LAPAROSCOPIC SLEEVE GASTRECTOMY

Laparoscopic Sleeve Gastrectomy and its impact on Obesity Related Hypertension



Laparoscopic Sleeve Gastrectomy and its impact on Obesity Related Hypertension

Introduction 

The prevalence of obesity has continued to rise over the last few decades. Over 300 million adults are considered clinically obese worldwide. In United States an estimated 60% of the population is considered overweight. Obesity is defined as a BMI = 30 kg/m2, and morbid obesity is defined as a BMI = 40 kg/m2.  

Obesity is a known risk factor for development of several comorbidities. Some significant obesity-related conditions include diabetes mellitus, hypertension, sleep apnea, hyperlipidemia, gastroesophageal reflex disease, and degenerative joint disease. It is estimated that 1 in 10 premature deaths are directly attributable to obesity in American adults aged 20 - 64. Obesity is one of the largest and most important epidemics facing Americans today.  The growing prevalence of obesity and the increasing incidence of super-obese patients (body mass index [BM!] > 50 kg/m2) seeking surgical treatment has led to the development of surgical techniques designed to provide adequate excess weight loss (EWL) with the least possible morbidity. A recent study has emphasized that weight loss also allows improvement of life expectancy.' The 2 procedures most frequently performed are laparoscopic adjustable gastric band (LAGB) and laparoscopic gastric bypass (LGB). Laparoscopic sleeve gastrectomy (LSG), a restrictive operation, consists of vertical gastrectomy including the entire greater curvature of the stomach. Although LSG is associated with a greater morbidity than LAGB, it avoids some of the disadvantages of LGB such as excessive restriction of intake, marginal ulceration, and dumping syndrome.v'' We report our experience with LSG, evaluating the safety and efficacy of this procedure as a standalone operation.

Bariatric Surgery 

Bariatric surgery is currently the most effective evidence-based method to obtain long-term weight loss in severely obese patients. Laparoscopic sleeve gastrectomy (LSG) is a new bariatric procedure introduced in the 1990s for the management of severely obese patients. It was initially used as the first step to a two-stage approach to biliopancreatic diversion with duodenal switch (BPD-DS), but has been recently shown to be an effective single procedure. LSG is characterized as a restrictive procedure and functions to mechanically limit food intake. Furthermore, it is thought that LSG may decrease appetite stimulation by resecting the portion of gastric fundus responsible for producing ghrelin.    

Obesity and Hypertension 

Obesity and the presence of adipose tissue have been associated with increased blood pressure. The precise pathophysiology to the development of hypertension in obese patients is currently unknown. However, there are several factors involved in obesity-related hypertension including physiologic, genetic and environmental factors. Hypertension is also a known component of the metabolic syndrome, which consists of centripetal obesity, dyslipidemia, impaired glucose tolerance and insulin resistance. It has been postulated that in the obese, activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system may contribute to high blood pressure. Estimates of up to 70% of hypertension in adults may be directly caused by adiposity. It has also been postulated that obesity-related hypertension may be in part due ...