Evaluation of the effectiveness of modified versus standard laparoscopic sleeve gastrectomy and postoperative care in elderly patients with morbid obesity: a single-center randomized clinical study
Sevak S. Shahbazyan
Department of General Surgery, Heratsi Yerevan State Medical University, Yerevan, Armenia
Shengavit Medical Center, Yerevan, Armenia
Abstract
Background: Obesity is a complex pathology resulting from metabolic disorders. It causes a high risk of cardiovascular diseases, insulin resistance, atherogenic dyslipidemia, hypertension and other conditions. Its prevalence has a steady upward trend due to the growing incidence of obesity and type 2 diabetes mellitus. Laparoscopic sleeve gastrectomy (LSG) has proven to be a safe, effective and technically undemanding method of weight loss, which has made this bariatric procedure popular worldwide. However, it does not always provide the desired reduction in excess weight and comorbidities.
Aim: The aim of this single-center, prospective randomized pre-post interventional study was to compare the safety and effectiveness of the modified (MLSG) versus the standard LSG (SLSG) in elderly patients with morbid obesity.
Methods: The study was conducted at the Shengavit Medical Center (Yerevan, Armenia) from February 2020 to February 2022 involving 168 patients aged > 50 years with a body mass index (BMI) of 40 to 50 kg/m2 who underwent SLSG with conventional postoperative care or MLSG with individualized postoperative management. The efficacy of surgical interventions was assessed by measuring and comparing BMI and quality of life (using the Bariatric Analysis and Reporting Outcome System [BAROS]) of patients pre-LSG, as well as 6 and 24 months post-LSG.
Results: The study did not reveal significant intergroup differences in BMI and BAROS values immediately before surgery and 6 months after surgery. After 6 months, intragroup differences were identified in both groups when compared with the corresponding preoperative values: a significant decrease in the BMI level and a significant increase in the BAROS level. These changes were more pronounced in the MLSG group. When BMI and BAROS values were measured 24 months post-surgery, their progressive changes were still evident with significantly more pronounced effect in the MLSG group.
Conclusion: MLSG in morbidly obese elderly patients can be an effective alternative to SLSG thanks to long-term high impact on weight and quality-of-life indicators.
Keywords: laparoscopic sleeve gastrectomy (LSG), body mass index (BMI), Bariatric Analysis and Reporting Outcome System (BAROS), morbid obesity, elderly, quality of life