SG results in weight loss and co-morbidity resolution up to ten years

Sleeve gastrectomy (SG) results sustained weight loss (WL) and co-morbidity resolution up to ten years post-operatively and although a notable portion of patients experience weight regain (WR), mean percent weight loss (%WL) exceeds 30%, translating in adequate weight loss also in the long term, according to researchers from Sapienza University of Rome, Rome, Italy.

The paper, ‘10-year follow-up after laparoscopic sleeve gastrectomy: Outcomes in a monocentric series’, published in SOARD, evaluated the long-term %WL, excess weight loss (%EWL), weight regain (WR) and co-morbidity resolution rates in a single-centre cohort undergoing SG as a primary procedure, with a minimum ten-year follow-up. The researchers also analysed the predictive value of sex, age, preoperative BMI, failure of previous bariatric procedures, and early and late post-operative complications on long-term results after SG.

In total, 182 morbidly obese patients (mean BMI of 46.6±7.3) underwent SG, eight patients received SG as revisional bariatric surgery after either laparoscopic gastric banding (six patients) or vertical banded gastroplasty (two patients). One hundred and fourteen patients reached a mean follow-up of 122.32 ± 8.33 months with a retention rate of 77.0% and a minimum follow-up of 113.99 months and a maximum follow-up of 130.65 months, and therefore were included in this report. Data from a prospectively collected database were retrospectively analysed. Age, sex, height, weight, BMI, obesity-related morbidities, previous bariatric surgery, and intraoperative and postoperative complications were recorded.

Outcomes

The researchers reported no instances of mortality over the follow-up period. Sixteen (11%) of 148 patients were readmitted to the hospital due to reoperation (44%), abdominal pain (31%) or nausea/vomiting (25%). Mean %EWL at ten years was 52.5%. Success rate (defined as %EWL>50), was evident in 50.9% of patients. Additionally, %WL was 30.9±12.4 at ten years, with a cumulative incidence of WL >20% in 83.3% of patients (n=95). WR was expressed as an increase in weight ≥25% of the maximum WL and occurred in 10.4% of patients, with a weight increase of 11 to 20kg in 18 patients, 21 to 30kg in 14 patients, and >31 kg in four patients.

Interestingly, baseline BMI significantly (p=0.001) and linearly predicted the %EWL at ten years. The super-obese subgroup generated significantly greater outcomes in terms of weight loss vs with those with a BMI<50 (%EWL 48.0±18.5 vs 61.5±23.2; p<0.001), even though mean BMI in super-obese patients was significantly greater compared with the morbidly obese group (BMI 34.7±8.1 vs 30.5±5.0; p<0.01). Influence of postoperative complications and formerly failed bariatric surgery were non-statistically significant factors as subgroups “were found to be insufficient.”

The prevalence of T2D at the time of the procedure was 14.9% and T2D remission occurred in 64.7% of the patients; 23.5% showed improvement in glycaemic control and 11.7% were unchanged or worsened at ten years from surgery, and the duration of T2D was found to be a predictive factor with patients with a duration of T2D more than ten years had lower remission rates compared with those with a minor duration.  They also noted that the lower the baseline weight, the higher the persistence of diabetes. The baseline weight was 123.4±23.4kg in the group without diabetes remission and 134.2±23.3kg in the group who achieved diabetes remission (p=0.048).

“SG seems to generate a significant and sustained weight loss and co-morbidity resolution, which can be observed up to ten years postoperatively. Even though a notable portion of patients undergoing this procedure experience WR, mean %WL persists to exceed 30% at ten years, translating in adequate WL also in the long term,” the authors conclude. “Additionally, WR does not seem to impact negatively on co-morbidity resolution rates. SG represents a safe and effective bariatric operation, which easily grants the possibility to proceed to revisional bariatric surgery in patients with WR or failure to WL.”