Aim: In this study, we aimed to explore the association between dysthyroidism and psychiatric disorders and to verify whether there are sociodemographic or family variables that can determine the likelihood of this comorbidity.

Material and Methods: A descriptive, analytical, cross-sectional and retrospective study, involved patients aged between 18 and 65 years, followed for thyroid pathologies comorbid with psychiatric disorders.

Results: The participants were women with the median age of 52 years, 69.4% of patients presented a mood disorder, 30.6% had another psychiatric disorder, 6.1% presented a clinical goiter with a normal biological assessment, 8.2% presented hyperthyroidism and 85.7% presented hypothyroidism. Age, family situation, obstetrical, family and surgical ATCD, therapeutic compliance of psychiatric and thyroid disease and pharmacological treatment of psychiatric disorders are variables that present a statistically significant difference with a P <0.05 between the two groups.

Discussion: Dysthyroidism and especially hypothyroidism is associated more with mood disorders than other psychiatric disorders in hospitalized patients.

Keywords: Mood Disorder, Dysthyroidism, Woman, Morocco

Introduction

The occurrence of mental disorders during endocrine pathologies has been established for more than a century. Conversely, psychological trauma may play a role in triggering certain endocrinopathies.
The association between thyroid function and psychiatric disorders, especially mood disorders, was recognized more than 200 years ago [1, 2]. Patients with mood disorders, including bipolar disorders and depressive disorders have a high prevalence of somatic comorbidity compared to the general population [3, 4]. Hypothyroidism is relatively common in these patients [4], this comorbidity would be correlated with a high risk of relapses and resistance to treatment, and suicide attempts [5, 6]. It is well established that the use of psychiatric drugs (eg lithium) increases the risk of thyroid dysfunction [3, 4, 7]
The role of thyroid dysfunction in depression is recognized [8]. Depressive symptoms often occur in patients with thyroid disorders and, conversely, patients with depression may have various thyroid abnormalities, including high or low levels of thyroid hormones [1].
Recent studies have confirmed a strong association between thyroid dysfunction in patients with mood disorders [9]. For example, Ojha et al reported that 21.4% of depressed patients had abnormal thyroid function, 11.4% met criteria for subclinical hypothyroidism, 5.7% for subclinical hyperthyroidism, and 4.3% for overt hypothyroidism [10]. Regarding the relationship between thyroid dysfunction and bipolar disorder, a recent study by Ying Zhao et al shows that early onset of bipolar disorder is correlated with higher rates of hypothyroidism [11].
In addition, thyroid dysfunction could have a significant influence on the cognition and emotion of those affected [1]. However, although previous studies have revealed associations between mood disorders and thyroid dysfunction, the roles of thyroid hormones, including free triiodothyronine (FT3), free thyroxine (FT4), (TSH), anti-thyroglobulin (TgAb) and anti-thyroid peroxidase antibodies (TPOAb) in the pathological mechanisms of mood disorders were not yet clear [1, 12].
The main objective of this study was to explore the association between dysthyroidism and psychiatric disorders, to confirm this association especially in patients with mood disorders and to verify whether there is a sociodemographic or family profile that may determine the likelihood of this comorbidity.

Material and Methods

A descriptive, cross-sectional, retrospective study made at the Ar-Razi Sale Psychiatric University Hospital in Morocco, from January 2014 to January 2020.

Data Collection

This study focused on patients whose age varied between 18 and 65 years. The female sex was chosen in our study due to a high frequency of this comorbidity in women compared to men during our research at the level of the Ar-Razi Psychiatric University hospital for patients followed for thyroid pathologies comorbid with psychiatric disorders whose diagnosis was based on the DSM 5 diagnostic criteria. The records of male patients, female patients under the age of 18 and records with missing data were excluded. The clinical data was collected using a pre-established exploitation sheet with socio-demographic data (age, origin, profession, socio-economic level, marital status), clinical data (personal and family history, circumstances of consultation, revealing psychiatric manifestations). The collection of clinical data was carried out with respect for the anonymity and confidentiality of patients with medical records from the archives of the Ar-Razi Psychiatric University Hospital.

