Ludzkie koronawirusy - autor: Krzysztof Pyrć z Zakładu Mikrobiologii, Wydział Biochemii, Biofizyki i Biotechnologii, Uniwersytet Jagielloński, Kraków

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© Borgis - Postępy Nauk Medycznych 4/2013, s. 296-300
*Artur Binda, Adam Ciesielski, Paweł Jaworski, Wiesław Tarnowski
Laparoskopowa, rękawowa resekcja żołądka w chirurgicznym leczeniu otyłości – doświadczenia własne
Laparoscopic sleeve gastrectomy in the treatment of obesity – own experience
Department of General, Oncological and Gastrointestinal Surgery, Medical Centre of Postgraduate Education, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw
Head of Department: prof. Wiesław Tarnowski, MD, PhD
Streszczenie
Wstęp. Rękawowa resekcja żołądka zyskuje coraz większą popularność ze względu na pozornie łatwą technikę wykonania, dobre wyniki w zakresie redukcji masy ciała i ustępowania chorób towarzyszących otyłości oraz akceptowalną liczbę powikłań. W pracy przedstawiono wyniki chirurgicznego leczenia pacjentów z otyłością patologiczną z wykorzystaniem laparoskopowej, rękawowej resekcji żołądka na podstawie materiału własnego.
Materiał i metody. Analizie poddano prospektywnie zbierane dane kolejnych pacjentów operowanych w okresie od stycznia 2010 do lutego 2012 roku. Oceniono dane demograficzne, parametry redukcji masy ciała, dane dotyczące operacji, powikłania oraz ustępowania chorób towarzyszących.
Wyniki. Operowano 95 pacjentów (63 kobiety i 32 mężczyzn). Masa ciała przed operacją wynosiła 126 ± 19 kg, BMI 44 ± 5 kg/m2 , a po roku od operacji odpowiednio 92 ± 18 kg i 32 ± 5 kg/m2. Procent utraty nadmiernej masy ciała (%EWL) po 12 miesiącach wyniósł 56 ± 19%. Odnotowano dwa poważne powikłania w tym 1 (1,1%) nieszczelność i 1 (1,1%) zwężenie. Ustąpienie lub poprawę po operacji stwierdzono w przypadku nadciśnienia tętniczego u 61 (84,7%) pacjentów, cukrzycy typu 2 u 20 (58,8%) pacjentów, ustąpienie dyslipidemii u 29 (50%) a dolegliwości stawowych u 25 (51%) pacjentów.
Wnioski. Rękawowa resekcja w okresie roku od operacji jest związana z satysfakcjonującą redukcją masy ciała. Rękawowa resekcja żołądka korzystnie wpływa na ustępowanie chorób towarzyszących otyłości. Operacja ta obarczona jest względnie niską liczbą powikłań. W przypadku wystąpienia poważnych powikłań, takich jak nieszczelność lub zwężenie, konieczne jest długotrwałe leczenie w warunkach szpitalnych.
Summary
Introduction. Sleeve gastrectomy has become more and more popular due to a seemingly easy method of performance, good outcomes with regard to body mass reduction and elimination of obesity-related diseases and an acceptable number of complications. The paper presents outcomes of surgical treatment of patients with morbid obesity using laparoscopic sleeve gastrectomy, based on authors’ own material.
Material and methods. The analysis included prospectively collected data of subsequent patients operated on between January 2010 and February 2012. Demographic data, parameters of body weight reduction, surgery parameters, complications and resolution of co-morbidities were evaluated.
Results. 95 patients (63 females and 32 males) were operated. The body weight prior to the surgery was 126 ± 19 kg and BMI 44 ± 5 kg/m2, whereas one year after the surgery the values were 92 ± 18 kg and 32 ± 5 kg/m2, respectively. The percentage of excess weight loss (%EWL) after 12 months was 56 ± 19%. Two serious complications, including 1 (1.1%) leak and 1 (1.1%) stenosis were observed. Complete remission or improvement after the surgery was observed for arterial hypertension in 61 (84.7%) patients, type 2 diabetes in 20 (58.8%) patients, regression of dyslipidaemia in 29 (50%) and of articular complaints in 25 (51%) patients.
Conclusions. Laparoscopic sleeve gastrectomy is effective weight loss procedure in the majority of patients. Sleeve gastrectomy has beneficial effects on the elimination of obesity-related diseases. This surgery is associated with a relatively low number of complications. In the case of serious complications such as a leak or stenosis long-term treatment at hospital is necessary.
INTRODUCTION
Within recent decades the number of patients requiring treatment due to morbid obesity has significantly increased. This phenomenon is accompanied by an increase in the frequency of obesity-associated diseases such as arterial hypertension, type 2 diabetes, dyslipidaemia, circulatory conditions, arthritis. The efficacy of conservative treatment with regard to permanent body weight reduction and elimination of comorbidities is lower than in the case of surgical treatment (1, 2). Among many surgical methods used in surgical treatment of obesity laparoscopic sleeve gastrectomy has become more and more popular (3). At the beginning this surgery used to be performed as the first stage, before surgeries that were technically more difficult, in patients with high BMI and a high risk of perioperative complications (4). At present sleeve gastrectomy is performed at many centres as a single-stage procedure with good outcomes with regard to body weight reduction and elimination of obesity-related diseases (5-8). The aim of the paper was to assess the efficacy and safety of laparoscopic sleeve gastrectomy in the treatment of morbid obesity based on authors’ own material.
MATERIAL AND METHODS
