Document Type

Manuscript

Submission Date

2025

Abstract

Abstract

Introduction: Obesity is a public health epidemic that continues to increase morbidity and mortality in the United States. 41.9% of adults have a BMI >30. Laparoscopic sleeve gastrectomy (LSG) remains a mainstay of bariatric surgery to combat this epidemic. The aim of this study is to determine what patient demographics, pre-operative factors, and intra-operative factors affect BMI reduction and diabetes mellitus (DM) remission following LSG to guide optimal surgical patient selection.

Methods: 1242 charts from patients who underwent LSG from 2010-2022 at the University of Vermont Medical Center were reviewed for patient demographics, pre-operative and one-year post-operative BMI, hemoglobin A1c, diabetes management, and intra-operative bougie size (≤40 Fr and >40 Fr). SPSS was utilized to assess BMI and hemoglobin A1c changes from pre- to post-operative setting via paired t-test. DM status/management was assessed via analysis of variance. Independent sample t tests were utilized to compare outcomes related to bougie size and patient demographics.

Results: When measuring pre-operative characteristics, 44% of the population did not have diabetes, 25% had pre-diabetes, and 31% had Type 2 DM. For diabetics, 17% were diet-controlled, 29% were insulin-dependent, and 54% utilized oral antihyperglycemic (OA). Patients with pre-operative DM had significantly lower BMI reduction (10.2 ± 4.6) compared to patients with pre-operative pre-diabetes (11.1 ± 4.3) and patients without diabetes (11.5 ± 4.3) (p<0.001). BMI reduction did not significantly differ between pre-diabetic and the non-diabetic groups (p>0.05). Of the diabetic patients with a pre-operative and one-year post-operative hemoglobin A1c, there was a significant difference in A1c reduction when comparing pre-op diabetes management between oral antihyperglycemic regimen and insulin-dependent DM (0.8 ± 1.1 compared to 0.4 ± 1.3; p<0.007). There was no statistically significant difference in decreases to hemoglobin A1c when analyzed by sex, but there was a statistically significant difference (p<0.004) in change to BMI when comparing female (10.8 ± 4.4) to males (11.8 ± 5.3). When intra-operative decisions were analyzed, there was no significant difference between the mean BMI reduction between the small (≤40 Fr) (11.0±4.6) compared to large bougie (>40 Fr) (10.9±4.3) cohorts (p>0.05). There was no significant difference (p>0.05) in hemoglobin A1c decrease between the small (0.7±1.0) bougie size or the larger size (0.7±1.2).

Conclusion: Though most patients experience a reduction in BMI and hemoglobin A1c as a result of laparoscopic sleeve gastrectomy (LSG), there was significantly less BMI reduction among diabetic patients compared to non-diabetic patients after LSG. Among individuals with diabetes, those with insulin-dependent disease showed the least reduction in hemoglobin A1c and were less likely to achieve medical remission after LSG. There was no significant difference in weight loss or hemoglobin A1c reduction based on sex at birth. There was no statistically significant difference in reduction of BMI or hemoglobin A1c between the smaller (≤40 Fr) and large (>40 Fr) bougie cohorts. This implies that there is no additional benefit to a smaller bougie for BMI reduction or DM remission.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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