Statistical analysis

Statistical analysis was carried out using JAMOVI software for Windows 2016. Qualitative variables were presented as frequencies and percentages, quantitative variables were presented in mean standard deviation (SD) or median (interquartile range, IQR). The Chi-square (x2) test or Fisher’s exact test were carried out according to their particular application conditions to identify the differences in the proportions of the categorical variables between the two groups (Group 1: dysthyroidism comorbid with a disorders, Group 2: dysthyroidism comorbid with another psychiatric disorder other than a mood disorder). In addition, multivariate logistic regression analyzes are used to identify risk factors. Independent variables presenting a statistically significant value with P < 0.05 between the two groups were taken into account in multivariate logistic regression.

Results

A total of 49 participants who met the study criteria were included in the study. The average age was 52 [41.59] years, more than half (53.1%) had a secondary education level, 55.1% were married, 95.9 % lived with a family, 55.1% did not have a profession. the majority were without antecedents 73.5%, and 28.6% without a child. More than half (69.4%) have a mood disorder, 30.6% had another psychiatric disorder (not a mood disorder). The majority (85.7%) had hypothyroidism, 6.1% had a clinical goiter with a normal biological assessment, 8.2% present hyperthyroidism.

Psychiatric disorder and dysthyroidism

By comparing the two groups and using the Chi-square (x2) test or Fisher’s exact test, we found that there is a statistically significant difference with a P <0.05 for age, family situation, obstetrical history, family and surgical, therapeutic compliance of psychiatric and thyroid disease and pharmacological treatment of psychiatric disorders see (Table 1).

Multinomial logistic regression

Using multivariate logistic regression and adjusting for confounding factors, concluding that being old, single, with surgical ATCDs and poor treatment compliance are risk factors for developing a mood disorder or even (Table 2).

Discussion

According to the results of our study, the participants were women with a median age of 52 [41.59] years, more than half (53.1%) had a secondary education level, the majority had no background 73.5%, 69.4% of patients presented a mood disorder, 30.6% had other psychiatric disorder (without mood disorder), 6.1% presented a clinical goiter with a normal biological assessment, 8.2% presented a hyperthyroidism and 85.7% presented a hypothyroidism.
Age, family situation, obstetrical, family and surgical history, therapeutic compliance with psychiatric and thyroid disease and pharmacological treatment of psychiatric disorders are variables that present a statistically significant difference with a P <0.05 between the two groups.
Risk factors for developing a mood disorder were older age, being single, a history of surgery and poor adherence to treatment for psychiatric disorders and dysthyroidism.
The female sex was chosen in our study due to a high frequency of this comorbidity in women compared to men. Several studies confirm our observation and found that women were associated with an increased risk of hypothyroidism comorbid with mood disorder [11].The same results were obtained in a retrospective cohort study, which included 13,017 subjects, and which revealed that the rate of depression was twice as high in women with TSH levels above 2.3 μIU/Ml [13].
In the present study the median age was 52 [41.59] years, and our results consistent with a recent study which showing that the prevalence of hypothyroidism in the subgroup with an age below 50 years was 8.53%, which was lower than that of patients over 50 years old, which was (10.8%) [11]. It is also it is consistent with another previous study that age was a risk factor for hypothyroidism [14].
Our results show that the association between dysthyroidism and psychiatric disorders is frequent, especially with mood disorders in 69.4% of patients, these results are consistent with the results of a recent study that shows an association between early onset of a psychiatric disorder and hypothyroidism, which may be present specifically in mood disorders, rather than non-specifically in other serious mental illnesses, as this association has not been observed in schizophrenia [11].
According to our results and the results of previous studies, there is a relationship between thyroid dysfunction and mood disorders. Thyroid hormones have multiple effects on body homeostasis and metabolism [15]. It is therefore not surprising that there are documented relationships between thyroid status and mood disorders. Specifically, thyroid disorders may increase the risk of mood disorders and the rate of depression is high in people with hypothyroidism [16].
Thyroid hormones exert a profound influence on behavior and appear capable of modulating the phenotypic expression of major mood disorders. Indeed, a recent study found that there is evidence that triiodothyronine (LT3) can accelerate antidepressant response to antidepressants, and that LT3 can also increase the response to antidepressants in depression resistant to medical treatment [17], always in the same study, adjunctive treatment with supraphysiological doses of levothyroxine (LT4) has shown its effectiveness in several studies, including rapid cycling and prophylaxis-resistant bipolar disorder, and in refractory acute unipolar or bipolar depression [17]. Another explanation for this comorbidity is related to immune system abnormalities that are seen in both thyroid and depressive disorders, but although the most common cause of thyroid disorders is autoimmune disease, dysregulated immune function, and not autoimmunity, is more clearly documented in depression [18, 19].
In addition to a high frequency of this comorbidity, resistance to antidepressant treatment is also documented. Bruce M. Cohen reported that depression in patients with high TSH levels is less severe but more resistant to treatment and he observed a weaker antidepressant response, especially to selective serotonin reuptake inhibitors, in patients with major depression and higher TSH levels, with no correlation of response to serum T 3 or T 4 levels [20].
The complex relationship between selective serotonin reuptake inhibitors and thyroid function remains clarified, on the one hand, hypothyroidism alters responses to SSRIs [20], and on the other hand, SSRIs cause a decrease in T4 levels, of free T4 and triiodothyronine (T3) without an appropriate compensatory response in TSH [21], one of the hypotheses to answer this question is that major depression is associated with a subtle chronobiological dysregulation of the hypothalamic-pituitary-thyroid axis ( HPT) [22].
There are several limitations to this study. First, no causal relationship could be established due to the cross-sectional design of this study. Future studies should use a longitudinal study design to better explore the causal relationship of these variables in patients with this comorbidity.
Second, the minimal number of patients was 49. Future research should include a wider range of patients with this comorbidity and both females and males.
Third, some confounding factors that may play an important role in mood disorders, and future research should incorporate more confounding factors to better elucidate the pathological mechanisms underlying the association between thyroid dysfunction and psychiatric disorders. Finally, we did not have a healthy control group in this study. Therefore, our results in this study should be considered preliminary, which merits replication in future studies before we can draw any conclusions.

