The Impact of Laparoscopic Sleeve Gastrectomy on Thyroid Functions in Egyptian Patients with Obesity.

BACKGROUND: Sleeve gastrectomy (SG) continues to be one of the most popular bariatric procedures all over the world. Thyroid-stimulating hormone (TSH) frequently shows a slight elevation in patients with obesity. The effect of SG on thyroid hormones has been rarely investigated. AIM OF THE STUDY: This study aimed to assess the short-term effect of SG on thyroid functions in Egyptian patients with morbid obesity and the potential predictors of the postoperative thyroid functions. PATIENTS AND METHODS: This study included patients undergoing SG at kasr al ainy hospitals. The patients underwent preoperative 3-, 6-, and 12-month postoperative analyses of the thyroid functions and other biochemical markers. RESULTS: The study included 106 patients who showed significant improvement in thyroid functions at the follow-up assessment. Twelve-month TSH positively correlated with the 12-month measures of LDL and HbA1c. TSH change at 12-month follow-up (TSH) was inversely correlated to 12-month BMI and positively correlated to preoperative TSH and 12-month percentage of total weight loss (TWL%). Univariable linear regression analysis demonstrated that preoperative TSH (p < 0.001), 12-month TWL% (p = 0.042), 12-month HbA1c (p = 0.001), and 12-month LDL (p = 0.049) were significant predictors for the 12-month TSH levels. Multivariable analysis showed that only preoperative TSH levels (p < 0.001) and 12-month HbA1c levels (p = 0.021) could affect the 12-month TSH levels. CONCLUSION: The current study supports the evidence of thyroid function improvement after sleeve gastrectomy. This improvement was affected by the amount of weight loss after surgery.

Water Tolerance After Laparoscopic Sleeve Gastrectomy.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is taking the lead as the most popular bariatric procedure in most regions of the world. Unlike other liquids, water is particularly affected by LSG. Because of its importance for safe hospital discharge, weight loss, and patients' lifestyle, we evaluated water tolerance after LSG. METHODS: The study included 106 consecutive patients who underwent LSG. All patients had upper gastrointestinal series (UGI) 48 h (early) and 3 months postoperatively (late), during which flow patterns (esophageal and gastric transit time) for water and juice were measured and correlated with subjective tolerance for water and juice at the same time of the contrast studies. Intraoperative measurements of the sleeve were also correlated with subjective tolerance. RESULTS: One-hundred and two (94 females, 92%) completed the 3-month follow-up. The mean age was 30.75 years; mean pre-operative BMI 46.76 kg/m2. The mean %EWL after 3 months was 32.17% ± 9.5%. Fifty patients (49%) expressed early difficulty drinking water (EDDW), and 30 (29.41%) showed late difficulty drinking water (LDDW), compared with 8 patients (7.8%) with early difficulty drinking juice (EDDJ) and 6 (5.9%) with late difficulty drinking juice (LDDJ). CONCLUSION: LSG reduces water tolerance significantly more than other liquids (juice) in the early postoperative period. Good water tolerance is a critical parameter for early hospital discharge after LSG. Larger studies with longer follow-up are warranted to determine the long-term fate of fluid tolerance following LSG and its effect on weight loss and quality of life.

Analysis of Medium-Term Weight Regain 5 Years After Laparoscopic Sleeve Gastrectomy.

