Impact of glucagon-Like peptide-1 agonists in optimizing abdominal wall Reconstruction patients.

Autor: Tran D; Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA., Farias DA; Health Science Center, University of North Texas, Fort Worth, TX, USA., Tanner M; Division of Minimally Invasive Surgery, Baylor Scott & White University Medical Center, Roberts Hospital, 1st Floor, 3500 Gaston Avenue, Dallas, TX, 75246, USA., Marroquin M; Baylor Scott & White Research Institute, Dallas, TX, USA., Jefferies RS; Health Science Center, University of North Texas, Fort Worth, TX, USA., Ogola GO; Baylor Scott & White Research Institute, Dallas, TX, USA., Quevedo S; Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA., Hlavinka WJ; Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA., Leeds SG; Center for Advanced Surgery, Baylor Scott & White University Medical Center, Dallas, TX, USA.; Division of Minimally Invasive Surgery, Baylor Scott & White University Medical Center, Roberts Hospital, 1st Floor, 3500 Gaston Avenue, Dallas, TX, 75246, USA.; Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA., Ward MA; Center for Advanced Surgery, Baylor Scott & White University Medical Center, Dallas, TX, USA.; Division of Minimally Invasive Surgery, Baylor Scott & White University Medical Center, Roberts Hospital, 1st Floor, 3500 Gaston Avenue, Dallas, TX, 75246, USA.; Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA., Aladegbami BG; Center for Advanced Surgery, Baylor Scott & White University Medical Center, Dallas, TX, USA. bola.aladegbami@bswhealth.org.; Division of Minimally Invasive Surgery, Baylor Scott & White University Medical Center, Roberts Hospital, 1st Floor, 3500 Gaston Avenue, Dallas, TX, 75246, USA. bola.aladegbami@bswhealth.org.; Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. bola.aladegbami@bswhealth.org.
Jazyk: angličtina
Zdroj: Hernia : the journal of hernias and abdominal wall surgery [Hernia] 2024 Nov 16; Vol. 29 (1), pp. 19. Date of Electronic Publication: 2024 Nov 16.
DOI: 10.1007/s10029-024-03214-6
Abstrakt: Purpose: Pre-optimization of obese patients prior to abdominal wall reconstruction (AWR) is essential in mitigating their increased preoperative risks. Traditionally diet, exercising, bariatric surgery are the tools typically prescribed for weight loss. The advent of glucagon-like peptide-1 agonists (GLP-1A) which stimulate insulin secretion and inhibit gastric emptying have improved the weight loss armamentarium. However, there is a limited amount of literature on GLP-1A effectiveness and postoperative outcomes in AWR patients. This study compares the efficacy of GLP-1A to Bariatric Surgery (BAS) in perioperative AWR patient.
Methods: A prospectively maintained database was retrospectively reviewed to identify all patients undergoing AWR at our institution between January 2021 and March 2024. We included patients who required GLP-1A or BAS for weight optimization prior to AWR. We excluded patients on GLP1-A or history BAS not performed for AWR preoptimization. Basic demographics such as age, sex, race, weight and BMI at initial clinic visit and at surgery were compared. Primary endpoints included time to surgery, time to bowel recovery and length of stay (LOS). Time to surgery was defined as the number of months between the initial clinic visit and AWR. Time to bowel recovery was defined as the number of days it took for the first postoperative bowel function. Secondary endpoints included standard 30-days postoperative variables. Nominal variables were analyzed using a Fisher exact test and continuous variables were analyzed with Student's T test.
Results: 35 patients were included in this study (GLP-1A: 17, BAS: 18). The GLP-1A cohort had a lesser BMI at the initial clinic visit (40.8 vs 43.4, p = 0.188). GLP-1A cohort made it to the operating room faster (9.1 months vs 13.5 months, p = 0.06) from the first clinic visit; and (7.9 months vs 9.7 months, p = 0.4) from initiation of weight loss intervention. Albeit losing less weight (14.9 kg vs 27.1 kg, p = 0.008) with a lesser reduction in the BMI (4.69 vs 9.23, p = 0.004). The GLP-1A cohort showed a non-significant elevated LOS (5.2 days vs 3.6 days, p = 0.25) and an increased ileus rate (17.6% vs 0%, p = 0.1). However, there were no differences noted in time to bowel recovery (2.9 days vs 3.1 days, p = 0.76).
Conclusion: GLP-1A is effective in optimizing patients needing weight loss before AWR. They shorten the timeline to AWR intervention and have comparable peri-operative outcomes to BAS patients.
Competing Interests: Declarations Competing interests None.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
Databáze: MEDLINE
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