Gastrektomia bertikala obesitate morbidoan. Sindrome metabolikoan duen eragina.

Abstract

[EUS] Sarrera: azken urteetan mundu mailan obesitatearen prebalentzia areagotzen ari da, morbi-mortalitatea areagotzen duen zenbait patologiarekin erlazionaturik egonez. Bereziki, sindrome metabolikoa (obesitate zentrala, DM, HTA, HDL, TG) da arrisku kardiobaskularra ugarituz, morbi-mortalitatean eragin handiena duena. Literaturak dioenez, kirurgia bariatrikoak pisu galera lortzeaz gain, obesitatearekin erlazionaturiko komorbilitateen hobekuntza bermatu dezakeen tratamendu bakarra da. Teknika kirurgiko ororen artean, azken hamarkadan indar gehien hartzen ari dena gastrektomia bertikala dugu, beteak beste gure ospitalean gehien buruturiko teknika izanik. Hori dela eta, gure ikerketaren helburua gastrektomia bertikala burutu eta urte batera sindrome metabolikoaren hobekuntzarik lortzen ote den ikustea da. Material eta metodoak: 2011ko urtarrilak eta 2015eko abenduak bitartean egindako 157 gastrektomia bertikalek urte batera izan dute eboluzioaren azterketa deskriptibo erretrospektiboa burutu da. Azterturiko bariableak sexua, adina, pisua, GMI, gluzemia, HbA1c, triglizeridoak, HDL, LDL, tentsio arteriala eta SAOS izanik. Emaitzak: Kirurgia burutu eta urte batera pisuaren eta GMIaren mediana 125 kg-tatik 81kg-tara eta 45 〖kg/m〗^2-tatik 30.76 〖kg/m〗^2-tara jaitsi da hurrenez hurren, bi kasuetan p < 0.001 izanik. Glukosa mailari dagokionez, 100 mg/dL-tatik 86 mg/dL-tara murriztu da (p < 0.001), HbA1c ere jaitsi da %5.8tik % 5.2ra (p < 0.001). Lipidoei dagokienez, HDL 48 mg/dL-tatik 61 mg/dL-tara igo da ( p < 0.001), TG 130 mg/dl-tatik 79.5 mg/dL-tara jaitsi ( p < 0.001) eta LDL ere 114mg/dL-tatik 110.5 mg/dL-tara jaitsi da ( p < 0.329). TA, berriz, 163/82mmHg-tatik 128/74.5 mmHg-tara (p < 0.001) murriztu da. Komorbilitatei dagokienez 2. motako diabetes mellitusa kasuen % 85.2an, hipertentsioa %62.46, dislipemia % 47.5an eta SAOSa % 76.6an lortu da sendatzea, orotan p < 0.001 suertatuz. Ondorioak: Gure kasua, urte bateko jarraipenaren ondoren, gastrektomia bertikalak 2. motako diabetesa, hipertentsioa, hiperlipemia eta SAOSaren hobekuntza dakarrela baieztatu dugu. Hala ere, ezin bestekoa litzateke epe luzeagorako jarraipena egitea. Hitz gakoak: gastrektomia bertikala, sindrome metabolikoa, obesitatea, kirurgia bariatrikoa.

[EN] Introduction: Obesity is a global health problem that is becoming more and more prevalent. It is also associated with various pathologies that increase both morbidity and mortality. It is closely related to “the metabolic syndrome”, which increasing cardiovascular risk, increases morbidity and mortality. Recent publications show that bariatric surgery is the only method able to improve these comorbidities. Among the different surgical techniques, laparoscopic sleeve gastrectomy is becoming more important in the last years, being the most performed surgical technique in our hospital. In this way, the goal of our study is to see metabolic syndrome improvement one year after surgery. Material and methods: A retrospective descriptive study of 157 laparoscopic sleeve gastrectomy surgeries, which include patients operated from January 2011 up to December 2015. All cases have been studied for a year and the analyzed variables have been gender, age, weight, BMI, glucose, HbA1c, HDL, LDL, triglycerides, blood pressure and SAOS. Results: After one year follow-up, weight and BMI has been significant decreased (p <0.001), from 125 kg to 81kg and from 45 〖kg/m〗^2 to 30.76 〖kg/m〗^2 respectively. Glycemia decreases from 100 mg/dL to 86 mg/dL (p> 0.001), HbA1c from %5.8 to % 5.2 (p <0.001), TA from 136/82 mmHg to 128/74.5 mmHg (p <0.001), TG from 130 mg/dL to 79.5 mg/dL (p <0.001), LDL from 114 mg/dL to 110.5 mg/dL (p <0.329) and HDL improves from 48 mg/dL to 61 mg/dL (p<0.001). Regarding comorbidities, it has succeeded in curing type 2 DM in 85% of cases, hypertension in 62.46%, dyslipidemia in 74.5% and SAOS in 76.6%, with a p <0.001. Conclusion: After a year of follow-up, we can observe in our study that sleeve gastrectomy improves type 2 diabetes, hypertension, hyperlipemia and SAOS. However, it would be essential to carry out a longer term study. Key words: laparoscopic sleeve gastrectomy, metabolic syndrome, obesity, bariatric surgery.