Araştırma Makalesi
Yıl 2019,
, 21 - 26, 14.03.2019
Öz
Amaç: Bu çalışmada, morbid obezite tanılı hastalarda tedavi amacıyla uygulanan LSG’nin kilo kaybı ve yandaş hastalıkların tedavisinin yanı sıra metabolik ve hormonal mekanizmalar üzerindeki etkinliğinin, operasyon öncesi ve operasyon sonrası dönemdeki hormon düzeyleri karşılaştırılarak irdelenmesi amaçlandı.
Gereç ve Yöntemler: Mayıs 2013-Mayıs 2014 tarihleri arasında, LSG uygulanan 38 hasta çalışmaya dahil edildi. Prospektif olan bu çalışmada hastaların demografik verileri, yandaş hastalıkları, takipte kilo kaybı, morbidite ve mortalite oranları, operasyon öncesi ve sonrası insülin düzeyleri ile operasyon öncesi ve operasyon sonrası sekizinci haftadaki leptin ve grelin hormonlarının düzeyleri irdelenerek karşılaştırıldı.
Bulgular: Çalışmaya dahil edilen 38 hastadan 32’si (%84.2) kadın, altısı (%15.8) ise erkekti. Operasyon öncesi alınan kandaki leptin düzeylerinin ortalaması 11.16 ng/mL iken, operasyon sonrası sekizinci haftadaki hormon seviyesi 4.39 ng/mL olarak belirlendi. Grelin düzeylerine bakıldığında ise; operasyon öncesi ortalama 25.72 pg/mL iken, operasyon sonrası sekizinci haftadaki hormon seviyesi 14.16 pg/mL olarak belirlendi. Operasyon öncesi ortalama vücut kitle indeksi (VKİ) 44.3, operasyon sonrası sekizinci haftada ise 36.6 olarak belirlendi. Hiçbir hastada mortalite gerçekleşmedi.
Sonuç: LSG, günümüzde mükemmel kilo kaybı sağlaması ve kabul edilebilir oranlarda düşük komplikasyon riskleri nedeniyle morbid obezite tedavisinde tek başına uygulanan bir cerrahi teknik haline gelmiştir. Çalışmamızın sonuçlarına baktığımız zaman; bu ameliyat tekniğinin sadece restriktif değil, aynı zamanda metabolik değişikliklere neden olarak da kilo kaybındaki devamlılığı sağladığı kanaatindeyiz.
Anahtar Kelimeler
Kaynakça
- Brinckerhoff TZ, Bondada S, Lewis CE, French SW, DeUgarte DA. Metabolic effects of sleeve gastrectomy in female rat model of diet-induced obesity. Surg Obes Relat Dis 2013;9(1):108-12.
- Gastrointestinal surgery for severe obesity: Proceedings of a National Institutes of Health Consesus Development Conference Statement. Am J Clin Nutr 1992;55(2):615-9.
- Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 2003;13(6):861-4.
- Kueper MA, Kramer KM, Kirschniak A, Königsrainer A, Pointner R, Granderath FA. Laparoscopic sleeve gastrectomy: standardized technique of a potential stand-alone bariatric procedure in morbidly obese patients. World J Surg 2008;32(7):1462-5.
- Nguyen NT, Nguyen XMT, Dholakia C. The use of endoscopic stent in management of leaks after sleeve gastrectomy. Obesity Surgery 2010;20(9);1289-92.
- Cummings DE, Purnell JQ, Frayo RS, Schmidova K, Wisse BE, Weigle DS. A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes 2001;50(8):1714-9.
- Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med 2002;346(21):1623-30.
- Holdstock C, Engstrom BE, Ohrvall M, Lind L, Sundbom M, Karlsson FA. Ghrelin and adipose tissue regulatory peptides: Effect of gastric bypass surgery in obese humans. J Clin Endocrinol Metab 2003;88(7):3177-83.
- Kalinowski P, Paluszkiewicz R, Wróblewski T, et al. Ghrelin, leptin, and glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass-results of a randomized clinical trial. Surg Obes Relat Dis 2017;13(2):181-8.
- Hellstrom PM, Geliebter A, Naslund E, et al. Peripheral and central signals in the control of eating in normal, obese and binge-eating human subjects. Br J Nutr 2004;92(1):47-57.
- Korbonits M, Goldstone AP, Gueorguiev M, Grossman AB. Ghrelin-a hormone with multiple functions. Front Neuroendocrinol 2004;25(1):27-68.
- Brethauer SA, Hammell JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis 2009;5(4):469-75.
- Hady HR, Dadan J, Gotaszewski P, Safiejko K. Impact of laparoscopic sleeve gastrectomy on body mass index, ghrelin, insulin and lipid levels in 100 obese patients. Wideochir Inne Tech Malo Inwazyjne 2012;7(4):251-9.
