Authors (including presenting author) :
Tsui TM1,5, Chan MP2,5, Cheng WTF3, Li KYJ4, Sze YS1,5
Affiliation :
1. Department of Surgery, Yan Chai Hospital, Hong Kong 2. Department of Surgery, Caritas Medical Centre, Hong Kong 3. Department of Pharmacy, Yan Chai Hospital, Hong Kong 4. Department of Medicine, Yan Chai Hospital, Hong Kong 5. Cluster Metabolic Surgery Team, Kowloon West Cluster, Hospital Authority, Hong Kong
Introduction :
Metabolic syndrome is a chronic illness as well as a major risk factor for cardiovascular diseases and diabetes mellitus. Traditional treatment of metabolic syndrome usually involves weight management and drugs targeting on hypertension, dyslipidaemia and diabetes. Primary care physicians are usually the only medical personnel involving in the management and occasionally supported by dietitians and endocrinologists. The control of the disease is not always promising. Data has shown how effective metabolic surgery in treating metabolic syndrome. However, surgery itself is not a procedure without risk. Multi-disciplinary team management approach, involving surgeons, endocrinologists, primary care physicians, anaesthetists, dietitians, physiotherapists, clinical psychologists, respiratory physicians, otopharyngolaryngologists, pharmacists and nurses, has been suggested to be the service model to provide the effective treatment safely.
Objectives :
To report the 1-year metabolic syndrome component treatment outcome of patients who had metabolic surgery performed and managed by a multi-disciplinary team in Yan Chai Hospital and the 30-day post-op complication rates of the surgery using Clavien-Dindo Classification.
Methodology :
Patients who were under the care of Yan Chai Hospital multi-disciplinary weight management team and had underwent Metabolic Surgery from January 2016 to November 2017 and completed one year of follow-up were included. Data were retrieved from a prospectively collected cohort. Body weight, BMI, number of diabetic and hypertensive drugs taken, glycated hemoglobin (HbA1c), fasting serum lipid profile: triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) was analyzed with reference to preoperative baseline. Data were expressed as mean ± SEM. Paired sample T tests were used for statistical analysis by SPSS 24.0. A 2-tailed significance level was defined as p ≤ 0.05.
Result & Outcome :
Forty-one patients were operated during the study period. All of them completed one year follow up. Twenty-two were female (53.7%) and nineteen were male (46.3%). Age at operation was 46.0 ( 1.3) years old. Preoperative body weight and BMI was 107.02.4 kg and 39.40.6 kg/m2 respectively. Twenty-three patients (56.1%) were on medical treatment (oral agent and/or insulin) for DM. Twenty-nine (70.7%) were on anti-hypertensives. Preoperative Lipid profiles were as follows: LDL-C 2.980.14 mmol/L, TG 1.800.12 mmol/L, HDL-C 1.110.03 mmol/L. Thirty-nine (95.1%) patients underwent laparoscopic sleeve gastrectomy and two (4.9%) had RY Gastric Bypass. At one year follow up, mean body weight reduction was 28.01.5 kg (p< 0.001), corresponded to 75.6 4.3% excess weight loss. Mean BMI reduction was 10.30.5 kg/m2 (p< 0.001). There was 0.480.13 mmol/L (p< 0.001) drop in LDL-C level; 0.760.12 mmol/L (p< 0.001) drop in TG level. HDL-C increased by 0.480.04 mmol/L (p< 0.001). Among patients on medical treatment for DM, HbA1c was improved by 1.730.25 % (p< 0.001). Eight patients (19.5%) were taking one drug and one patient (2.4%) two drugs post-operatively compared from eight patients (19.5%) in both groups before operation respectively. These nine patients only required oral agents but not insulin. For hypertension control, seventeen (58.6%) patients were able to stop medication. No major complication (i.e. Clavien-Dindo Class III, IV or V) was recorded. 7(17%) minor complications including six Clavien-Dindo class I and one Clavien Dindo class II were recorded.
Co-location with:
