Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

Abstract

AIMTo prospectively evaluate the postoperative morbi-mortality and weight loss evolution of patients who underwent a laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure during 5 years of follow-up.METHODSSince 2006, data from patients undergoing a highly restrictive primary LSG have been prospectively registered in a database and analysed. Preoperative co-morbid conditions, operating time, hospital stay, early and late complications rate and evolution of weight loss after 5 years of follow-up were analysed.RESULTSA total of 156 patients were included, 74.3% of whom were women. The mean age was 43.2 ± 13.1 years and the mean body mass index (BMI) was 41.5 ± 7.9 kg/m2. Seventy patients (44.8%) presented a BMI under 40 kg/m2. The mortality rate was 0%. The leakage rate was 1.2%, and the total 30-d morbidity rate was 5.1% (8/156). With a mean follow-up of 32.7 ± 28.5 (range 6-112) mo, the mean percent of excess of weight loss (%EWL) was 82.0 ± 18.8 at 1 year, 76.7 ± 21.3 at 3 years and 60.3 ± 28.9 at 5 years. The mean percent of excess of BMI loss (%EBMIL) was 94.9 ± 22.4 at 1 year, 89.4 ± 27.4 at 3 years and 74.8 ± 29.4 at 5 years. Patients with preoperative BMI less than 40 kg/m2 achieved greater weight loss than did the overall study population. Diabetes remitted in 75% of the patients and HTA improved in 71.7%. CPAP masks were withdrawn in all patients with obstructive sleep apnoea.CONCLUSIONLSG built with a narrow 34 F bougie and starting 3 cm from the pylorus proved to be safe and highly effective in terms of weight loss as a stand-alone procedure, particularly in patients with a preoperative BMI lower than 40 kg/m2.

Single Anastomosis Duodeno-ileostomy (SADI-S) Versus One Anastomosis Gastric Bypass (OAGB-MGB) as Revisional Procedures for Patients with Weight Recidivism After Sleeve Gastrectomy: a Comparative Analysis of Efficacy and Outcomes

“…Over the past decade, bariatric surgery has become the main approach to deal with obesity and its related comorbidities, showing great efficacy and durability in managing this epidemic disease [1,2]. However, it has been noticed that significant percentage of patients regain an excess weight after bariatric surgery, especially after laparoscopic sleeve gastrectomy (LSG) and mainly in patients with a higher body mass index (BMI) before the primary procedure [3,4]. Therefore, such patients would not sufficiently benefit from a stand-alone LSG and are advised to undergo a revisional surgery.…”

Failed Sleeve Gastrectomy: Single Anastomosis Duodenoileal Bypass or Roux-en-Y Gastric Bypass? A Multicenter Cohort Study

“…However, if weight loss is inadequate or patients experience weight regain, they are advised to undergo revisional surgery. This is especially apparent in those with a higher initial BMI before the SG [ 2 , 3 ]. Other patients have satisfactory weight loss but suffer from functional complications such as severe gastroesophageal reflux disease (GERD) or dysphagia due to a stenosis.…”

Results in Weight Loss and Improvement of Comorbidities

“…A comparative study involving 476 patients who underwent LSG impressively observed that all (100%) patients were off CPAP and showed improvement in symptoms of OSA after 2 years of follow-up [55]. Likewise, the collected data of 156 patients who underwent LSG with a mean follow-up of 32 months found that the use of CPAP could be withdrawn in all patients with OSA (13% -21/156) [56]. Additionally, a longitudinal study with 36 OSA patients followed for 5 years after LSG observed a significant improvement in AHI (80.6% -29/36) and an even more expressive improvement in the Modified Epworth Sleepiness Scale (91.6%), a scale which evaluates patients' level of habitual sleepiness during the day [57].…”