Conclusion

Dysthyroidism and especially hypothyroidism are associated more with mood disorders than with other psychiatric disorders, and clinicians must look for this association, so as not to miss hypothyroidism which, without treatment, will aggravate the clinical picture of a disorder from mood to resistance to pharmacological treatment and increased prevalence of suicide.
Longitudinal cohort studies are needed to explore the clinical significance and potential mechanism of this association.

Scientific Responsibility Statement

The authors declare that they are responsible for the article’s scientific content including study design, data collection, analysis and interpretation, writing, some of the main line, or all of the preparation and scientific review of the contents and approval of the final version of the article.

Animal and human rights statement

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. No animal or human studies were carried out by the authors for this article.

Funding: None

Conflict of interest

None of the authors received any type of financial support that could be considered potential conflict of interest regarding the manuscript or its submission.

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Soukaina Stati, Mohamed Amine Baba, Ahmed Kharbach, Aya Kaoutar Rhaouti, Aouatef Khallouk, Majdouline Obtel, Fouad Laboudi, Abderrazzak Ouanass. Dysthyroidism in patients with psychiatric disorders in Morocco. Ann Clin Anal Med 2024;15(3):141-144

Citations in Google Scholar: Google Scholar

Aim: The purpose of this study was to examine the 30-day morbidity and mortality rates after Laparoscopic Sleeve Gastrectomy (LSG) over a 5-year period.

Material and Methods: A retrospective analysis was conducted using prospectively collected data from patients who underwent LSG by the same surgeon between July 2017 and August 2022. The study identified LSG-related 30-day morbidity and mortality rates, as well as risk factors for 30-day morbidity. Furthermore, the impact of comorbidities on patients was evaluated at the 1-year follow-up.

Results: The study analysed the outcomes of 342 patients who underwent laparoscopic sleeve gastrectomy (LSG) over a period of five years. Early postoperative complications were experienced by 11.40% of patients (39 individuals), with six patients requiring blood transfusions, and 2.34% of patients (eight individuals) requiring readmission to hospital. The reoperation rate was 0.87% (three individuals) and the mortality rate was 0.29% (one individual). The study identified body mass index, diabetes, and hypertension as significant factors contributing to early postoperative complications. Technical term abbreviations were defined upon first use. At the six-month follow-up, patients demonstrated an average body weight loss of 62.9 ± 16.17%.

