND METHODS: Between December 2012 and January 2020, patients who completed at least 3 months after surgery with bariatric / metabolic surgery at the Ondokuz Mayıs University Faculty of Medicine General Surgery Department were retrospectively analyzed. 561 patients who were checked for the 3rd month, 6th month, 1st year, 2nd year and 3rd year after the operation were included in the study. Hospital database, e-pulse system and patient files were scanned. Patients with incomplete information were contacted and the data were recorded. The effects of bariatric surgery on metabolic syndrome components were assessed as partial and complete remission according to their last follow-up status. Partial healing criteria were determined for each disease. Statistical software program (SPSS Version 22.0 Armonk, NY: IBM Corp.) was used to analyze the data. RESULTS: The results obtained in the study, in which the metabolic syndrome components of patients undergoing LSG and MGB at the Ondokuz Mayıs University Faculty of Medicine General Surgery Department with the diagnosis of morbid obesity were evaluated before and after the operation, were revealed. In 516 patients who underwent LSG and 45 patients who underwent MGB, a decrease in BMI and an increase in EWL (%) were observed in the 3rd month, 6th month, 1st year and 2nd year control compared to the preoperative period. It was observed that the patients gained back weight at the 3rd year control of LSG patients, so there was an increase in BMI and a decrease in EWL (%) values compared to the 2nd year. In patients who underwent MGB, the decrease in BMI continued in the 3rd year, while EWL (%) values increased. Bariatric / metabolic surgery methods provide significant improvement in comorbidities such as ir / dm, ht, hl / dl, osas, hypothyroidism, which are the components of metabolic syndrome accompanying obesity. According to before operation, dm 92.86% after LSG; ht 89.23%; hl / dl 75.70%; osas 97.62%; hypothyroidism improved by 73.08%. Compared to before the operation, dm 100% after the MGB; ht 88%; hl / dl 82.36%; osas 90%; hypothyroidism improved by 66.67%. When the change of metabolic syndrome components in follow-up period is analyzed, dm partial recovery rates increased from 5.1% to 18.5%; complete recovery rates decreased from 92.3% to 55.6%. As the follow-up time increases, the proportion of patients with complete recovery decreases (p = 0.0001). It was observed that there was no change in the follow-up time for other parameters. No mortality was observed in the patients who underwent LSG and MGB during follow-up. As a major complication, leakage is only in the LSG group and the rate is 0.2%. Minor complication rates were similar for both types of surgery. CONCLUSION: As a bariatric / metabolic surgery procedure, LSG is reliably administered with low morbidity and mortality rates. The therapeutic effect of LSG on metabolic syndrome components has been strongly demonstrated. However, when diabetes mellitus remission and sustainable weight loss after bariatric / metabolic surgery is evaluated, MGB appears more effectively in the long term. The bariatric / metabolic surgery method should be preferred considering the patient's criteria, especially age and the presence of additional diseases. KEYWORDS: Bariatric/metabolic surgery, obesity, metabolic syndrome
BACKGROUND: Obesity is an epidemic that negatively affects human health globally. Comorbidities that accompany obesity and obesity are serious diseases that impair quality of life and even threaten human life. Today, bariatric surgery procedures are the most effective method to achieve sustainable weight loss in the treatment of obesity. OBJECTIVE: We aimed to evaluate the therapeutic effect of bariatric / metabolic surgery methods on abdominal obesity, insulin resistance / diabetes mellitus, hypertension, hyperlipidemia / dyslipidemia, obstructive sleep apnea / obesity-related asthma and hypothyroidism. We planned to investigate complications after bariatric surgery, whether patients gain weight again and the short, medium and long-term effects of bariatric surgery. PATIENTS AND METHODS: Between December 2012 and January 2020, patients who completed at least 3 months after surgery with bariatric / metabolic surgery at the Ondokuz Mayıs University Faculty of Medicine General Surgery Department were retrospectively analyzed. 561 patients who were checked for the 3rd month, 6th month, 1st year, 2nd year and 3rd year after the operation were included in the study. Hospital database, e-pulse system and patient files were scanned. Patients with incomplete information were contacted and the data were recorded. The effects of bariatric surgery on metabolic syndrome components were assessed as partial and complete remission according to their last follow-up status. Partial healing criteria were determined for each disease. Statistical software program (SPSS Version 22.0 Armonk, NY: IBM Corp.) was used to analyze the data. RESULTS: The results obtained in the study, in which the metabolic syndrome components of patients undergoing LSG and MGB at the Ondokuz Mayıs University Faculty of Medicine General Surgery Department with the diagnosis of morbid obesity were evaluated before and after the operation, were revealed. In 516 patients who underwent LSG and 45 patients who underwent MGB, a decrease in BMI and an increase in EWL (%) were observed in the 3rd month, 6th month, 1st year and 2nd year control compared to the preoperative period. It was observed that the patients gained back weight at the 3rd year control of LSG patients, so there was an increase in BMI and a decrease in EWL (%) values compared to the 2nd year. In patients who underwent MGB, the decrease in BMI continued in the 3rd year, while EWL (%) values increased. Bariatric / metabolic surgery methods provide significant improvement in comorbidities such as ir / dm, ht, hl / dl, osas, hypothyroidism, which are the components of metabolic syndrome accompanying obesity. According to before operation, dm 92.86% after LSG; ht 89.23%; hl / dl 75.70%; osas 97.62%; hypothyroidism improved by 73.08%. Compared to before the operation, dm 100% after the MGB; ht 88%; hl / dl 82.36%; osas 90%; hypothyroidism improved by 66.67%. When the change of metabolic syndrome components in follow-up period is analyzed, dm partial recovery rates increased from 5.1% to 18.5%; complete recovery rates decreased from 92.3% to 55.6%. As the follow-up time increases, the proportion of patients with complete recovery decreases (p = 0.0001). It was observed that there was no change in the follow-up time for other parameters. No mortality was observed in the patients who underwent LSG and MGB during follow-up. As a major complication, leakage is only in the LSG group and the rate is 0.2%. Minor complication rates were similar for both types of surgery. CONCLUSION: As a bariatric / metabolic surgery procedure, LSG is reliably administered with low morbidity and mortality rates. The therapeutic effect of LSG on metabolic syndrome components has been strongly demonstrated. However, when diabetes mellitus remission and sustainable weight loss after bariatric / metabolic surgery is evaluated, MGB appears more effectively in the long term. The bariatric / metabolic surgery method should be preferred considering the patient's criteria, especially age and the presence of additional diseases. KEYWORDS: Bariatric/metabolic surgery, obesity, metabolic syndrome
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