Five‐year long‐term clinical outcome after bariatric metabolic surgery: A multi‐ethnic Asian population in Singapore

Abstract

Bariatric surgery is an effective treatment for morbid obesity and its metabolic related comorbidities; type 2 diabetes, hypertension and hyperlipidaemia. However, the literature is scarce regarding the long-term outcome after bariatric surgery, especially among multi-ethnic Asian populations. Considering the growing number of bariatric metabolic surgeries in Asia, we have attempted to provide a regional perspective on 5-year long-term clinical outcomes post bariatric surgery in Singapore. Between 2010 and 2016, all bariatric operative cases were included, and these comprised: laparoscopic sleeve gastrectomy (LSG), 393; laparoscopic Roux-En-Y gastric bypass (RYGB), 125; laparoscopic mini-gastric bypass (MGB), 43. The primary outcome measure was the percentage of excess weight loss (% EWL) at 6 months, 1, 2, 3, 4 and 5 years, with % remission of type 2 diabetes mellitus (T2DM) at 1 year following LSG (49.7%, 61.2%, 56.1%, 47.8%, 40.8% and 47.3%; 82.2%), RYGB (60.2%, 62.1%, 57.6%, 50.1%, 48.7% and 47.7%; 86.9%) and MGB (58%, 68.1%, 62.7%, 66.2%, 64.0%, 65.2%; 71.9%). In conclusion, MGB and RYGB showed the greatest % EWL at 5 years and are recommended for moderate T2DM. LSG is an effective bariatric operation with a high % EWL up to 2 years, and a high remission rate of mild T2DM. The remission rate of T2DM was equally high in all 3 surgical groups, independent of ethnic differences.

Long-term Relapse of Type 2 Diabetes After Roux-en-Y Gastric Bypass: Prediction and Clinical Relevance

“…Further validation in other ethnic groups will be of interest. Despite this, the current literature, including Africans Americans, Caucasians, or different Asian ethnic groups, displays no general effect of ethnicity in T2D remission after BS (47,48).…”

Timing of Maximal Weight Reduction Following Bariatric Surgery: A Study in Chinese Patients

“…In western countries, research evidences support the consensus that postoperative body weight decreases to a trough at 12–36 months after bariatric surgery ( 3 – 5 ). However, there is currently no published investigation on standardized weight loss after bariatric surgery in Asian settings, except a few studies in Japan and Singapore showed that the average percent total weight loss (%TWL) following bariatric surgery was 20–25% within the first 3 years ( 6 , 7 ). On account of differences in the baseline body height and weight, and body composition, it is not completely grounded to interpret the weight loss on the Asian communities according to westerner physical standards.…”

Five‐year effectiveness of bariatric surgery on disease remission, weight loss, and changes of metabolic parameters in obese patients with type 2 diabetes: A population‐based propensity score‐matched cohort study

“…Bariatric surgery is currently considered as one of the most effective therapies for morbidly obese patients since approximately 30% of initial weight of patients is reduced and their weight loss is maintained for 10 to 15 years after the surgery . Evidence has also suggested that bariatric surgery can ameliorate metabolic syndromes, as well as help patients achieve diabetes and other metabolic disorders remission . Around 75% to 90% of patients who underwent bariatric surgery achieved comorbidity resolution, particularly for patients with insulin resistance, hypertension, and respiratory disorders .…”

“…4 Evidence has also suggested that bariatric surgery can ameliorate metabolic syndromes, as well as help patients achieve diabetes and other metabolic disorders remission. [5][6][7] Around 75% to 90% of patients who underwent bariatric surgery achieved comorbidity resolution, particularly for patients with insulin resistance, hypertension, and respiratory disorders. 4 Though relapse in recovered patients may occur over time, the long-term effect of bariatric surgery on disease remission was supported by a systematic review, where 66.7% of T2DM patients, 38.2% of hypertensive patients, and 60.4% dyslipidaemia patients achieved disease remission at up to 5 years after bariatric surgery.…”