A clinical audit on Bariatric/Metabolic surgery

S.Sowmiya1, S. Velmurugan2

1DNB – Final year, General surgery, Kauvery Hospital, Cantonment, Trichy

 

2HOD, Dept.of SGE, Kauvery Hospital, Cantonment, Trichy

Background

Bariatric surgery is the umbrella term for all weight-loss surgeries reserved for obese patients. We performed this study on the measures taken for these surgeries and the outcomes.

Burden of Obesity

 

WHO classification

StatusBMI
Normal18.5 – 22.9
Pre-obese25 – 29.9
Obese30
Morbid obese>40
Super obese>50

Definition of Metabolic syndrome

Classification of metabolic surgery

Criteria’s for the Surgery

  • BMI > 37.5
  • BMI > 32.5 with associated co morbidities
  • No endocrine cause of obesity
  • Acceptable operative risk
  • Understands surgery and risks
  • Absence of substance abuse
  • No uncontrollable psychological conditions
  • Dedicated to lifestyle change and follow up

Other Bariatric Surgeries

Duodenal switch

Preoperative evaluation

  • Laboratory investigations including serum ferritin, sr. calcium, vitamin levels
  • Consideration of co morbidities
  • Coagulation profile
  • Cardiovascular factors – ECG, ECHO
  • Pulmonary function – Spirometry
  • Hepatic function – LFT, USG
  • Gastrointestinal function – OGD scopy
  • Sleep study
  • Endocrine
  • Psychological evaluation
  • Anaesthetic fitness

What we do?

Laparoscopic sleeve gastrectomy

Post op follow up

  • 2, 4, 6 weeks
  • 3 monthly till 2 years
  • Biannually
  • Investigations:Sr. ferritin, vitamin D, folate, vit.B12, CBC
  • Medication:Multivitamin and calcium supplements

Set Standards

Success for a weight loss surgery usually defined as %TWL>10% or %EWL >50%

Metabolic remission of diabetes mellitus – >60% by the end of second year or decreased requirement of insulin/OHA

Remission of Hypertension, dyslipidemia and near complete normalization of menstrual disturbances

Materials and Methods

  • Study area: Kauvery hospitals, Trichy
  • Study population: All patients who underwent laparoscopic sleeve gastrectomy
  • Duration:2011- Till date
  • Sample size:59

Results and Discussion

Demographic details

Age
RangeMean
22-6440
Gender
MaleFemale
2237

BMI

Range: 33.3 – 85

Mean BMI: 46.6

Comorbidities

Other comorbidities

  • Cardiac issue – 1
  • Menstrual disturbance -4 (2 had primary infertility)
  • 50% – feeling low because of their weight
  • Hypothyroid- 8

Performance

Complication

  • 1 patient had delayed staple line leak on POD-10
  • Managed with drainage and feeding jejunostomy
  • Healed after 6 weeks
  • Doing well on 12 years follow up
  • No Mortality

Weight loss estimation

  1. Percentage of total weight loss

TWL% = [(Initial weight-postop weight)] / [(Initial weight)] × 100

  1. Percentage of excess weight loss

EWL% = [(Initial weight-postop weight)] / [(Initial weight)- (ideal weight)] × 100

Where ideal weight is defined by the weight corresponding to a BMI of 25kg/m2

 

Metabolic remissions- Diabetes

Hypertension

Dyslipidaemia

Discussion

  • A 78.57% of patients with OSA felt better after surgery
  • In 8/13 people with arthralgia required less analgesic and 2 patients underwent knee replacement surgery and doing well
  • Among the 4 patients with menstrual irregularity- cycles became regular
  • Among the two with infertility, 1 patient got conceived and delivered and other one is in follow up
  • A >60% of people feel positive and confident following surgery

Follow up chart

Comparison with other Studies

VariablesOur studySaeed et alLee et al
Total body weight loss30.9%-20.7 – 64.7%
Excess body weight loss70%15.3 – 86.4%43.1 – 94.4%
DM remission65%56.5 – 88.9%
HTN remission71%46.6 – 75%
Dyslipidemia remission59%41.8 – 86.7%
VariableShivansuMisra et alOur data
%TWL (1 year)31.327.8
%EWL76.363.5
%TWL (3 years)30.930.9
%EWL73.170
DM Remission71.4%65%

Setbacks

  • 22 patients – mean EWL% – 60.2+/-23.2
  • (Mean years of follow up – 9.1)
  • Lack of follow up
  • Patient education

Recommendations

  • Dedicated nurse / paramedical practitioner for obesity
  • Follow up by regular calls / app to track patients
  • Regular camps to create awareness every 6 month 

Reference

  • Shoar S, Saber AA. Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies. SurgObesRelat Dis. 2017;13(2):170-180
  • Lee Y, Doumouras AG, Yu J, et al. Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis of Weight Loss, Comorbidities, and Biochemical Outcomes From Randomized Controlled Trials. Ann Surg. 2021;273(1):66-74

 

Dr. S.Sowmiya
DNB – Final year, General surgery

Dr. Velmurugan

Dr. S. Velmurugan
HOD, Dept. Of SGE

Journals

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