Discussion: The previously reported short-term safety of LSG, in terms of low 30-day postoperative morbidity and mortality rates, was confirmed by this study. Preoperative BMI, diabetes, and hypertension were found to be risk factors for 30-day morbidity and mortality. Additionally, an average 80% improvement in comorbidities was observed at one year.

Keywords: Sleeve Gastrectomy, Early Complications, Single Surgery, Comorbidity

Introduction

Obesity has been recognized as a widespread problem that is considered a public health crisis, due to the significant negative impact it has on one’s health [1]. Obesity surgery has proven to be a successful solution for patients who have not been able to achieve weight loss through non-surgical methods, and has shown to improve comorbidities related to obesity [2, 3]. This surgical intervention can be considered an important tool in the fight against obesity, and may be a vital treatment option for patients.
Laparoscopic sleeve gastrectomy (LSG) is a bariatric procedure that is rapidly increasing in popularity owing to its simple technical structure, safety and efficacy [4]. Based on a report by IFSO (International Society for the Surgery of Obesity) in 2018, this surgical procedure has been the most widely performed bariatric surgery since 2014 [5]. This can be considered a significant development in the treatment of obesity, and has become the preferred option for many patients for weight loss and health improvement.
Like any surgical intervention, LSG can be complicated by adverse events and involves risks that can result in death. The 30-day morbidity and mortality rates are important measures of the safety of surgical procedures and have been used for many years [6,7].
The aim of this study was to identify 30-day morbidity and mortality risk factors for LSG and to contribute to the development of strategies for perioperative management of patients undergoing this procedure. Focusing especially on at-risk groups may contribute to a safer implementation of LSG and help reduce adverse outcomes. This allows for the development of more effective and safe practices in the field of bariatric surgery.

Material and Methods

This study is based on data collected retrospectively from a consecutive group of patients who underwent LSG performed by a single surgeon over a 5-year duration. This study was approved by the Ethics Committee of Medeniyet University (Date: 22.07.2022 – No: 259).
The inclusion criteria were as follows: Patients aged 18-65 years, BMI = 35 – 39.90 kg/m2 with at least one obesity-related chronic comorbidity, and BMI > 40 kg/m2.
Exclusion criteria: Patients admitted for revisional bariatric surgery and those who opted for other bariatric surgical procedures, concurrent cholecystectomy, or herniation surgery were excluded. Furthermore, patients without follow-up data in the hospital registry system were excluded from the study.
Patients underwent a routine preoperative workup, including personal history taking, multidisciplinary clinical evaluation, laboratory investigations, and upper gastrointestinal endoscopy. A total of 72 patients were excluded based on the exclusion criteria.

Surgical Procedure

All patients underwent surgery according to the ERABS protocol [8]. After the usual preoperative preparations, the surgery was carried out under general anaesthesia. Pneumoperitoneum was induced, and a sleeve was inserted through a 38 Fr spark plug with resection taking place about 3-4 cm proximal to the pylorus. Subsequently, customary postoperative care was administered, and patients were advised to mobilise early and given a postoperative dietary regime, supplement plan, and schedule of follow-up visits. Patients were also informed to seek medical attention in the event of any adverse reaction.
Demographic characteristics, operative details, and perioperative events were recorded and analyzed.
Thirty-day postoperative data was available for all patients while excluding one case of death, resulting in 341/342 patients (99.7%) having available 6-month follow-up data. Moreover, data for 338 patients (98.8%) were accessible at the 1-year follow-up..

Statistical Analysis

Patient data were analyzed using the Statistical Package for Social Sciences (SPSS) software (IBM Corp., Armonk, NY, USA), version 28. Numerical data were presented using mean, standard deviation, and range, while frequencies and percentages were used for categorical values. To identify early postoperative morbidity risk factors, a binary logistic regression analysis was conducted, with statistical significance set at 0.05.

