ORIGINAL ARTICLE
Bali Medical Journal (Bali MedJ) 2021.
Volume 10.
Number 3: 1045-1049 P-ISSN.
E-ISSN: 2302-2914
Published by Bali Medical Journal Short-Term effects of laparoscopic sleeve gastrectomy on anatomical & biochemical parameters in morbidly obese Iraqi Patients Ahmed Riyad Laibee1.
Sameh S.
Akkila2.
Nibras Khamees3.
Samia A.
Eleiwe4* ABSTRACT Ch.
FIBMS.
Baghdad Teaching Hospital.
Baghdad-Iraq.
Ph.
Anatomy.
Assist.
Professor Anatomy.
Dept.
Histology and Embryology.
College of Medicine.
AlMustansiriyah University.
Baghdad-Iraq.
Ph.
Anatomy.
Lecturer Anatomy.
Dept.
Histology and Embryology.
College of Medicine.
Al- Mustansiriyah University.
Baghdad-Iraq.
Ph.
Anatomy.
Professor Embryology.
Dept.
Histology and Embryology.
College of Medicine.
AlMustansiriyah University.
Baghdad-Iraq.
*Corresponding to:
Samia A.
Eleiwe.
Ph.
Anatomy.
Professor Embryology.
Dept.
Histology and Embryology.
College of Medicine.
Al- Mustansiriyah University.
Baghdad-Iraq.
samia_a_eleiwe@yahoo.
Received: 2021-08-03 Accepted: 2021-11-28 Published: 2021-12-30 Background: Osteoporosis Background: With the worldwide and national increased prevalence of obesity and high failure rates of conventional methods of treatment, bariatric surgeries .
specially laparoscopic sleeve gastrectom.
offer a safe and rapid therapeutic way for correction of obesity and its numerous related clinical complications.
Aim: The current study examined the short-term effects of laparoscopic sleeve gastrectomy on anatomical & biochemical markers in morbidly obese patients and investigated whether or not there was gender difference in the changes of these Patients and methods: 65 morbidly obese (BMIOu.
patients undergoing laparoscopic sleeve gastrectomy were enrolled.
Pre-operative & 4-week-post-operative assessment of anatomical parameters included body weight, height & calculation of body mass index (BMI).
Similar biochemical assessment included lipid profile, fasting blood sugar (FBS).
Hemoglobin, renal function tests and liver enzymes.
Results: Patients of both sexes showed statistically significant reduction of body weight.
BMI.
FBS and improved serum levels of lipid profiles, renal function tests and liver enzymes.
Many pre-operative abnormally high-level percentages were normalized or markedly decreased, with no statistically significant difference between males and females except for ALT changes.
Discussion: Sleeve gastrectomy is very effective in improving body weight.
BMI and lipid profiles by altering the anatomy and physiology of the stomach towards less food consumption, and also damping the secretion of hunger-stimulating hormones.
The BMI reduction improves insulin sensitivity and FBS levels.
Better glycemic & blood pressure control improve renal function, while improving HDL levels reduces liver steatosis and improves serum liver enzyme levels.
The main disadvantage is reduced hemoglobin level due to macronutrient and micronutrient deficiencies.
Conclusion: Laparoscopic sleeve gastrectomy provides a permanent safe therapeutic choice for morbid obesity.
The presence of vitamin and nutritional deficiencies after surgery is a common disadvantage mandating adequate pre-operative correction of the deficiencies, adequate post-operative supplementation and regular long follow-up.
Keywords: Obesity.
Body mass index.
Laparoscopic sleeve gastrectomy.
Lipid profile.
Glucose.
Hemoglobin.
Renal function.
Liver enzymes.
Cite This Article: Laibee.
Akkila.
Khamees.
Eleiwe.
Short-Term effects of laparoscopic sleeve gastrectomy on anatomical & biochemical parameters in morbidly obese Iraqi Patients.
Bali Medical Journal 10.
: 10451049.
DOI: 10.
15562/bmj.
INTRODUCTION
The prevalence of obesity in Iraq has increased dramatically from 28.
