Clinical efficacy of laparoscopic stomach intestinal pylorus sparing surgery in the treatment of severe obesity

Objective To investigate the clinical efficacy of laparoscopic stomach intestinal pylorus sparing surgery (SIPS) in the treatment of severe obesity. Methods The retrospective and descriptive study was conducted. The clinical data of 5 patients with severe obesity who were admitted to the China-Japan Union Hospital Affiliated to Jilin University from October to November 2018 were collected. There was 1 male and 4 females, aged from 18 to 55 years, with an average age of 33 years. All the 5 patients underwent laparoscopic SIPS. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was performed by outpatient examination, telephone interview and Wechat up to February 2019, including general condition, changes in body weight, body mass index, waistline, blood pressure, percentage of excess weight loss, fasting plasma glucose, glycosylated hemoglobin, blood lipid, and uric acid at 3 months after surgery. Measurement data with normal distribution were represented as Mean±SD, and they were tested with Hotelling T2 test. Measurement data with skewed distribution were represented as M (range). Results (1) Surgical situations: 5 patients underwent successfully laparoscopic SIPS under clear surgical field, without obvious bleeding, conversion to open surgery or perioperative death. The operation time was 240 minutes (range, 165-345 minutes). (2) Postoperative situations: the time to initial out-of-bed activity, time to first and flatus, and time to initial drinking and liquid intake were 2 days (range, 2-3 days), 3 days (range, 2-3 days), and 3 days (range, 3-4 days), respectively. On the third day after surgery, all the 5 patients were confirmed anastomotic patency, without gastric leakage, stenosis, or obstruction by upper gastrointestinal contrast. The abdominal drainage-tube was removed on the fourth day after feeding without obvious discomfort and foreign substances extraction from the drainage-tube. The duration of postoperative hospital stay was 6 days (range, 6-7 days). (3) Follow-up: 5 patients with severe obesity were successfully followed up for 3 months. During the follow-up, one patient had significantly increased frequency of defecation, roughly 5-8 times a day, especially after eating greasy food. According to the dietary guidance of the case manager, diarrhea was improved significantly after reducing the intake of oily food. Of the 5 patients with severe obesity, color doppler ultrasonography examination revealed that cholestasis was found in 2 patients at 3 months after operation, which may be related to significant weight loss, ratio imbalance of bile acid to and cholesterol, intestinal microbiota, injury of vagus nerve, significant increasing in mucin of gallbladder, and without oral ursodeoxycholic acid as prescribed by the doctor. The body weight, body mass index, waistline, systolic blood pressure, and diastolic blood pressure of 5 patients with severe obesity were (100±15)kg, (36±4)kg/m2, (111±10)cm, (130±12)mmHg (1 mmHg=0.133 kPa), and (78±14)mmHg at 3 months after operation, respectively, showing significant differences compared with these of preoperation (F=61.631, 75.558, 87.045, 9.501, 16.248, P<0.05). The percentage of excess weight loss was 44%±9%. Among the 5 patients with severe obesity, the fasting plasma glucose of 2 patients with type 2 diabetes mellitus decreased from 9.55 mmol/L and 13.49 mmol/L to 5.18 mmol/L and 5.62 mmol/L after operation, respectively. Level of glycated hemoglobin decreased from 10.0% and 9.9% to 5.2% and 6.2% after operation, respectively. In the 2 patients with hyperlipidemia, one patient with hypertriglyceride had level of triglyceride, total cholesterol, and low density lipoprotein increased from preoperative 2.24 mmol/L, 4.84 mmol/L and 2.92 mmol/L to 2.47 mmol/L, 6.68 mmol/L and 5.51 mmol/L after operation, another patient with hypercholesterol had cholesterol level decreased from preoperative 5.97 mmol/L to postoperative 5.75 mmol/L after operation. In the 3 patients with hyperuricemia, two patients had the uric acid decreased from 404 μmol/L and 484 μmol/L to 319 μmol/L and 417 μmol/L after operation, respectively, one had the uric acid increased from 531 μmol/L to 674 μmol/L after operation. Conclusions Laparoscopic SIPS has a significant short-term effect on patients with severe obesity, but its long-term safety and efficacy need to be further followed up. Key words: Obesity; Type 2 diabetes mellitus; Stomach intestinal pylorus sparing surgery; Biliopancreatic diversion surgery; Laparoscopy