Laparoscopic sleeve gastrectomy (LSG) has become the most popular procedure in the past decade. The aim of this study is to evaluate the weight loss and weight regain (WR) results of LSG at a single center.
Materials and Methods:
The patients who underwent LSG between 2015 and 2018 were examined. The percentage of excess weight loss (EWL%), percentage of total weight loss (TWL%), and body mass index (BMI) were reported. WR was defined as patients who regained >25% of the peak median EWL%. Failure in weight loss (FWL) was defined as EWL% <50%. Comorbidity resolutions were recorded.
Results:
A total number of 202 patients were included in the study. The median follow-up time was 59 (interquartile range: 18) months. The baseline median BMI was 47.6 kg/m2. The peak median EWL and TWL were 89.5% and 42%, respectively. The median EWL and TWL at the median 5 years follow-up were 70% and 34%, respectively. No WR was reported in the first 3 years. The number of patients with WR and rates during the follow-up were as follows: 2 (1%) in 4 years, 25 (12%) in 5 years, 42 (21%) in 6 years, 58 (29%) in 7 years, and 62 (31%) patients in 8 years follow-up. The WR group has a significantly shorter time to reach the peak median EWL% and the lowest median BMI. FWL was observed in 38 patients, and 31 (82%) of them also showed WR. Total remission rates of hypertension and type 2 diabetes mellitus were 65% and 77%, respectively.
Conclusion:
Although LSG shows excellent outcomes in short-term follow-ups, more extended follow-ups showed unsatisfying results. In 8 years, almost one in three patients showed WR in this series. The patient-based treatment options might be more appropriate in bariatric surgeries.
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References
1.
RenCJ, PattersonE, GagnerM. Early results of laparoscopic biliopancreatic diversion with duodenal switch: A case series of 40 consecutive patients. Obes Surg, 2000; 10(6):514–523; doi: 10.1381/096089200321593715
2.
FrezzaEE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice?. Surg Today, 2007; 37(4):275–281; doi: 10.1007/s00595-006-3407-2
3.
SammourT, HillAG, SinghP, et al.Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Obes Surg, 2010; 20(3):271–275; doi: 10.1007/s11695-009-0038-x
4.
LeybaJL, AulestiaSN, LlopisSN. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study of 117 patients. Obes Surg, 2011; 21(2):212–216; doi: 10.1007/s11695-010-0279-8
5.
GrönroosS, HelmiöM, JuutiA, et al.Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss and quality of life at 7 years in patients with morbid obesity: The SLEEVEPASS randomized clinical trial. JAMA Surg, 2021; 156(2):137–146; doi: 10.1001/jamasurg.2020.5666
6.
KehagiasI, KaramanakosSN, ArgentouM, et al.Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI <50 kg/m2. Obes Surg, 2011; 21(11):1650–1656; doi: 10.1007/s11695-011-0479-x
7.
AngrisaniL, SantonicolaA, IovinoP, et al.Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg, 2017; 27(9):2279–2289; doi: 10.1007/s11695-017-2666-x
8.
AngrisaniL, SantonicolaA, IovinoP, et al.Bariatric surgery worldwide 2013. Obes Surg, 2015; 25(10):1822–1832; doi: 10.1007/s11695-015-1657-z
9.
BakrAA, FahmyMH, ElwardAS, et al.Analysis of medium-term weight regain 5 years after Laparoscopic sleeve gastrectomy. Obes Surg, 2019; 29(11):3508–3513; doi: 10.1007/s11695-019-04009-w
10.
CesanaG, UccelliM, CiccareseF, et al.Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy. World J Gastrointest Surg, 2014; 6(6):101–106; doi: 10.4240/wjgs.v6.i6.101
11.
ReinholdRB. Critical analysis of long term weight loss following gastric bypass. Surg Gynecol Obstet, 1982; 155(3):385–394.
12.
PeterliR, WölnerhanssenBK, PetersT, et al.Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: The SM-BOSS randomized clinical trial. JAMA, 2018; 319(3):255–265; doi: 10.1001/jama.2017.20897
13.
SalminenP, HelmiöM, OvaskaJ, et al.Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: The SLEEVEPASS randomized clinical trial. JAMA, 2018; 319(3):241–254; doi: 10.1001/jama.2017.20313
14.
KumarSB, HamiltonBC, WoodSG, et al.Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? A comparison of 30-day complications using the MBSAQIP data registry. Surg Obes Relat Dis, 2018; 14(3):264–269; doi: 10.1016/j.soard.2017.12.011
15.
CarlinAM, ZeniTM, EnglishWJ, et al.The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Ann Surg, 2013; 257(5):791–797; doi: 10.1097/SLA.0b013e3182879ded
16.
ParikhM, IssaR, McCrillisA, et al.Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: A systematic review and meta-analysis of 9991 cases. Ann Surg, 2013; 257(2):231–237; doi: 10.1097/SLA.0b013e31826cc714
17.
