Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Feb 15, 2019; 10(2): 78-86
Published online Feb 15, 2019. doi: 10.4239/wjd.v10.i2.78
New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients
Ohad Guetta, Alex Vakhrushev, Oleg Dukhno, Amnon Ovnat, Gilbert Sebbag
Ohad Guetta, Alex Vakhrushev, Oleg Dukhno, Amnon Ovnat, Gilbert Sebbag, Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
Author contributions: Guetta O performed data collection, statistical analysis, and the writing of this article; Ovnat A and Vakhrushev A recruited the patients and performed all the operations as well as treated further complications and perioperative care; Sebbag G made critical revision of the article and final approval of the version to be published; Dukhno O contributed to this paper.
Institutional review board statement: This study was approved by the local institutional review board.
Informed consent statement: The study was exempt of signed informed consent according to the local Institutional Review Board Approval due to its retrospective nature.
Conflict-of-interest statement: The authors have no competing interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ohad Guetta, MD, Surgeon, Department General Surgery B, Soroka University Medical Center, Rager Ave. 151, POB 151, Be’er Sheva 8457108, Israel. ohadgu@clalit.org.il
Telephone: +972-52-2523899 Fax: +972-8-6239930
Received: November 6, 2018
Peer-review started: November 6, 2018
First decision: November 29, 2018
Revised: January 8, 2019
Accepted: January 22, 2019
Article in press: January 23, 2019
Published online: February 15, 2019
Abstract
BACKGROUND

It has been established that bariatric surgery, including laparoscopic sleeve gastrectomy (LSG), has a positive impact on type 2 diabetes mellitus (T2DM). However, less frequently T2DM is reported as a risk factor for complications with this type of surgery.

AIM

To evaluate the safety of LSG in T2DM.

METHODS

A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015. Data was collected through digitized records. Any deviation from normal postoperative care within the first 60 d was defined as an early complication, and further categorized into mild or severe.

RESULTS

Nine hundred eighty-four patients underwent LSG, among these 143 (14.5%) were diagnosed with T2DM. There were 19 complications in the T2DM group (13.3%) compared to 59 cases in the non-T2DM (7.0%). Out of 19 complications in the T2DM group, 12 were mild (8.4%) and 7 were severe (4.9%). Compared to the non-T2DM group, patients had a higher risk for mild complications (Odds-ratio 2.316, CI: 1.163-4.611, P = 0.017), but not for severe ones (P = 0.615). An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications (P = 0.013, CI: 1.074-1.843) but not for mild ones.

CONCLUSION

Our data suggest that LSG is relatively safe for patients with T2DM. Whether pre-operative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.

Keywords: Bariatric surgery, Laparoscopic sleeve gastrectomy, Type 2 diabetes, Complications, Morbidity, Hemoglobin A1c, Fasting plasma glucose, Clavien-Dindo classification

Core tip: Laparoscopic sleeve gastrectomy is the most popular bariatric procedure worldwide today. Its impact among diabetic patients has been beneficial regarding diabetes control. This study is the first to examine the safety of the procedure in this subgroup of the population. We found that the diagnosis of diabetes mellitus is associated with an increased rate of mild postoperative complications but not with severe ones. Elevated hemoglobin A1c is a good predictor for the risk of severe complications.