title: Midterm impact of sleeve gastrectomy, calibrated with a 50-Fr bougie, on weight loss, glucose homeostasis, lipid profiles, and comorbidities in morbidly obese patients.
abstract: Bariatric surgery has been shown to be effective in achieving and maintaining weight change and reducing obesity-related comorbidities. Recent reports have shown that sleeve gastrectomy could have similar resolution rates of the metabolic syndrome than Roux-Y bypass after a short-term  follow-up of 1 year. Most surgeons calibrate the sleeve with 32-Fr to 40-Fr bougies. There is little mid- and long-term information available about the evolution of these comorbidities with this procedure and with calibration of the sleeve with a 50-Fr bougie. A retrospective study of all  the morbidly obese patients undergoing laparoscopic sleeve gastrectomy, calibrated with a 50-Fr bougie, as bariatric procedure between October 2007 and September 2009 was performed. Mean excessive body mass index loss was 76.9 per cent after 1 year and 79.9 per cent after 2 years. After surgery,  83.3 per cent of patients with Type 2 diabetes mellitus discontinued their hypoglycemic medication at 1 month. All the patients with hypertension discontinued antihypertensive drugs at 6 months. One hundred per cent of patients with hypertriglyceridemia discontinued their hypolipidemic drugs  at 3 months. Glucose levels decreased significantly 3 months after surgery (mean reduction of 24.7 mg/dL; 95% confidence interval [CI], 8.8 to 40.7; P = 0.003). Triglyceride levels decreased 3 months after surgery (mean reduction of 54.4 mg/dL; 95% CI, 22.8 to 86.1; P = 0.004).  High-density lipoprotein (HDL) cholesterol increased significantly after 12 months (increase of 16.7 mg/dL; 95% CI, 11.7 to 21.7; P < 0.001). The changes observed were maintained 24 months after surgery. Sleeve gastrectomy, calibrated with a 50-Fr bougie, significantly reduced glucose  and triglyceride levels and the cardiovascular risk predictor triglyceride/HDL ratio and increased HDL levels after surgery and maintained them under normal ranges for at least 2 years.
authors.affiliation: Department of Surgery, General University Hospital Elche, Alicante, Spain. jruiztovar@gmail.com
authors.forename: Jaime
authors.initials: J
authors.lastname: Ruiz-Tovar
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Oller
authors.forename: Andres
authors.initials: A
authors.lastname: Tomas
authors.forename: Carolina
authors.initials: C
authors.lastname: Llavero
authors.forename: Antonio
authors.initials: A
authors.lastname: Arroyo
authors.forename: Alicia
authors.initials: A
authors.lastname: Calero
authors.forename: Amparo
authors.initials: A
authors.lastname: Martinez-Blasco
authors.forename: Rafael
authors.initials: R
authors.lastname: Calpena
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002138:Calibration; D015897:Comorbidity; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000517:prevention & control; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000517:prevention & control; D015228:Hypertriglyceridemia / Q000188:drug therapy / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D000960:Hypolipidemic Agents / Q000008:administration & dosage; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D008055:Lipids