AuroraAR, KhaitanL, SaberAA. Sleeve gastrectomy and the risk of leak: A systematic analysis of 4,888 patients. Surg Endosc, 2012; 26(6):1509–1515; doi: 10.1007/s00464-011-2085-3
18.
BenedixF, PoranzkeO, AdolfD, et al.Staple line leak after primary sleeve gastrectomy-risk factors and mid-term results: Do patients still benefit from the weight loss procedure?. Obes Surg, 2017; 27(7):1780–1788; doi: 10.1007/s11695-017-2543-7
19.
DericiS, AtilaK, BoraS. The effect of the cartridge used in laparoscopic sleeve gastrectomy on the development of a staple-line leak. Am Surg, 2018; 84(9):1499–1503.
20.
SepúlvedaM, AlamoM, SabaJ, et al.Long-term weight loss in laparoscopic sleeve gastrectomy. Surg Obes Relat Dis, 2017; 13(10):1676–1681; doi: 10.1016/j.soard.2017.07.017
21.
KowalewskiPK, OlszewskiR, WalędziakMS, et al.Long-term outcomes of laparoscopic sleeve gastrectomy—A single-center, retrospective study. Obes Surg, 2018; 28(1):130–134; doi: 10.1007/s11695-017-2795-2
22.
El MoussaouiI, Van VyveE, JohanetH, et al.Laparoscopic sleeve gastrectomy for morbid obesity in a Belgian-French prospective multicenter study: Outcomes and predictors weight loss failure. Acta Chir Belg, 2021; 121(6):413–419; doi: 10.1080/00015458.2020.1841485
23.
LautiM, KularatnaM, HillAG, et al.Weight regain following sleeve gastrectomy—A systematic review. Obes Surg, 2016; 26(6):1326–1334; doi: 10.1007/s11695-016-2152-x
24.
HimpensJ, DobbeleirJ, PeetersG. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg, 2010; 252(2):319–324; doi: 10.1097/SLA.0b013e3181e90b31
LiuSYW, WongSKH, LamCCH, et al.Long-term results on weight loss and diabetes remission after laparoscopic sleeve gastrectomy for a morbidly obese Chinese population. Obes Surg, 2015; 25(10):1901–1908; doi: 10.1007/s11695-015-1628-4
29.
KarmaliS, BrarB, ShiX, et al.Weight recidivism post-bariatric surgery: A systematic review. Obes Surg, 2013; 23(11):1922–1933; doi: 10.1007/s11695-013-1070-4
30.
BozaC, DarochD, BarrosD, et al.Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure. Surg Obes Relat Dis, 2014; 10(6):1129–1133; doi: 10.1016/j.soard.2014.03.024
31.
RawlinsL, RawlinsMP, BrownCC, et al.Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis, 2013; 9(1):21–25; doi: 10.1016/j.soard.2012.08.014
32.
GillRS, BirchDW, ShiX, et al.Sleeve gastrectomy and type 2 diabetes mellitus: A systematic review. Surg Obes Relat Dis, 2010; 6(6):707–713; doi: 10.1016/j.soard.2010.07.011
33.
LeeW-J, AlmulaifiA, TsouJJ, et al.Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: Predicting the success by ABCD score. Surg Obes Relat Dis, 2015; 11(5):991–996; doi: 10.1016/j.soard.2014.12.027
34.
EidGM, BrethauerS, MattarSG, et al.Laparoscopic sleeve gastrectomy for super obese patients: Forty-eight percent excess weight loss after 6 to 8 years with 93% follow-up. Ann Surg, 2012; 256(2):262–265; doi: 10.1097/SLA.0b013e31825fe905
35.
NeagoeR, MuresanM, TimofteD, et al.Long-term outcomes of laparoscopic sleeve gastrectomy—A single-center prospective observational study. Wideochir Inne Tech Maloinwazyjne, 2019; 14(2):242–248; doi: 10.5114/wiitm.2019.84194
36.
KhanIA, K AA, AsgharM, et al.Comparative effectiveness of laparoscopic sleeve gastrectomy in morbidly obese and super obese patients. Cureus, 2021; 13(12):e20767; doi: 10.7759/cureus.20767
37.
RosenthalRJ, DiazAA, ArvidssonD, et al.International sleeve gastrectomy Expert Panel Consensus Statement: Best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis, 2012; 8(1):8–19; doi: 10.1016/j.soard.2011.10.019
38.
CalP, DelucaL, JakobT, et al.Laparoscopic sleeve gastrectomy with 27 versus 39 Fr bougie calibration: A randomized controlled trial. Surg Endosc, 2016; 30(5):1812–1815; doi: 10.1007/s00464-015-4450-0
39.
Ruiz-TovarJ, MartínezR, BoneteJM, et al.Long-term weight and metabolic effects of laparoscopic sleeve gastrectomy calibrated with a 50-Fr Bougie. Obes Surg, 2016; 26(1):32–37; doi: 10.1007/s11695-015-1731-6
