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Ten-year sleeve gastrectomy outcomes

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

They also noted that the lower the baseline weight, the higher the persistence of diabetes

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.”

To access this paper, please click here

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