Results

This investigation comprised 342 individuals who received LSG carried out by a single surgeon from July 2017 to August 2022. The average age of the patients was 37.89 ± 11.36 years, with a higher prevalence among women (82.74%, n = 283). The preoperative weight ranged from 96 to 192 kg, with a mean of 126.93 ± 23.32, and preoperative BMI ranged from 37.7 to 69.2 kg/m2. On average, the body mass index (BMI) of patients was 45.3 ± 8.06 kg/m2 and the excess body weight (EBW) before surgery ranged from 38.3 to 122.1 kg with a mean of 62.1 ± 4.64 kg. The patients had accompanying diseases, such as dyslipidemia, hypertension, type 2 diabetes, and obstructive sleep apnea (Table 1).
The preoperative prophylaxis against deep vein thrombosis (DVT) was given subcutaneously as Enoxaparin (0.4 mL). Two weeks of anticoagulant therapy for DVT prophylaxis was continued. Table 2 shows the distribution of complications.
The total surgical duration ranged from 34 to 96 minutes, with an average of 52.18 ± 25.22. Early postoperative side effects were observed in 39 (11.42 %) patients. Complications occurred in 25 patients before discharge and in 14 within the first 30 days after discharge. The total hospital stay varied from 2 to 16 days.
Ten patients had intra-abdominal hemorrhage in the postoperative period, which developed within the first 24 h. Four patients were treated conservatively, while six patients with hemodynamic instability were treated with erythrocyte suspension.
Hematoma was present at the trocar site in three patients, two at the 10 mm port site, and one at the 15 mm port site, and the patients were treated with local drainage by suturing.
Postoperative leakage developed in three patients, with one occuring within the first 24 hours and the other two within 48 hours. These three patients typically developed leakage at the His angle and were treated primarily through open laparotomy. Two patients experienced an intraoperative leakage. In both patients, the nasogastric catheter was found in the stapler line, and intraoperative primary repair was performed. Intraoperative hemorrhage was observed in four patients, which was due to gastrolienal ligament dissection in two patients, splenic capsule rupture in one patient, and retractor entry due to left liver injury. Three patients had intra-abdominal abscesses complicated with hematoma formation and were treated with percutaneous abscess drainage under the umbrella of antibiotic therapy. Three patients had hematoma at the trocar site, one patient developed hematoma after coughing at the 10 mm port site, and the other two hematomas developed after intraoperative inadequate drainage at the 15 mm port site. All three patients were treated with local hematoma drainage by suturing.
A 36-year-old woman with a BMI of 53.1 kg/m2, type 2 diabetes (T2D), hypertension and dyslipidemia developed portal vein thrombosis on day 20. She underwent thrombolysis under radiological monitoring, followed by continuous thromboprophylaxis. A 52-year-old male patient with a BMI of 62.5 kg/m2, T2D, and hypertension developed bleeding in the first 24 hours postoperatively and was administered a total of 3 units of erythrocyte suspension. However, pulmonary embolism developed on the 14th postoperative day despite thromboprophylaxis in the patient who had inadequate mobilization afterwards, and the patient was transferred to the intensive care unit.
During one year of regular ultrasonography follow-up, herniation developed at the trocar entry site in 3 cases. Two of the herniations were at the 15 mm port site, and one was at the 10 mm port site. Richter’s hernia developed at the 10 mm port site on the left upper part of the umbilicus on the 8th day and small bowel resection and anastomosis was performed at 120 cm because the jejunum anus was necrotic. Another patient had volvulus in the incisura angularis due to persistent vomiting on postoperative day 20, which was resolved with gastric bypass.
Factors contributing to early postoperative adverse events are shown in Table 3.
Binary logistic regression analysis showed that BMI (OR = 1.078, CI 0.962 – 1.2, p = 0.048), T2D (OR = 0.88, CI 0.762 – 0.952, p = 0.037), hypertension (OR = 0.091, CI 0.021 – 0.469, p = 0.003), and reoperation (OR = 0.55, CI 0.137 – 0.982, p = 0.058) were significant predictors of early postoperative morbidity.
At 6 months follow-up, the mean BMI was 35.82 ± 5.69 kg/m2. The mean EBWL% was 62.9 ± 16.17%. The mean BMI was 28.92 ± 5.32 kg/m2, and the mean EBWL% was 81.57 ± 16.15% at 1 year post-op. Considering associated comorbidities, 96.05% of patients with dyslipidemia (n=84), 72.31% of patients with hypertension (n=89), 89.12% of patients with diabetes (n=82), and 100% of patients with obstructive sleep apnea (n=19) had complete recovery.

