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Analysis of quality of life in patients with clinically severe obesity and type 2 diabetes mellitus after laparoscopic sleeve gastrectomy – a 12-month prospective observational study

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Wysocki M., Mizera M., Karpińska I., Ptaszkiewicz K., Małczak P., Pisarska-Adamczyk M., Kania M., Major P.
Polish Journal of Surgery
|
2024
|
vol. 96
|
issue 6
20-30
EN
Introduction: Due to a short history of laparoscopic sleeve gastrectomy (LSG) as an independent bariatric procedure, we still lack studies providing analysis of the quality of life (QoL) in patients with type 2 diabetes mellitus (DM2). Aim: We aimed to assess the influence of LSG on QoL in obese patients with DM2. Material and Methods: Prospective, observational study included patients with: morbid obesity, body mass index (BMI) ≥ 35 kg/m² and ≤ 50 kg/m2, DM2 shorter than 10 years, qualified for LSG. Bariatric Analysis and Reporting Outcome System (BAROS) that included the Moorehead-Ardelt Quality of Life Questionnaire II (MA-QoLQII) score, and the SF-36 Health Survey (SF-36) questionnaire were used for repetitive assessment of QoL before LSG and after one and 12 months following surgery. Selected clinical and biochemical parameters were also repeatedly measured. Results: Thirty-three patients were included in the study (23 females). Patients’ mean age was 45 ±10 years. BAROS significantly increased before LSG, one month, and one year after surgery (0.63 ±1.12, 2.94 ±1.90, and 4.97 ±2.08, respectively). The MA-QoLQII score significantly rose with an increase of excess body mass index loss (EBMIL) (P = 0.002) and remission of DM2 (P = 0.049), while inversely correlated with Homeostatic Model Assessment for Insulin Resistance index (HOMA-IR) (P = 0.003). Degenerative joint disease (P = 0.025) and average time of low glucose concentration in continuous glucose monitoring (CGM) (P = 0.005) had an inverse correlation with SF-36 Physical Component Summaries (PCS), standardized for cardiovascular comorbidity, EBMIL and HOMA-IR (P = 0.839; P = 0.086; P = 0.571, respectively). EBMIL (P = 0.003), remission of DM2 (P < 0.001) had a positive correlation with Mental Component Summaries (MCS), while HOMA-IR (P < 0.001) and count of low glucose concentration events (P = 0.022) had an inverse correlation with MCS, while standardized for average glucose concentration in CGM after 12 months (P = 0.586). Discussion: Significant improvement in QoL was observed in patients with DM2 after LSG. Remission of DM2, higher EBMIL, lower HOMA-IR, fewer and shorter low glucose concentration events in CGM after 12 months were factors that increased selected QoL scores.
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Effect of preoperative intragastric balloon treatment on perioperative and postoperative outcomes after laparoscopic sleeve gastrectomy: A retrospective cohort study

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Rzepa A., Karpińska I., Wierdak M., Pisarska-Adamczyk M., Stefura T., Kawa I., Pędziwiatr M., Major P.
Polish Journal of Surgery
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2024
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vol. 96
|
issue 3
56-62
EN
Introduction: Intragastric balloon (IGB) insertion is used as a bridging therapy in patients with body mass index (BMI) ≥ 50 kg/m2 . We arranged a retrospective study to evaluate whether pre-operative IGB treatment influences perioperative and postoperative weight loss outcomes after laparoscopic sleeve gastrectomy (SG), and especially to evaluate the impact of post - IGB percentage of excessive weight loss (%EWL) on postoperative %EWL. Materials and methods: Patients who underwent IGB placement followed by laparoscopic SG were divided into the following groups considering %EWL after IGB: Group 1 <=10.38%; Group 2 >10.38% and <=17.27%; Group 3 >17.27% and <=24.86%; Group 4 >24.86%. 1 year after SG data were collected. The following parameters were compared between groups: operative time, total blood loss, length of stay and weight, BMI, percentage of total weight loss (%TWL), %EWL. Results: There were no statistically significant differences between groups in perioperative results. Post-SG %EWL was the highest in intermediate groups: 2 and 3. Post-treatment results were observed: body weight and BMI were the lowest in Group 4 and the highest in Group 1. Post-treatment %EWL was the highest in Group 4, the lowest in Group 1 and grew gradually in subsequent groups. Discussion: The study confirmed the impact of weight loss on IGB on postoperative results. The study showed that %EWL after the IGB treatment influences %EWL after SG and most of all affects definitive %EWL after two-stage treatment and it could be a foreshadowing factor of these outcomes. Importance: The importance of research for the development of the field %EWL after IGB influences the final BMI and final weight, which means that patients with the greatest %EWL after IGB are more likely to have the greatest postoperative weight loss and overall weight loss.
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