8% in the 1980Aos1 to more than 40% in recent 2 Unbalanced diet rich with fats and carbohydrates and inactive lifestyle ae the main causative factors for overweight or obesity defined as abnormal or excessive fat accumulation and body mass index (BMI) above normal values.
may impair health.
3 Obesity treatment with conventional methods such as diet restriction & physical exercise is often met with high rates of failure.
while different bariatric surgical therapies have yielded rapid, permanent and safe alternative 4 Over the last decade, sleeve gastrectomy gained a lot of popularity as a modern, safe, and effective method for the treatment of obesity with higher survival rates and less complications.
PATIENTS AND METHODS
Study settings:
Sixty-five morbidly obese patients who were candidates for laparoscopic sleeve gastrectomy were enrolled in the study.
Inclusion criteria included morbid obesity (BMI Ou40 Kg/m.
with previous failed adequate conservative treatment and no evident endocrine or otherwise treatable cause of obesity and no current drug treatment affecting weight or Published Open by Bali Medical Journal | Bali Medical Journal 2021.
: 1045-1049 | doi: 10.
15562/bmj.
ORIGINAL ARTICLE
Exclusion criteria included psychological or eating disorder, active alcohol or substance abuse, active gastric ulcer disease, severe gastroesophageal reflux or chronic conditions rendering the patient unfit for surgery.
The randomly selected sample included 25 males .
& 40 females .
5%) with comparable age ranges .
3A9.
9 & 33.
6A8.
7 years Body weight (K.
, height .
, body mass index calculations (Kg/ m.
and biochemical parameters were recorded preoperatively and repeated 4 weeks following the surgical procedure.
Ethical issues:
The study was performed at Al-Khadraa Private Hospital (Baghdad.
Ira.
over the period of 1 year (February 2019January 2.
All participants were over 21 years old and were thoroughly informed of the study design and its purpose and signed an informed-consent form for the study and the surgical Body measurements were recorded professionally in respected SubjectsAo confidentiality was not compromised at any time.
Surgical technique:
After performing pneumo-peritoneum and gastric decompression with the patient in reverse Trendelenburg position, the five-trocar technique was used.
The greater omentum was released and ligated from the greater gastric curvature and the greater curvature was dissected and After securing staple joints & bleeding foci, methylene blue test was applied to test for leakage.
The resected stomach was removed and all incisions were sutured after removing all trocars.
Study parameters:
Measurements were taken after Ou4 hours from a meal and were performed according to the World Health OrganizationAos data gathering protocol.
Calculations were done according to established epidemiological equations.
Weight was recorded with no shoes and wearing minimal underwear using an electronic body scale (SECAA Electronic patient weighing scale 704.
UK) to the nearest 100g.
The scale also contained a height rod that was used to measure the standing height to the nearest centimeter.
Body mass index (BMI) was calculated by dividing the weight in Kg by the squared value of the height in meters (Kg/m.
Biochemical parameters were double checked at the hospitalAos laboratory by two double-blinded professionals.
Biochemical tests included a lipid profile [Serum triglycerides (TGL), total cholesterol, low-density lipoproteins (LDL), very lowdensity lipoproteins (VLDL)& high-density lipoproteins (HDL)], hemoglobin level, renal function tests [Blood urea, serum creatinine & serum potassiu.
, fasting blood sugar (FBS) and liver enzyme tests [Serum aspartate aminotransferase (AST), alanine transaminase (ALT) & alkaline phosphatase (Alk.
)].
Outcome:
The primary outcome was to study the short-term effects of laparoscopic sleeve gastrectomy on BMI and biochemical The secondary outcome was to determine whether there was any difference in such effects between males and females.
Statistical analysis:
Data analysis was performed using IBM(R) SPSS(R) Statistics software for Windows, version 26 .
and presented using Microsoft(R) Excel(R) .
MSO.
Continuous variables were expressed as mean Astandard deviation (SD) or median .
nterquartile range, 25-75% IQR) when Figure 1.
Numerical data were first examined using box plots to determine distribution normality and detect extreme outliers which could then be excluded from calculations.
