The acute phase reactant CRP is a sensitive marker of inflammation

The acute phase reactant CRP is a sensitive marker
of inflammation, and several studies have demonstrated
that elevated CRP levels are independently
associated with an increased risk for cardiovascular
disease morbidity and mortality as well as acute coronary
events 12–16.
Since obesity represents a serious risk factor in
several metabolic diseases, identifying the status of
carbohydrate antigen-125 (CA-125) would further
link obesity and tumors.
The aim of our study was to detect the effect of
weight loss after the laparoscopic sleeve gastrectomy
(LSG) operation on plasma CRP, lipid profile and
CA-125 in morbidly obese female patients.
Material and methods
This prospective study was conducted in the
Surgery Department, Fayoum University Hospital,
between August 2013 and September 2015. To assess
the effect of this operation on excess weight
loss, CRP, lipid profile and CA-125 were measured
before and 12 months after the LSG operation
for weight loss. The study included 30 cases of
morbidly obese patients: 30 (100%) women aged
23–55 years who were considered clinically obese
with a mean body mass index (BMI) of 42.71 ±4.3
(38–46) kg/m2, mean age 40.3 ±8.5 (23–55) years.
The National Institute of Health (NIH) inclusion criteria
for bariatric surgery were used: patients with
BMI > 40 kg/m2 or over 35 kg/m2 with at least one
comorbidity and this via LSG technique, and all of
them had failed in trials of conservative management
including dietary control and they are bulky
eaters but not sweet eaters, also ASA (American
Society of Anesthesiology patient classification)
I and II. Laboratory investigations took the form of
complete blood count (CBC), fasting blood sugar
(FBS), renal functions, liver functions, coagulation
profile, beside hormonal assay, to detect any endocrinal
causes of obesity such as hypothyroidism.
We took plasma sample from all patients (prior
to surgery and 12 months after surgery), by centrifugation
of blood samples by 3000 rpm for 20 min.
Plasma triglyceride levels, and total LDL and HDL
cholesterol concentrations were measured enzymatically
by colorimetric (enzymatic) end-point analysis.
Plasma CRP levels were measured by means of a colorimetric
competitive ELISA. Regarding CA-125, we
used a two-step immunoassay for the quantitative
determination of CA-125.
Pulmonary evaluation including chest X-ray and
pulmonary function tests were carried out to detect
if there were any tumors such as lung cancer. Cardiac
assessment, ECG and echocardiography were
done if needed. In addition, all patients underwent
abdominopelvic ultrasound and computed tomography
(CT) scan to detect any abdominopelvic diseases
such as endometriosis or tumors such as pancreatic,
liver tumors and to evaluate the presence or absence
of cancer ovary, colon, and mammography for
breast cancer.
Patients were then operated on after undergoing
a 2-week low caloric (800–1000 kcal/day) preoperative
diet. Informed consent was obtained from all
patients. We included patients who were psychologically
stable with no endocrinal causes of obesity and
accepting surgery. We excluded patients who were
pregnant or breast feeding females, psychologically
unstable patients and any patient suffering from
significant longstanding heart/lung disease or other
severe systemic disease.
Surgical procedure
A nasogastric tube was inserted at the beginning
to decompress the stomach. A window was dissected
at the junction of the greater curvature and the greater
omentum, around 10 cm from the pylorus. Division
of the gastroepiploic, short gastric and posterior fundic
vessels was done starting at 4 cm proximal to the
pyloric ring all the way until the angle of His using
the ultracision Harmonic scalpel (Harmonic; Ethicon
Endosurgery, Cincinnati, OH, USA) (Photo 1).
Once the dissection part was over, a bougie was
introduced orally by the anesthesiologist through
the esophagus and inside the stomach; the bougie
sizes used ranged from 32–46 Fr. The surgeon then
guided it along the lesser curvature and into the pyloric
channel and duodenal bulb.
Gastric transection began 4 to 6 cm proximal to
the pylorus. A 60-mm, green or gold cartilage was
placed across the antrum through the right midepigastric
port and was fired. The second stapler was
placed approximately 1 to 2 cm from the border of
the lesser curvature in the direction of the gastroesophageal
junction (Photo 2).
Sequential firings of the stapler along the border
of the bougie on the lesser curvature completed the