Five-Year Outcomes in Bariatric Surgery Patients

Abstract

Background and objectives: Obesity presents as a multifactorial, pandemic disease that arises as a consequence of unequal energy intake and energy consumption. Obesity adversely affects the quality of life, leading not only to disability, but also to various other disorders. Bariatric surgery is the most effective method for achieving significant and sustained weight loss in individuals with extreme obesity. The aim of this study was to examine how well surgically induced weight loss is maintained after five years of follow-up and its effects on cardiovascular risk factors and outcome. Materials and Methods: This is a retrospective cross-sectional study of 66 patients with morbid obesity, with body mass index (BMI) ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 and obesity-related health conditions, aged 20 to 61 years, mostly women (77.3%) who underwent laparoscopic Roux-en-Y gastric bypass surgery. Results: Average follow-up was 6.42 years (95% CI 6.30–6.54 years) after surgery, with survival rate of 97% in operated individuals. There was a statistically significant reduction of weight and body mass index 6 months and 5 years after surgery in comparison to the initial values (p < 0.001). Of 62 patients who presented weight loss at the end of the follow-up period, 38 were able to maintain the amount of weight loss that was attained 6 months after surgery, while 24 patients regained weight compared to their postoperative weight at 6 months. Two patients reported no weight loss after treatment. Significant weight reduction was associated with better control of diabetes and increased self-reported physical activity at 6 months and 5 years after surgery, as well as with a reduction of the use of anti-diabetic and anti-hypertensive medications. Conclusions: Our research demonstrates a positive long-term impact of bariatric surgery on patients’ health conditions, significant and sustained weight loss, and decrease in BMI, which were associated with a reduction of co-morbidities and risk factors for cardiovascular diseases.

Late (≥5 y) Complications of Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB): A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…The results of our systematic review suggest that both LRYGB and LVSG are associated with negligible long-term mortality rates and are equally safe in this regard. These results are in keeping with both prospective and retrospective observational studies that report no treatment-related mortality at 5 years or later postoperatively in either LVSG42,43 and LRYGB 44,45. Similarly, the PCORnet Bariatric Surgery study cohort data showed no differences in mortality between surgical interventions and an overall low mortality at 5 years (<1%) 22.…”

“…These results are in keeping with both prospective and retrospective observational studies that report no treatment-related mortality at 5 years or later postoperatively in either LVSG 42,43 and LRYGB. 44,45 Similarly, the PCORnet Bariatric Surgery study cohort data showed no differences in mortality between surgical interventions and an overall low mortality at 5 years (< 1%). 22 By contrast, however, Howard et al 23 demonstrated a lower mortality associated with LVSG (4.27%; 95% CI: 4.25%-4.30%) versus LRYGB (5.67%; 95% CI: 5.63%-5.69%) at 5 years, corresponding to a ~33% relative difference in mortality.…”

Associação no longo-termo entre a prática de atividade física, o reganho de peso, fatores de risco metabólico e qualidade de vida, em pacientes submetidos a cirurgia bariátrica - Revisão Sistemática da Literatura (Asociación a largo plazo entre la actividad física, el aumento de peso, los factores de riesgo metabólicos y la calidad de vida en pacientes sometidos a cirugía bariátrica – Revisión de la literatura sistemática) (Long-term association between physical activity, weight gain, metabolic risk factor

“…O nível de atividade física tem indícios de aumentar em mais de 70%, tal como comprovado em outros estudos com avaliações superiores a 5 anos, em que apenas 3% dos pacientes não tinha aumento da perda de peso e uma redução significativa dos pacientes a usar antidiabéticos orais. A análise dos resultados aos 5 anos permite logo ter referência que a atividade física regular é um dos mais importantes preditores que combate o reganho de peso, sustentados em percentagem de 72% dos pacientes ativos fisicamente (Nedeljkovic-Arsenovic et al, 2020).…”

“…Quando abordamos os fatores de risco metabólico verificamos que existe uma diminuição da sua prevalência nos primeiros dois anos após a cirurgia, com diminuição de terapêuticas farmacológicas (36%), mas aos cinco anos a percentagem diminui (14%) (Nedeljkovic-Arsenovic et al, 2020). Apesar de existir uma boa resposta de comorbilidades como a diabetes, dislipidemia e hipertensão no primeiro ano pós cirurgia bariátrica, mantido em pacientes que aos 10 anos têm níveis regulares de atividade física, é a diabetes que melhor resposta demonstra à cirurgia bariátrica, com níveis de atividade física mantidos (Costa Pereira et al, 2019).…”