- Kojima M, Hosoda H, Date Y, Nakazato M, Matuso H, Kangawa K. Ghrelin is a growth- hormone-releasing acylated pep- tide. Nature 1999;402(6762):656-60.
- Ariyasu H, Takaya K, Tagami T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab 2001;86(10):4753-8.
- Müller TD, Nogueiras R, Andermann ML, et al. “Ghrelin” molecular metabolism 2015;4(6):437-60.
- Shiiya T, Nakazato M, Mizuta M, et al. Plasma ghrelin levels in lean and obese humans and the effect of glucose on ghrelin secretion. J Clin Endocrinol Metab 2002;87(1):240-4.
- Vigneshwaran B, Akshat W, Sandeep A, et al. Impact of sleeve gastrectomy on type 2 diabetes mellitus, gastric emptying time, glucagon-like peptide 1 (GLP-1), ghrelin and leptin in non-morbidly obese subjects with BMI 30–35.0 kg/m2: A prospective Study. Obes Surg 2016;26(12):2817-23.
- Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg 2005;15(7):1024-9.
- Kotidis EV, Koliakos GG, Baltzopoulos VG, Ioannidis KN, Yovos JG, Papavramidis ST. Serum ghrelin, leptin and adiponectin levels before and after weight loss: Comparison of three methods of treatment--a prospective study. Obes Surg 2006;16(11):1425-32.
- Zhang Y, Proenca R, Maffel M, Barone M, Leopold L, Friedman JM. Positional cloning of the mouse obese gene and its human homologue. Nature 1994;372(6505):425-32.
- Keim NL, Stern JS, Havel PJ. Relation between circulating leptin concentrations and appetite during a prolonged, moderate energy deficit in women. Am J Clin Nutr 1998;68(4):794-801.
- Campfield LA, Smith FJ, Guisez Y, Devos R, Burn P. Recombinant Mouse OB protein: Evidence for a peripheral signal linking adiposity and central neural networks. Science 1995;269(5223):546-9.
- Wang MY, Lee Y, Unger RH. Novel form of lipolysis induced by leptin. J Biol Chem 1999;274(25):17541-4.
- van Dielen FM, van’t Veer C, Buurman WA, Greve JW. Leptin and soluble leptin receptor levels in obese and weight-losing individuals. J Clin Endocrinol Metab 2002;87(4):1708-16.
- Weiss CR, Gunn AJ, Kim CY, et al. Bariatric embolization of the gastric ar¬teries for the treatment of obesity. J Vasc Interv Radiol 2015;26:613-24.
- Behrens C, Tang BQ, Amson BJ. Early results of a Canadian laparoscopic sleeve gastrectomy experience. Can J Surg 2011;54(2):138-43.
- Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese highrisk patients. Obes Surg 2006;16(9):1138-44.
Yıl 2019,
, 21 - 26, 14.03.2019
Öz
Aim: The objective of this study was to evaluate the effects of laparoscopic sleeve gastrectomy (LSG), performed upon patients with morbid obesity, on weight loss and recovery of comorbid diseases as well as on metabolic and hormonal mechanisms by comparing pre and postoperative hormone levels.
Materials and Methods: 38 patients having undergone LSG between May 2013 and May 2014 were included in the study. In this prospective study, patients’ demographic data and associated diseases; weight loss; pre and post-operative insulin levels in addition to pre and post-operative leptin and ghrelin levels in the eighth weeks were compared.
Results: Of 38 patients included in the study there were 32 (84.2%) females and 6 (15.8%) males. Median leptin level was 11.16 ng/mL in the preoperative blood sample, whereas postoperative hormone level in the eighth week was 4.39 ng/mL. When ghrelin levels were examined; preoperative median was 25.72 pg/mL, whereas postoperative hormone level was 14.16 pg/mL in the eighth week. Preoperative median body mass index was determined to be 44.27 and post-operative median was observed to be 36.6 in the eighth week. No mortality was observed.
Conclusion: Today LSG has become a unique surgical technique in the treatment of morbid obesity due to its efficiency in obtaining weight loss and its feasible complication rates. After reviewing the results of our study; we believe this surgical technique does not only provide continuity in weight loss by restrictive changes but at the same time by metabolic ones, too.
Anahtar Kelimeler
Kaynakça
- Brinckerhoff TZ, Bondada S, Lewis CE, French SW, DeUgarte DA. Metabolic effects of sleeve gastrectomy in female rat model of diet-induced obesity. Surg Obes Relat Dis 2013;9(1):108-12.
- Gastrointestinal surgery for severe obesity: Proceedings of a National Institutes of Health Consesus Development Conference Statement. Am J Clin Nutr 1992;55(2):615-9.
- Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 2003;13(6):861-4.
