RESUMEN
BACKGROUND: Optimal obesity therapy is a matter of debate. Besides weight reduction, other criteria such as safety and nutritional status are of relevance. Therefore, we compared a favored surgical intervention with the most effective conservative treatment regarding anthropometry and nutritional status. METHODS: Fifty-four obese patients were included who underwent laparoscopic sleeve gastrectomy (LSG, n = 27) or a 52-week multidisciplinary intervention program (MIP, n = 27) for weight loss. Body weight, body composition assessed by bioelectrical impedance analysis, and serum protein levels were measured before and within 12 months after intervention. RESULTS: After 1 year of observation, excess weight loss was more pronounced following LSG (65 %) compared to MIP (38 %, p < 0.001). In both groups, body fat was clearly reduced, but a higher reduction occurred in the LSG group. However, protein status deteriorated particularly in the LSG group. Within 1 year, body cell mass declined from 37.1 to 26.9 kg in the LSG group, but only from 35.7 to 32.2 kg in the MIP group. This resulted in an increased mean extracellular mass/body cell mass ratio (1.42 versus 1.00, p < 0.001), in a decreased mean phase angle (4.4° versus 6.6°, p < 0.001), and in a lower prealbumin level in serum (p < 0.02) in the LSG group compared to the MIP group. CONCLUSIONS: LSG, compared to MIP, was more effective regarding excess weight loss and body fat loss within 1 year, however, induced more pronounced muscle mass and protein loss, possibly requiring particular interventions such as exercise or protein supplements.
Asunto(s)
Composición Corporal , Gastrectomía , Laparoscopía , Obesidad/terapia , Grupo de Atención al Paciente , Desnutrición Proteico-Calórica/etiología , Pérdida de Peso , Programas de Reducción de Peso , Adolescente , Adulto , Índice de Masa Corporal , Peso Corporal , Suplementos Dietéticos , Terapia por Ejercicio , Femenino , Estudios de Seguimiento , Gastrectomía/efectos adversos , Gastrectomía/métodos , Humanos , Masculino , Persona de Mediana Edad , Estado Nutricional , Obesidad/metabolismo , Evaluación de Programas y Proyectos de Salud , Desnutrición Proteico-Calórica/prevención & control , Resultado del Tratamiento , Programas de Reducción de Peso/métodosRESUMEN
BACKGROUND: The aim of this study was to define a standardized technique for laparoscopic sleeve gastrectomy in the morbidly obese patient. METHODS: There are several surgical options for the morbidy obese patient. In general, there are the restrictive procedures [e.g., laparoscopic adjustable gastric banding (LAGB)] and the malabsorptive procedures [e.g. laparoscopic Roux-en-Y gastric bypass (LRYGBP)]. Those techniques are already standardized. The laparoscopic sleeve gastrectomy (LSG) seems to have some advantages over both procedures, but it is not standardized yet, and so there can be no comparison between the different techniques. In our center we have standardized the LSG technique with respect to abdominal access and narrowness of the gastric sleeve. After dissection of the greater omentum and the short gastric vessels, the greater curvature is resected along a 34-Fr gastric tube using the Endo-GIA. The remaining gastric sleeve has a volume of about 100 ml. RESULTS: The standardized LSG procedure is presented step by step. A comparison of operative data and early outcome with a matched group of patients with adjustable gastric banding showed no difference between the two techniques with respect to operating time, surgical complications, and weight loss 6 months after surgery. CONCLUSION: With our standardized LSG technique it is possible to evaluate the positive aspects of the LSG compared with other standardized bariatric procedures like LAGB or LRYGBP.