The analysis was performed on prospectively collected data of patients operated on at the Department of General, Oncological and Gastrointestinal Surgery between January 2010 and February 2012. The study included patients with a follow-up period of at least 12 months. Demographic parameters, co-morbidities before the surgery, body weight reduction parameters, effects of surgical treatment on resolution or improvement of arterial hypertension, type 2 diabetes, dyslipidaemia and complaints associated with the osteoarticular system were analysed. Patients were considered eligible for surgical treatment based on the criteria that have been generally accepted: BMI > 40 kg/m2 or BMI 35-40 kg/m2 with at least one coexisting obesity-associated disease, age 18-60 years. After preliminary tests patients were supervised by a dietician in order to reduce body weight prior to the surgery. As part of preparation for the surgery patients were hospitalised at the Department of Family and Internal Medicine CMKP in order to perform expanded internal medicine diagnostics. All patients had a laparoscopic surgery. Pneumoperitoneum at the pressure 12 to 15 mmHg was created using the Veres needle. Five trocars were used as a standard. Using LigaSure (Covidien) or SonoSurg (Olympus) harmonic knife the omentum was dissected from the greater curvature and, if required, all adhesions between the posterior gastric wall and the pancreas were released. ECHELON FLEX (Ethicon Endo-Surgery) or EndoGIA (Covidien) endostaplers were used to divide the stomach, starting the incision 4-6 cm off the pylorus, calibrating the width of a remainder using 36F bougie. The staple line was reinforced with continuous suture. A methylene blue leak test was routinely performed. A Redon drain was left along stapling line. On the first day a radiological follow-up with gastrografin was performed. In case of no leak symptoms and maintained passage to the duodenum a Redon drain was removed and patients were advised to consume fluids. According to the guidelines patients were discharged on the second day after the surgery, when a liquid diet had been started. A schedule of follow-up visits after a surgery included a follow-up visit 10 days after a discharge combined with suture removal, and then follow-up visits every 3 months. In order to evaluate body weight reduction parameters data from the date of admission to the General Surgery Department were considered as baseline. Body weight loss in kilograms, body weight change, BMI and percentage of excess weight loss (%EWL) were calculated. %EWL was calculated using the following formula – %EWL = (baseline body weight-present body weight/baseline body weight-ideal body weight)x100. Regression of comorbidities was evaluated during a follow-up visit 12 months later based on the criteria mentioned below. Type 2 diabetes: regression – normal fasting glycaemia (< 105 mg%), HbA1c levels < 6.5%, no hypoglycaemic medications for at least 3 months, improvement – normal fasting glycaemia (< 105 mg%), HbA1c levels < 6.5%, reduced doses of hypoglycaemic medications, no improvement – abnormal results of any of the test above, or the need to take hypoglycaemic medications at doses as prior to the surgery. Arterial hypertension: regression – systolic pressure < 140 mmHg, diastolic pressure < 90 mmHg during minimum 2 weeks before the visit after 12 months, no antihypertensives + normal pressure during a follow-up visit after 12 months, improvement – systolic pressure < 140 mmHg, diastolic pressure < 90 mmHg during minimum 2 weeks before the visit after 12 months, reduced doses of antihypertensives + normal pressure during a follow-up visit after 12 months, no improvement – systolic pressure ≥ 140 mmHg, diastolic pressure ≥ 90 mmHg or the need to take antihypertensives at doses as prior to the surgery. Dyslipidaemia: regression – normal lipid parameters: total cholesterol < 200 mg%, LDL cholesterol < 135 mg%, HDL cholesterol 42 – 80 mg%, triglycerides 44 – 183 mg%, without lipid-lowering drugs for 30 days prior to the follow-up visit after 12 months, no improvement – the need to take lipid-lowering agents due to persistent lipid disorders during 30 days prior to the follow-up visit after 12 months. Articular pain and complaints: regression – no articular pain or complaints and discontinuation of analgesics, no improvement – persistent complaints or the need to take analgesics due to this condition. In addition, data regarding a surgical procedure, hospitalisation time, readmission to the Department and early (up to 30 days) and late (between 30 days to one year) complications were recorded. Duration of the surgery was calculated starting from placement of the first trocar to placement of the last skin suture, whereas intraoperative blood loss was calculated based on the amount of blood in the suction pump, in millilitres.
RESULTS

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Piśmiennictwo
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otrzymano: 2013-02-19
zaakceptowano do druku: 2013-03-27

Adres do korespondencji:
*Artur Binda
Department of General, Oncological and Gastrointestinal Surgery Medical Centre of Postgraduate Education
ul. Czerniakowska 231, 00-416 Warszawa
tel.: +48 (22) 621-71-73, +48 (22) 584-11-36
e-mail: quiz0@interia.pl

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