Discussion

This retrospective cohort study was conducted to evaluate the safety and efficacy of bariatric surgery, particularly LSG. These findings suggest that bariatric surgery is an important treatment option for obese patients. In this retrospective cohort study of 342 patients who underwent LSG by a single surgeon in our center, the early postoperative morbidity, reoperation, local intervention, rehospitalization, and mortality rates were 11.40%, 0.87%, 0.87%, 0.87%, 2.34%, and 0.29%, respectively.
Despite the reported safety of bariatric surgery, varying rates of perioperative complications have also been reported. Patients undergoing bariatric surgery are at high risk of developing early postoperative complications. Therefore, it is important to identify the risk factors for early postoperative complications to optimize pre- and post-operative care. In the literature, 30-day complication rates after bariatric surgery range from 0.2% to 5%, and reoperation rates range from 0.6% to 1.1% [9, 10]. Mortality rates were found to be between 0 and 0.3% [11]. Although our total complication rate in the first 30 days seems to be high, this may be because we included data such as local drainage, intraoperative hemorrhage, and dehydration, which do not prolong the patient’s hospitalization period. Furthermore, mortality and reoperation are consistent with the literature. These data were collected in order to expand the scope of our study and provide a more thorough evaluation. Additionally, including this data allows for a more comprehensive assessment of the success of surgical interventions, rather than solely focusing on severe complications. Timely diagnosis and management of adverse events that may occur during the 30-day postoperative follow-up directly affect the success of surgery. The mortality rate was 0.13% in a database of 3.6 million cases [12]. In the present study, the single-case mortality rate was 0.29%. This finding is consistent with the general literature. These results emphasize the relative safety of bariatric surgery and reflect the advances in minimizing the risks associated with this procedure.
In our study, the patient’s BMI, presence of hypertension, and diabetes were found to be predictors of early perioperative morbidity. A greater risk of disease has been documented in patients with a BMI of 40.0 or higher, particularly when they have both hypertension and diabetes. The risk of disease in this group is 15% [12, 13]. These results suggest that a patient’s preoperative status and metabolic syndrome have a significant impact on the risk of complications after bariatric surgery. Furthermore, it has been observed that patients with a higher BMI have an increased rate of leakage, and hypertension is associated with an increased risk of early bleeding [13].
In addition to these risk factors, the learning curve for specialized surgery also affects early complications. In a survey conducted in Italy, 54.3% of bariatric surgeons stated that they had never received bariatric surgery training during their specialty training [14]. When we assigned our study patients to three consecutive equal groups, 19 (48.7%) complications were observed in the first 100 cases, and serious complications, such as fistula and bleeding, were observed in this period. On the other hand, forgetting to withdraw the orogastric catheter, which seems to be a preventable complication, was also observed in the first 100 cases. It is possible that many surgeons have learned the principles of surgery through courses and short training sessions. This finding suggests that complications may occur more frequently during learning.
The rates of comorbidities in the first 6 months and the first year after LSG in our patients were comparable to those previously reported [15,16]. The rates of improvement in dyslipidemia, hypertension, and T2DM at 6 months and 1 year were > 80%. In a previous study, dyslipidemia and hypertriglyceridemia improved by 45% and 86%, respectively [17].
Unlike the literature, we found that all of our patients with apnea syndrome (all 19 cases) had resolution of their complaints and were device-free [18, 19]. We believe that this high rate is due to the low number of patients with apnea syndrome in our cohort and the fact that we evaluated the patients’ drug and device use rather than postoperative measured data.
The postoperative bleeding rate after LSG has been reported to vary between 2-4% [20, 21]. The rate in our study was 2.9%. Although these rates are similar to those reported in the literature, it is worth noting that we still found them high. We did not apply any reinforcement to the stapler line in ⅔ of the cases. Later, with increasing experience, we observationally decreased the bleeding rates by selecting patients with bleeding risk, using postoperative tranexamic acid, and, in some cases, using reinforcing sutures on the stapler line. However, we did not transfuse blood products in patients who developed bleeding unless vital signs significantly deteriorated. Adequate fluid resuscitation and blood product supplementation when necessary for the diagnosis of bleeding can solve these problems. Reoperation should be avoided, whenever possible because possible complications of the new operation may cause more difficult and longer treatment processes [22].
