LAPAROSCOPIC SLEEVE GASTRECTOMY AND GASTRIC PLICATION: INFLUENCE ON THE MAIN INDICATORS OF HORMONAL HOMEOSTASIS IN METABOLIC SYNDROME
Authors: Dzubanovsky I. Ya. , Havrysh Y. I. , Prodan A. M. , Halei M. M. 
Published: January 2023

Improvements in living standards have led to an increase in the annual global incidence of obesity to 13% among adults in 2021.

Laparoscopic gastroplication is safe to perform, essentially organ-preserving and relatively inexpensive from an economic point of view.

Among the advantages of gastroplication should be included its simplicity in performance, which makes a wider circle of its use. It should also be noted that during gastroplication there is no crossing of the organ cavity (stomach), which makes such complications as failure of the suture line, bleeding from the suture line impossible. However, it remains relevant to determine the effect of this type of intervention on the level of orexogenic and anorexigenic hormones in the postoperative period.

Aim of the research: to evaluate the influence of sleeve-gastrectomy and gastric plication on the main indicators of hormonal homeostasis in metabolic syndrome.

The Goal is to evaluate the influence of sleeve gastrectomy and gastroplication on the main indicators of hormonal homeostasis in metabolic syndrome.

Materials and methods. The work is based on the materials of clinical examination and surgical treatment of 12 patients with metabolic syndrome, 4 men and 8 women aged 45±3.75 years with a body mass index >40 kg/m2. Depending on the chosen surgical intervention, all patients included in the study were divided into two groups: laparoscopic sleeve gastrectomy - 5 patients, laparoscopic gastric plication - 7 patients.

Results. A decrease in ghrelin concentration was established 4 weeks after sleeve-1 surgery by 35.06% (p=0.0595), while after 3 months this indicator decreased by 58.57% (p=0.0065), and after 6 months by 60.31% (p=0.0057 ). Gastric plication also demonstrated a decrease in the ghrelin level (1 month – 22.17% (p=0.1290), 3 months – 32.82% (p=0.0245), however, this type of surgical intervention did not cause its significant decrease in the corresponding time periods. The use of surgical sleeve-1 and sleeve-2 methods showed a significant decrease in the level of leptin, which is evidence of a decrease in the degree of resistance. Thus, after sleeve-1 in terms of 1, 3 and 6 months, a decrease in its serum level by 38.47% was noted (p=0.0342), 54.67% (p=0.0056), 56.95% (p=0.0069), respectively. And in patients after word-2 in terms of 1, 3 and 6 months, a decrease in its serum level by 24.67% (p =0.1230), 35.68% (p=0.0193), 48.29% (p=0.0028), respectively.

On the other hand, the used bariatric surgical interventions caused an increase in the concentration of adiponectin. Its level increased by 7.14% (p=0.9124) after 1 month, by 30.63% (p=0.5741) after 3 months, and by 36.64% (p=0.4093) six months after sleeve-1 surgery. After gastric plication, an increase of 7.71% (p=0.8731), 16.71% (p=0.6198) and 30.89% (p=0.4304) was registered in the respective observation periods.

Conclusions. Significant changes in the levels of adipokines after bariatric surgery, such as an increase in adiponectin and a decrease in leptin, indicate a high potential in reducing the manifestations of metabolic syndrome and the risk of developing type 2 diabetes. And the decrease in the level of ghrelin, which interacts with these hormones in a feedback type, is the trigger for the regulation of hormonal homeostasis, which can be achieved by bariatric surgery.