OBJECTIVE: Some patients fail to maintain weight loss after bariatric surgery. Weight regain (WR) disturbs the patients due to possible reappearance of obesity-related comorbidities. This study aimed to assess WR 5 years after laparoscopic sleeve gastrectomy (LSG). PATIENTS AND METHODS: This retrospective study included 100 adults who underwent LGS. The percentage of excess weight loss (%EWL) was recorded. WR was defined as an increase of at least 10% of the lowest postoperative weight. Patients with WR were subjected to CT gastric volumety. Eating behavior was assessed by the Three-Factor Eating Questionnaire-Revised 18-Items (TFEQ-R18). RESULTS: Preoperative comorbidities improved in 89.5% of the patients. Twenty-five females (32.5%) got pregnant within 3 years after surgery. Age, maximum weight loss, and uncontrolled and emotional eating scales of the TFEQ-R18 were independently affecting %EWL. Also, pregnancy negatively affected %EWL. Fourteen patients regain weight: 11 females and three males. CT volumetry of the 14 patients showed a median stomach volume of 515 mL (range 172-1066 mL). CT estimated gastric volume was negatively correlated with % EWL (r = - 0.674, p = 0.008). Patients who developed WR were significantly older (p = 0.006), with lower maximum weight loss, and having higher scores of uncontrolled and emotional eating scales of TFEQ-R18. CONCLUSION: Medium-term postsurgical weight regain and unsuccessful weight loss in patients who had undergone LSG is associated with older age, maladaptive eating behavior, larger residual stomach, and pregnancy.

Greater curvature as a gastric pouch for sleeve gastrectomy: a novel bariatric procedure. Feasibility study in a canine model.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has serious complications, such as leaks, reflux, stenosis, and kinks, which are also consequences of shortcomings in the LSG technique. OBJECTIVES: We evaluated the feasibility and weight loss of a novel bariatric procedure, using the greater curvature as the gastric pouch for sleeve gastrectomy (SG) in dogs. SETTING: Animal house in Faculty of Medicine, Cairo University. METHODS: Five 20- to 25-kg stray mongrel male dogs were subjected to open SG using the greater curve as the gastric pouch (GCSG group). The weight was monitored at day of surgery and at postoperative weeks 2, 4, 6, and 8; weight progression was compared with a sham and a standard SG group. By the end of the follow-up period autopsy was done. RESULTS: The mean operative time in GCSG group was 39.6 ± 3.97 minutes. At the end of the study, dogs in the sham group had gained 8% of their preoperative weight, while the GCSG and standard SG groups lost 24.7% and 25% of their preoperative weight, respectively. At autopsy, the gastric sleeve in the GCSG group showed excellent healing with no stenotic areas, kinks, or mucosal ulcerations. CONCLUSION: Greater curvature SG is technically feasible in a canine model. Larger studies with longer follow-up period will be needed to assess weight progression and resolution of the metabolic co-morbidities.

Early Weight Recidivism Following Laparoscopic Sleeve Gastrectomy: A Prospective Observational Study.

BACKGROUND: Although weight loss following laparoscopic sleeve gastrectomy (LSG) can be substantial, weight recidivism is still a major concern. The aim of our work is to study early weight recidivism following LSG and to evaluate the role of gastric computed tomography volumetry (GCTV) in the assessment of patients experiencing early weight regain. METHODS: One-hundred and one morbidly obese patients undergoing LSG were prospectively studied. Patients were followed up for 2 years. Those who presented with weight recidivism were counseled for dietary habits and assessed for the amount of weight regain. Patients who regained weight were scheduled for GCTV. RESULTS: Twelve patients were excluded from the study. Weight recidivism was reported in 9/89 patients (10.1 %) [weight loss failure (n = 1), weight regain (n = 8)] and was almost always first recognized 1½-2 years after LSG. The amount of weight regain showed negative correlations with preoperative body weight and body mass index (r = -0.643, P = 0.086 and r = -0.690, P = 0.058; respectively) and positive correlations with the distance between the pylorus and the beginning of the staple line (r = 0.869, P = 0.005), as well as with the residual gastric volume (RGV) on GCTV 2 years after LSG (r = 0.786, P = 0.021). CONCLUSIONS: In the small group of patients who regained weight, a longer distance between the pylorus and the beginning of the staple line, as well as a higher RGV on GCTV 2 years after LSG, were both associated with increased weight regain. Gastric computed tomography volumetry with RGV measurement holds promise as a useful research tool after LSG.