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LSG efficacy

Sleeve gastrectomy effective out to five years

High rates for nutritional deficiencies despite routine supplementation

Laparoscopic sleeve gastrectomy results in excessive BMI loss of almost 60% after 5.9 years postoperatively and a considerable improvement or even remission of co-morbidities, according to the results from a single-centre study entitled "Five-Year Results of Laparoscopic Sleeve Gastrectomy," published in the journal Surgery for Obesity and Related Diseases.

Investigators from Basel, Switzerland, retrospectively assessed the outcomes from sixty-eight patients who underwent laparoscopic sleeve gastrectomy SG either as primary bariatric procedure (n=41) or as redo-operation after failed laparoscopic gastric banding (n=27) between August 2004 and December 2007.

At the time of LSG the mean BMI was 43.0 ±8.0, the mean age 43.1 ±10.1 years, and 78% were female. The follow-up rate one year postoperatively was 100%, 97% after two, and 91% after five years; the mean follow-up time was 5.9 ±0.8 years.

Results

The outcomes showed that the average excessive BMI loss after one year was 61.5 ±23.4%, 61.1 ±23.4% after two, and 57.4 ±24.7% after five years. They also reported that co-morbidities improved considerably with a remission of type 2 diabetes reported in 85% of patients.

Indeed, only one patient required needed insulin therapy five years after laparoscopic sleeve gastrectomy, from four insulin-dependent patients at the beginning of the study. Two switched to oral antidiabetic therapy, while one remained in full remission after years.

They researchers report some complications including; one leak (1.5%), two incisional hernias (2.9%), and new onset gastro-oesophageal reflux in 11 patients (16.2%). Reoperation due to insufficient weight loss was necessary in eight patients (11.8%).

However, they found that patients undergoing a redo procedure had worse results concerning weight loss, with 34.3% of patients who had sleeve gastrectomy as their primary procedure and 50% of those who'd had it after a failed gastric banding still had a BMI >35 after five years.

Five years after the procedure, 77.9% of patients developed vitamin D deficiency, 41.2% had iron deficiency, 39.7% had zinc deficiency, 39.7% had a vitamin B12 deficiency, 25% had a folic acid deficiency, and 10.3% developed anaemia, despite routine supplementation.

Conclusion

"The main weight loss occurred in the first postoperative year and appeared in the following years for the most part stable," they concluded. "Although sleeve gastrectomy was initially only carried out as the first part of a two-step procedure, we could show that a rather small percentage needed a second-line procedure ... for treatment of insufficient weight loss."

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