Effects of bariatric surgery on cardiopulmonary functional capacity in morbidly obese patients

Uvod: Gojaznost je vodeći javno zdravstveni problem u 21. veku. Ona predstavlja hroničnu bolest, uzrokovanu prekomernim nakupljanjem masti u telu i povećanjem telesne mase, koja dovodi do zdravstvenih poremećaja , lošeg kvaliteta života i morbiditeta. Takođe, gojaznost i prekomerna telesna masa povezani su sa poremećajima kardiopulmonalne funkcije i sa povećan im ukupnim mortalitetom, pre svega od kardiovaskularnih bolesti. Barijatrijska hirurgija, posebno Roux-en-Y želudačni bajpas (RYGB), postala je jedna od najefikasnijih hirurških metoda koja dovodi do značajnog i dugoročnog gubitka telesne mase kod ekstremne gojaznosti, sa veoma niskom stopom smrtnosti. Cilj: Ispitivanje efekata barijatrijske hirurgije na kardiopulmonalni funkcionalni kapacitet kod morbidno gojaznih pacijenata posle šest meseci od zahvata, kao i efekat takve intervencije na poznate faktore rizika za kardiovaskularne bolesti. Takođe, praćena je stopa preživljavanja bolesnika kao i stepen održavanja stabilnog gubitka telesne mase posle pet godina od hirurške intervencije uz analizu uticaja na poznate kardiovaskularne faktore rizika. Metodologija: Rađena je retrospektivna studija preseka koja je obuhvatila 66 morbidno gojaznih pacijenata (BMI ≥ 40kg/m2 ili BMI ≥ 35kg/m2 sa prisutnim komorbiditetima), starosti od 20 do 61 godinе, uglavnom ženskog pola (77.3%) koji su podvrgnuti barijatrijskoj operaciji u periodu od 1.06.2011-31.12.2012. godine. Oni su u sklopu pripreme za operaciju pregledani od strane endokrinologa, dijetologa, pulmologa, kardiologa, psihijatra, anesteziologa i hirurga. Za pravljenje baze korišćeni su podaci iz istorije bolesti. Kardiopulmonalni test fizičkim opterećenjem (CPET) rađen je na pokretnoj traci prema Bruce protokolu uz istovremenu analizu gasova u izdahnutom vazduhu preko maske na licu i sistema za ergospirometriju. Kardiopulmonalni funkcionalni kapacitet procenjivan je pre i šest meseci posle RYGB u Laboratoriji za CPET. Kompletna statistička analiza podataka izvršena je pomoću statističkog softverskog paketa PASV Statistics 18® [SPSS (Hong Kong) Ltd., Hong Kong]...Obesity is a leading public health problem in the 21st century. It is a chronic disease caused by excessive body fat accumulation and weight gain leading to health disorders, poor quality of life and morbidity. Also, obesity and being overweight are associated with cardiopulmonary function disorders and with increased total mortality, especially due to cardiovascular disease. Bariatric surgery, especially Rouxen- Y gastric bypass (RYGB), has become the most effective surgical method for significant and sustained weight loss in extreme obesity, with very low mortality rate. Objectives: The aim of this study was to examine the effects of surgically induced weight loss on cardiopulmonary function six months after the procedure, as well as the effect of such an intervention on well known risk-factors for cardiovascular diseases. Also, how surgically induced weight loss is maintained after five years of follow up has been examined and how it effects on cardiovascular risk factors. Method: This is cross-sectional study with 66 morbidly obese patients (BMI ≥ 40kg/m2 or BMI ≥ 35kg/m2 with present co-morbidities), age 20 to 61 years, mostly women (77.3%) who underwent bariatric surgery in the period 1.06.2011-31.12.2012. During the preparations for the operation, they were examined by endocrinologists, dieticians, pulmologists, cardiologists, psychiatrists, anesthesiologists and surgeons. Data from the history of the disease were used to create the database. The cardiopulmonary exercise test was done on treadmill using Bruce protocol, while simultaneously analyzing gases in the exhaled air through the facial mask and the ergospirometry system. Cardiopulmonary functional evaluation was performed prior and 6 months after RYGB. Also a follow up of those patients comparing their body mass and co-morbidities prior to and five years after Roux-en-Y bypass, as well as the global outcome has been done. All patients were examined at the Clinical Center of Serbia, in the Laboratory for CPET. Complete statistical analysis of data was done using the statistical software package, PASW Statistics 18® [SPSS (Hong Kong) Ltd., Hong Kong]..