Means were compared using paired t-test to determine the anthropometric & biochemical changes induced by surgery.
Two sample t-test was used to compare discrepancies in male & female response to the surgery-induced changes in the study parameters.
RESULTS
Figure 1 shows the distribution of height, body weight and BMI in both males & females pre-operatively.
There were statistically significant differences in all three parameters between morbidly obese males and females (Figure .
Males had significantly greater heights and body weights but females had greater BMI values pe-operatively.
Post-operative changes in weight.
BMI and all biochemical parameters were also of high statistical significance (P<0.
as shown in Table 1.
While body weight & BMI value dropped significantly, they remained above normal values over short-term.
Lipid profiles & FBS values dropped significantly and the percentage of abnormal values was also significantly Renal function tests improved dramatically as the percentage of abnormal urea levels was almost halved while serum creatinine & potassium levels Box plot graph showing the distribution of height .
, weight (K.
and body mass index (BMI) (Kg/m.
in morbidly obese Iraqi patients.
Published by Bali Medical Journal | Bali Medical Journal 2021.
: 1045-1049 | doi: 10.
15562/bmj.
ORIGINAL ARTICLE
were completely normalized.
On the other hand, hemoglobin levels worsened significantly over short term.
Serum AST levels were normalized while abnormal ALT levels were greatly reduced.
Although Alkaline phosphatase levels increased, none of the increased values were above normal reference level.
The present change in difference did not differ significantly between males and females for any parameter except for serum ALT change which was significantly more pronounced in males (Table .
The percent change of BMI was only slightly greater in males.
Regarding lipid in both sexes.
the greatest percent change was seen in HDL levels while the least change was seen in LDL levels.
For Figure 2.
Clustered column graph showing the difference in height .
, weight (K.
and body mass index (BMI) (Kg/m.
in morbidly obese Iraqi males & females (Columns represent means, error bars represent standard deviation.
red stars indicate statistical P<0.
Table 1.
Changes in body weight.
BMI and biochemical parameters and their abnormal value percentages in morbidly obese Iraqi patients undergoing laparoscopic sleeve gastrectomy.
(P-value was <0.
0001 for all parameter.
Parameter Weight (K.
BMI(Kg/m.
TGL .
g/dL) Total S.
Cholesterol .
g/dL) LDL .
g/dL) VLDL .
g/dL) HDL FBS .
g/dL) Hemoglobin .
/dL) urea .
g/dL) creatinine .
g/dL) potassium .
mol/L) AST (U/L) ALT (U/L) Alk.
Phosphatase (U/L) Table 2.
MeanASD 1A12.
8A5.
7A82.
7A91.
2A28.
66A29.
3A15.
7A43.
3A1.
6A30.
5A0.
3A0.
2A12.
7A13.
5A29.
Pre-operative %of abnormal level Post-operative MeanASD %of abnormal 1A9.
5A4.
2A69.
1A62.
6A29.
53A26.
2A18.
0A23.
12A1.
9A10.
5A0.
8A0.
4A7.
5A7.
2A29.
Percent changes in BMI and biochemical parameters between male & female morbidly obese Iraqi patients undergoing laparoscopic sleeve gastrectomy.
(Data presented as MeanAStandard deviatio.
Parameter BMI(Kg/m.
TGL .
g/dL) Total S.
Cholesterol (.
g/dL) LDL .
g/dL) VLDL .
g/dL) HDL FBS .
g/dL) Hemoglobin .
/dL) urea .
g/dL) creatinine .
g/dL) potassium .
mol/L) AST (U/L) ALT (U/L) Alk.
Phosphatase (U/L) Male 5.
Female -14.
Published by Bali Medical Journal | Bali Medical Journal 2021.
: 1045-1049 | doi: 10.
15562/bmj.
P-value ORIGINAL ARTICLE renal function tests, the greatest percent change was observed for creatinine levels for both sexes.
