Background Bariatric procedures are the most effective management for obesity. There is no standard venous thromboembolism (VTE) prophylaxis for both dosing and duration of anticoagulation following laparoscopic sleeve gastrectomy. Our purpose was to assess the optimum regimen for VTE prophylaxis in bariatric procedures and to reduce the incidence of perioperative bleeding. Methods and materials This is a prospective randomized study which involved 100 morbidly obese patients, subdivided into two groups; group A received postoperative low molecular weight heparin (LMWH) prophylaxis alone starting from day 1 to day 15 in dose 1 mg/kg/day in a maximum dose 120 mg/day, and group B received both preand postoperative LMWH; at night of surgery 12 h preoperatively and postoperative starting from day 1 to day 15 with the same dose. All patients underwent mesenteric and bilateral lower limbs duplex 15 days postoperative using Philips iU machine and linear (L9-3), convex (C5-1) and sector (S5-1) probes. Results Regarding postoperative VTE, we found statistically significant increase in postoperative VTE in patients of group A (four cases) without any case complicated with VTE in patients of group B (P value = 0.041). Regarding postoperative bleeding, we found statistically insignificant percent of cases complicated with postoperative bleeding in group B compared to group A (P value 0.315). Conclusion Preoperative as well as a postoperative prophylactic anticoagulant as LMWH is recommended to prevent perioperative VTE. There was an insignificant increase in postoperative bleeding in patients who received preoperative prophylactic anticoagulants.
Background Obesity is a risk factor for chronic kidney disease and albuminuria. Despite the well-documented obesity association with diabetes mellitus and hypertension, its predisposition to albuminuria is not related to these comorbidities, and, in some times, its occurrence is independent of DM or hypertension. Purpose of the study The present study aimed to evaluate bariatric surgery effect on albuminuria in patients with severe obesity with no DM or hypertension. Materials and methods The study consisted of 137 patients with extreme obesity and albuminuria scheduled for bariatric surgery and did not have diabetes or hypertension. They underwent an assessment for 24-h urinary albumin at baseline (T0) and 6 months postoperatively (T2). Results Albuminuria remission occurred in 83% of patients; there was a statistically highly significant difference between the baseline and the 6-month postoperative in the 24-h urinary albumin assessment. Weight loss and BMI at T2 were independent predictors of albuminuria remission. Conclusion The current work emphasizes the importance and promising role of bariatric surgery as an effective weight reduction management method in improving albuminuria, an early sign of chronic kidney disease, and a potential risk factor for cardiovascular disease.
Background Sleeve gastrectomy (SG) continues to be one of the most popular bariatric procedures all over the world. Thyroid-stimulating hormone (TSH) frequently shows a slight elevation in patients with obesity. The effect of SG on thyroid hormones has been rarely investigated. Aim of the Study This study aimed to assess the short-term effect of SG on thyroid functions in Egyptian patients with morbid obesity and the potential predictors of the postoperative thyroid functions. Patients and Methods This study included patients undergoing SG at kasr al ainy hospitals. The patients underwent preoperative 3-, 6-, and 12-month postoperative analyses of the thyroid functions and other biochemical markers. Results The study included 106 patients who showed significant improvement in thyroid functions at the follow-up assessment. Twelve-month TSH positively correlated with the 12-month measures of LDL and HbA1c. TSH change at 12-month follow-up (TSH) was inversely correlated to 12-month BMI and positively correlated to preoperative TSH and 12-month percentage of total weight loss (TWL%). Univariable linear regression analysis demonstrated that preoperative TSH (p < 0.001), 12-month TWL% (p = 0.042), 12-month HbA1c (p = 0.001), and 12-month LDL (p = 0.049) were significant predictors for the 12-month TSH levels. Multivariable analysis showed that only preoperative TSH levels (p < 0.001) and 12-month HbA1c levels (p = 0.021) could affect the 12-month TSH levels. Conclusion The current study supports the evidence of thyroid function improvement after sleeve gastrectomy. This improvement was affected by the amount of weight loss after surgery.
BACKGROUND: Obesity has been reported to be a risk factor for chronic kidney disease and albuminuria. Obesity-related glomerulopathy (ORG) usually has a gradual onset, with microalbuminuria or clinically dominant proteinuria as the primary manifestation, with or without impaired renal function, and a small number of patients manifesting with microscopic hematuria or nephrotic syndrome. AIM: The present study aimed to evaluate the prevalence of ORG in morbidly obese patients and its impact on renal function. PATIENTS AND METHODS: This is a descriptive cross-sectional study that included patients with morbid obesity who visited the bariatric clinic in our institution during the period from October 2019 to February 2021. Patients who had no history of diabetes mellitus (DM) or hypertension underwent blood pressure measurement, assessment for 24-h urinary albumin to detect patients with laboratory-based ORG, kidney function tests, urine analysis and HbA1c, and examination by abdominal sonogram focused on both kidneys. Patients with asymptomatic micro or macroalbuminuria were recruited to the study. RESULTS: The total number of patients screened during the study period was 1,045, out of whom 100 patients were eligible for the study according to the inclusion and exclusion criteria, denoting an albuminuria prevalence of 9.5% and there is no statistically significant relationship between this albuminuria and age, gender, and BMI. CONCLUSION: ORG is a rising problem in the field of morbid obesity management, the current study shows that the prevalence of ORG is 9.5% in our screened cohort.
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