Intermediate and long-term clinical results after metabolic and bariatric surgery

Aim: The prevalence of obesity has increased day by day all over the world and reached pandemic proportions. Obesity is not only an aesthetic problem, it is a disease that negatively affects almost every system. Today, the most effective treatment for obesity is surgery, and different surgical procedures are increasingly performed all over the world. Although the most commonly used procedure today is sleeve gastrectomy, single anastomosis gastric bypass and roux-n-y gastric bypass are also frequently preferred. These procedures have advantages and disadvantages compared to each other. The aim of our study is to evaluate the effects and complications of surgery on weight loss, obesity and related comorbid factors in the short and medium term after bariatric and metabolic surgery. Materials and Methods: The study was planned retrospectively at Samsun University Faculty of Medicine, Department of General Surgery. Between January 2014 and December 2021, 570 patients who were diagnosed with obesity and underwent sleeve gastrectomy, Roux-en-Y gastric bypass and mini gastric bypass, and who could be checked by telephone or outpatient clinic for follow-up purposes, were included. In the preoperative period, patients' age, gender, height, weight, BMI, co-morbid diseases, complete blood count, biochemistry and hormone tests, vitamins, preoperative gallstone status, operation type, length of stay, postoperative complications, re-hospital admission and mortality, in the postoperative the period, follow-up period, EWL (Excess weight loss), TWL (Total weight loss), post-surgical weight changes, regression of comorbidities, and revision surgery were evaluated. SPSS program was used to analyze the data. P values less than 0.05 were considered significant. Results: 570 patients, 464 (81.4%) of whom were women, were included in the study. 55.3% (315) of the patients included in the study were between the ages of 20-39. Sleeve gastrectomy was performed in 346 (60%) patients, and Roux-en-Y gastric bypass was performed in 15.6% (89) patients. According to body mass index classification, 96% (547) of the patients had Grade 3 obesity. 284 of the patients included in the study had comorbidities and 219 patients were using medications before surgery. Complications were observed in 52 (9.1%) patients in the postoperative period. Complications were most frequently observed after sleeve gastrectomy (53.8%). While the most common complications seen in male patients were leakage and atelectasis, the most common complications in female patients were bleeding and leakage. It was observed that the most common reason for patients to be readmitted to the hospital was the need for blood replacement. The median of the lowest excess weight loss percentage (EWL%) values of the patients was calculated as 92.4, and the median of the final EWL% values was calculated as 81.1. A significant difference was found between the median EWL% minimum and EWL% final values according to surgery types. Conclusion: Surgery remains the gold standard in obesity treatment. In addition to weight loss after surgery, metabolic results are quite satisfactory regardless of the procedure. However, a common consensus has still not been established regarding the selection of metabolic and bariatric surgical procedures performed in experienced centers with low complication rates. In our study, it was concluded that among the procedures applied to the patients, the results of Mini gastric bypass were comparable to Roux-en-Y gastric bypass, and the mid- and long-term clinical results were better compared to sleeve gastrectomy.