Regarding liver enzymes, the greatest percent change was seen in ALT levels in males but for AST levels in DISCUSSION The majority of patients enrolled in the study were females who had significantly higher BMI levels than their counterpart This could be related to the facts that in middle eastern societies many females are of the non-working housewives with limited access to physical activities and that body image is more frowned upon in females than in males.
The anatomically and inherently lower female heights rendered their BMI levels greater than males, despite greater male weights.
The effect of sleeve gastrectomy on body weight & BMI is twofold.
In addition to altering the anatomy and physiology of the stomach towards less food consumption, it also affects metabolism by decreasing the secretion of hunger-stimulating hormones8 and altering the effects of gut microbiome on the brain regulation of 9 The reduction of weight and BMI improves the clinical risk factors of chronic diseases in addition to improving a vast array of biochemical, inflammatory, hematological & histological markers.
The current study is in agreement with such effect as evident by the rapid reduction in body weight and BMI and significant improvement in lipid profile and fasting blood sugar levels.
Sleeve gastrectomy has been proven to improve these parameters not only by altering dietary intake but also by improving the regulatory actions of insulin on glucose, amino acid, and lipid Holcomb demonstrated that bariatric surgery .
hether gastric bypass or sleeve filtration rate (GFR) by improving both blood pressure and glycemic control following surgery.
The normalization of serum creatinine & potassium levels in the current study is in agreement of such effect.
The fact that some patients remained to have high blood urea levels following surgery may not be related to renal function per se, but may be related to other factors like inadequate fluid intake or high protein diet .
andating proper patient education on fluid & dietary One of the adverse outcomes of sleeve gastrectomy encountered in this study was the reduction in hemoglobin levels over short term.
Nutritional deficiencies, including anemia, are commonly met following bariatric surgery.
13 Iron deficiency is common in people with morbid obesity and may be aggravated by bariatric surgery.
14 The mechanism of iron deficiency may be related to intraoperative bleeding but more likely to high transferrin deficiency rates accompanied by no ferritin deficiency resulting in relative iron deficiency.
15 In the current study, hemoglobin reduction was also slightly .
hough insignificantl.
greater in females than in males.
This may be attributed to menstrual bleeding since the majority of the study subjects were premenopausal women.
Another factor that may be implicated in the development of post-gastrectomy anemia is vitamin B12 deficiency due to malabsorption secondary to diminished intrinsic factor secretion because of decreased volume of intrinsic factor-producing parietal cells.
Morbid associated with non-alcoholic fatty liver disease (NAFLD) and hepatic steatosis, evident by elevated liver enzymes (AST.
ALT) and low HDL levels.
The postoperative increase of HDL levels shows an inverse correlation with liver steatosis progression and positive correlation with normal liver enzyme levels.
17 In agreement with the current study.
Ruiz-Tovar et al showed that liver steatosis, as measured by ultrasonography and liver enzymes, improves after sleeve gastrectomy.
18 In the current study, the gender difference in ALT change may be related to the gender difference in the role of fat loss.
Previous studies have shown that serum ALT was associated with body fat mass index in men but with lean mass index in men and women in an overweight and obese population.
19 The Auwithin-normalAy increase in alkaline phosphatase levels in both sexes in the current study may be related to post-gastrectomy deficiencies in vitamin D, calcium, protein, magnesium and/or zinc.
CONCLUSION
Laparoscopic sleeve gastrectomy provides a permanent safe therapeutic choice for morbid obesity and results in rapid reduction in body weight & BMI with concurrent improvement of lipid and glucose metabolism and renal & liver The presence of vitamin and nutritional deficiencies after laparoscopic sleeve gastrectomy is a common Pre-operative correction of the deficiencies, adequate post-operative supplementation and regular long followup are important to avoid the serious consequences of such deficiencies.
CONFLICT OF INTEREST
All authors declared that there is no conflict of interest regarding this article.
ETHICS APPROVAL
All subjects had given consent before participating in this study and all patientAos data are remain confidential.
An ICJME form has been filled to accompany this FUNDING This study was self-funded by authors.
AUTHOR CONTRIBUTION
All authors contributed equally in the research process, manuscript writing, and REFERENCES