Effectiveness of Laparoscopic Sleeve Gastrectomy for Weight Loss in Morbid Obese Patients

Objective: To determine the effectiveness of laparoscopic sleeve gastrectomy for weight loss in morbidly obese patients at Capital Hospital, Islamabad. Methodology: This descriptive case series study was done at Capital Hospital, CDA, Islamabad during a period of one-year from February 2019 to January 2020. All the patients with a body mass index of 35 or greater, with or without comorbidities, aged 18 to 65 years of either gender were included. All the patients underwent laparoscopic sleeve gastrectomy for weight loss. At the 1 st , third, and 6 th month’s follow-up, postoperative weight loss was noted. Effectiveness was taken in terms of > 10% weight loss maintained at 6 months. Results: The overall study participants' average age was 57±9.77 years, and females were in the majority (62%). Overall, laparoscopic sleeve gastrectomy was effective in 85% of patients and was not effective in 15% of patients. The average BMI was 37.31 kg/m 2 . Laparoscopic sleeve gastrectomy showed effectiveness in 57 (85%) patients, while 10 (15%) of the patients' weight was not lost. Effectiveness was statistically insignificant according to age, gender, and comorbidities, p-values were quite insignificant (>0.05). Conclusion: Laparoscopic sleeve gastrectomy was observed to be an effective technique for weight loss in morbid obese patients. It did decrease the morbidities and improve the quality of life.


In trodu ction
Obesity is a medical disorder when extra body fat builds up to the point that it could be harmful to one's health. The Body Mass Index (BMI), which is calculated by dividing a person's weight by their height squared, is used to assess and categories obesity. When a person's BMI exceeds 30 kg/m2, they are typically termed obese, with a BMI of 25 to 30 kg/m2 being considered overweight. Class I Obesity is defined as a BMI of 30 to 34.9. A Class II obesity BMI ranges from 35.0 to 39.9. BMI 40 is considered Class III Obesity. 1 A combination of excessive food intake, inactivity, and genetic predisposition frequently results in obesity. With rising rates among adults and kids, obesity is the greatest preventable cause of mortality in the globe. 100 million children and 600 million adults (12%) were obese in 2015. 2 Women are more likely than men to be obese. The American Medical Association designated obesity as an illness in 2013. 3 Diet and exercise are considered the main treatments for obesity. To suppress the appetite or minimize the absorption of fat, medications may also be used in conjunction with a healthy diet. Conservative treatments like diet, exercise, and medications have given disappointing long-term results 4 , surgeons are using minimally invasive techniques for the management of Obesity. [5][6] One of them is the laparoscopic sleeve gastrectomy, in which a significant section of the stomach is surgically Original Article removed along the larger curve, reducing the stomach to 25% of its initial size. Today, it is well accepted that bariatric surgery is a reliable and secure procedure for treating severe obesity. It also has advantages in terms of reducing mortality, comorbidities, and health care expenditures. The percentage total weight loss is 43% after 6 months of Laparoscopic Sleeve Gastrectomy respectively. 7 The purpose of this descriptive study is to ascertain that, Laparoscopic Sleeve Gastrectomy proved to be the safest and most effective approach for achieving lengthy-time period weight loss and correction of metabolic abnormalities in patients tormented by morbid obesity.
Meth odo log y This descriptive case study was carried out at Capital Hospital, CDA, Islamabad after taking permission form Hospital's ethical committee. The study duration was one year from February 2019 to January 2020. All the patients with body mass index of 35 or greater with or without comorbidities, aged 18 to 65 and both genders were included. Patients were excluded if they were unfit for general anesthesia, had active substance abuse, undiagnosed and untreated mental problems such as psychoses and severe depression, had a significant hiatus hernia or barrette esophagus, or were unwilling to follow dietary advice. A total of 67 individuals selected by sample size was calculated using the WHO sample size calculator, taking confidence level 90%, anticipated population proportion 43% 7 and confidence interval 10%. After taking informed written consent from the patients, they underwent laparoscopic sleeve gastrectomy for weight loss. The procedures were performed under general anaesthesia by experienced consultant surgeon having a minimum experience of more than 5 years. Postoperative weight loss was noted on 1 st , third, and 6 th month's follow-up. Effectiveness was taken in terms of > 10% of weight loss maintained at 6 months. All the information was collected by the study proforma and data analysis was carried out using SPSS version 26.

Results
A total of 67 patients were studied; their average age was 57± 9.77 years and females were in majority 62%, while males were 38%. The majority of the 58 patients (86%) were married, while 9 (14%) were unmarried. As per comorbidities, 44(65%) patients were diabetic, 46(69%) patients were hypertension and 41(61%) patients had lipid profile abnormalities. (Table I) Effectiveness in laparoscopic sleeve gastrectomy was analyzed as weight loss >10% in 57(85%) patients during post operative six months and was not effective in 10(15%) patients. (Table II) Stratification of effectiveness laparoscopic sleeve gastrectomy with respect to age, gender, marital status, education, hypertension, diabetes, and hyperlipidemia is given in table III.

Discu ssion
A medical disease called obesity occurs when extra body fat builds up to the point where it could be harmful to   On the other hand, the study reported that the out of all study participants who underwent the surgery, the females were (68%) and males were (32%). 9 Interestingly in that study stated that another important risk factor for postoperative mortality and morbidity is male gender, along with high BMI, and is linked to technical challenges during surgery. In actuality, men frequently possess a mechanical body habit in which extra body fat is located in the hepatic left lobe and the peritoneal cavity is frequently enlarge, 9,10 making access to the stomach and hiatal area challenging. As a result, the literature's relatively high proportion of male patients receiving SG indicates the bariatric surgeon's preference for SG that would be less difficult than other operations necessitating more extensive anastomoses of intestine and dissections. 9 In this study laparoscopic sleeve gastrectomy found effective in 85% of the participants and was not seen effective in 15% patients. Consistently Eid GM et al 11 reported that the seventy-four cases underwent LSG, and the mean age was 50 years, the occurrence of the long and the short-term complications was 15% postoperatively and mortality rate was 0. In their study, the overall follow-up duration average was seventy-three months and excess weight loss (EWL) (52%)

Conclu sion
Laparoscopic sleeve gastrectomy was observed to be the effective technique for weight loss in morbid obese patients do decrease the morbidities and improve the quality of life. Although further large-scale studies are recommended on such subject.