On-line version ISSN 2078-5151
S. Afr. j. surg. vol.50 n.3 Cape Town Aug. 2012
50th SAGES/SASES Congress 9 - 11 August 2012, Durban
SASES abstracts (oral presentations)
METABOLIC SURGERY: BASELINE PATIENT PROFILE AND 3-YEAR OUTCOME DATA
T van der Merwe; J H Pieters; G K Fetter
University of Pretoria
INTRODUCTION: We performed baseline patient profiling and documented biochemical, morbidity and mortality outcomes after bariatric surgery in our centre.
METHODS: Fifty baseline variables were expressed as percentage of total patient population (data not shown), including dietary and social history, and major and minor comorbidities. Biochemical clinical outcome, disease resolution, morbidity and mortality were documented.
RESULTS: Baseline parameters (3 months - 3 years; p-values not shown): number of subjects n=730 - n=193; weight 127.0 - 93.1 kg; BMI: 44.6 - 32.0 kg/m2; waist 123 - 97 cm; hips: 133 - 113 cm; neck: 3.5 - 37 cm; BP(S) 147 - 132 mmHg; BP(D) 89 - 80 mmHg; comorbid diseases 6 - 0.6; F-glucose 6.8 - 4.9 mmol/l; F-TG 1.8 - 1.0 mmol/l; F-HDL 1.0 - 1.6 mmol/l; F-LDL 3.3 - 2.0 mmol/l; ALT 31 - 22 U/l; AST 25 - 21 U/l; GGT 38 - 21 U/l; U/A 0.44 - 0.28 mmol/l; and CRP 16 - 5 mg/l. Mortality: surgical - 0%, medical - 0.1%. Morbidity: major surgical - 2.9%, minor surgical - 6.1%; major medical - 3.1%, minor medical - 1.9%.
Patients presented with a long-standing history of attempts at weight loss (>17 years). There was a strong history of childhood and family obesity. The presence of true eating disorders was low. Male patients had a higher BMI and a more adverse clinical profile at baseline. Biochemical profiling was more adverse and anaesthetic risk was higher in male patients; technically more difficult surgery (android fat deposition). Infertility and PCOS were present in 21% of women. Comorbid diseases decreased from a mean of 6 to 0.5 at 2 years post-surgery. Disease resolution was high at 3 years with approximately 88% of patients having diabetes resolution; hypertension resolution was lower in male patients. Food tolerance and follow-up at our centre was good at 3 years. The true incidence of gallstones was approxiately 7.5%, and stomal ulceration was present in 7% of patients.
Surgical and medical morbidity is low in very high-volume centres; in our centre these were on a par with the best reported data internationally. Surgical and medical morbidity in our centre were approximately 0%.
CONCLUSION: Metabolic surgery is a modern-day solution for obesity, with high disease resolution and very low mortality in exceptional centres of excellence.
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