- Kueper MA, Kramer KM, Kirschniak A, Königsrainer A, Pointner R, Granderath FA. Laparoscopic sleeve gastrectomy: standardized technique of a potential stand-alone bariatric procedure in morbidly obese patients. World J Surg 2008;32(7):1462-5.
- Nguyen NT, Nguyen XMT, Dholakia C. The use of endoscopic stent in management of leaks after sleeve gastrectomy. Obesity Surgery 2010;20(9);1289-92.
- Cummings DE, Purnell JQ, Frayo RS, Schmidova K, Wisse BE, Weigle DS. A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes 2001;50(8):1714-9.
- Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med 2002;346(21):1623-30.
- Holdstock C, Engstrom BE, Ohrvall M, Lind L, Sundbom M, Karlsson FA. Ghrelin and adipose tissue regulatory peptides: Effect of gastric bypass surgery in obese humans. J Clin Endocrinol Metab 2003;88(7):3177-83.
- Kalinowski P, Paluszkiewicz R, Wróblewski T, et al. Ghrelin, leptin, and glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass-results of a randomized clinical trial. Surg Obes Relat Dis 2017;13(2):181-8.
- Hellstrom PM, Geliebter A, Naslund E, et al. Peripheral and central signals in the control of eating in normal, obese and binge-eating human subjects. Br J Nutr 2004;92(1):47-57.
- Korbonits M, Goldstone AP, Gueorguiev M, Grossman AB. Ghrelin-a hormone with multiple functions. Front Neuroendocrinol 2004;25(1):27-68.
- Brethauer SA, Hammell JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis 2009;5(4):469-75.
- Hady HR, Dadan J, Gotaszewski P, Safiejko K. Impact of laparoscopic sleeve gastrectomy on body mass index, ghrelin, insulin and lipid levels in 100 obese patients. Wideochir Inne Tech Malo Inwazyjne 2012;7(4):251-9.
- Kojima M, Hosoda H, Date Y, Nakazato M, Matuso H, Kangawa K. Ghrelin is a growth- hormone-releasing acylated pep- tide. Nature 1999;402(6762):656-60.
- Ariyasu H, Takaya K, Tagami T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab 2001;86(10):4753-8.
- Müller TD, Nogueiras R, Andermann ML, et al. “Ghrelin” molecular metabolism 2015;4(6):437-60.
- Shiiya T, Nakazato M, Mizuta M, et al. Plasma ghrelin levels in lean and obese humans and the effect of glucose on ghrelin secretion. J Clin Endocrinol Metab 2002;87(1):240-4.
- Vigneshwaran B, Akshat W, Sandeep A, et al. Impact of sleeve gastrectomy on type 2 diabetes mellitus, gastric emptying time, glucagon-like peptide 1 (GLP-1), ghrelin and leptin in non-morbidly obese subjects with BMI 30–35.0 kg/m2: A prospective Study. Obes Surg 2016;26(12):2817-23.
- Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg 2005;15(7):1024-9.
- Kotidis EV, Koliakos GG, Baltzopoulos VG, Ioannidis KN, Yovos JG, Papavramidis ST. Serum ghrelin, leptin and adiponectin levels before and after weight loss: Comparison of three methods of treatment--a prospective study. Obes Surg 2006;16(11):1425-32.
- Zhang Y, Proenca R, Maffel M, Barone M, Leopold L, Friedman JM. Positional cloning of the mouse obese gene and its human homologue. Nature 1994;372(6505):425-32.
- Keim NL, Stern JS, Havel PJ. Relation between circulating leptin concentrations and appetite during a prolonged, moderate energy deficit in women. Am J Clin Nutr 1998;68(4):794-801.
- Campfield LA, Smith FJ, Guisez Y, Devos R, Burn P. Recombinant Mouse OB protein: Evidence for a peripheral signal linking adiposity and central neural networks. Science 1995;269(5223):546-9.
- Wang MY, Lee Y, Unger RH. Novel form of lipolysis induced by leptin. J Biol Chem 1999;274(25):17541-4.
- van Dielen FM, van’t Veer C, Buurman WA, Greve JW. Leptin and soluble leptin receptor levels in obese and weight-losing individuals. J Clin Endocrinol Metab 2002;87(4):1708-16.
- Weiss CR, Gunn AJ, Kim CY, et al. Bariatric embolization of the gastric ar¬teries for the treatment of obesity. J Vasc Interv Radiol 2015;26:613-24.
- Behrens C, Tang BQ, Amson BJ. Early results of a Canadian laparoscopic sleeve gastrectomy experience. Can J Surg 2011;54(2):138-43.
- Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese highrisk patients. Obes Surg 2006;16(9):1138-44.
Toplam 28 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 14 Mart 2019 |
| Gönderilme Tarihi | 23 Ocak 2018 |
| Yayımlandığı Sayı | Yıl 2019 |
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