Leakage is an important and frightening complication. Most leaks occur in the first week and reported rates are between 0.5-5% [23, 24].
Our results were consistent with those reported in the literature. Based on our experience, the leak rate decreases with increasing experience and follow-up. All our leakage cases were within the first 20 consecutive cases. Although endoscopic stenting for leaks is prioritized in the literature, we performed early laparotomy and primary repair because of individual concerns. In the following cases, applying clips to the stapler joints, paying particular attention to the His angle, and applying clips to the last point in the fundus region were found to be very effective in preventing leaks.
During one year of regular ultrasonography follow-up, three patients developed herniation at the trocar entry site. Two of these herniations occurred at the 15 mm port entry, and the other at the 10 mm port entry. Trocar site herniation occurs in 0.1-2% [24]. Richter’s hernia developed on the 8th day especially at the 10 mm port entry in the upper left region of the umbilicus and small bowel resection and anastomosis were required because the jejunum anus was necrotic. Another patient was diagnosed with volvulus in the incisura angularis on postoperative day 20 because of persistent vomiting and underwent gastric bypass surgery. During the surgical operation, regardless of surgical experience, in two patients, the orogastric catheter was forgotten before stapling, and the catheter remained in the stapler line. Fortunately, this error was quickly recognized, and a primary repair was performed. This highlights the importance of synchronization within the surgical team. It should also be kept in mind that due to staff turnover, every step should be checked, and the staff should be careful, even though it may seem like a continuous routine.
The most common reason for readmission in our patient group was dehydration [25]. This occurs because of patients’ fear after LSG and difficulty in adapting to their new lifestyle. In this case, patients should be hospitalized before their vital signs worsen, appropriate nutrition should be provided, and vitamin and electrolyte disorders should be corrected.
Based on the results of our study, we confirmed that LSG is an effective method for weight loss and the improvement of obesity-related comorbidities. The first 30-day complication rates are consistent with those in the current literature, and the success rate has increased in proportion to timely complication management and increasing experience.
Limitations: The study was limited to a single center with a single surgeon and a relatively small number of cases. The advantages are that it included all cases in the learning curve and experience gaining phase and that the records and treatments were recorded in detail from a single source.
In conclusion, this study shows that bariatric surgery is a safe and effective treatment option for obese patients. Preoperative review can be an important tool for surgeons to identify risk factors. Although undesirable, encountering and managing a range of complications within limits have contributed to lower complication rates by making subsequent surgeries more careful and safer. However, while more research is needed, keeping records without omitting minor details will help us better understand the long-term effectiveness of bariatric surgery and the risk of complications.
In summary, this study affirms that the Laparoscopic Sleeve Gastrectomy (LSG) procedure is linked with minimal complications during the 30-day postoperative period. These findings highlight the potential for LSG as a dependable and advantageous alternative for addressing obesity in clinical settings. Specifically, the low incidence of complications may assist patients in recovering postoperatively and provide health practitioners with a secure surgical choice. Additionally, the results indicate that patients with other obesity-related health issues, such as type 2 diabetes or hypertension, have a reduced risk of postoperative complications. This information could serve as a significant source of guidance for patients contemplating this procedure. The findings of this research can enhance the approach to managing obesity and its related comorbidities, thus enabling healthcare professionals to make more informed choices.

Scientific Responsibility Statement

The authors declare that they are responsible for the article’s scientific content including study design, data collection, analysis and interpretation, writing, some of the main line, or all of the preparation and scientific review of the contents and approval of the final version of the article.

Animal and Human Rights Statement

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or compareable ethical standards.

Funding: None

Conflict of Interest

The authors declare that there is no conflict of interest.

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Medeni Sermet. Effects of laparoscopic sleeve gastrectomy on early complications and 1-year comorbidity in a single center, single surgeon cohort of 342 patients. Ann Clin Anal Med 2024;15(3):160-164

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