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Long-term follow-up of LSG

Long-term follow-up shows decrease in T2DM remission

The outcomes should be taken into consideration in the decision-making process for the most appropriate operation for a given obese patient

Long-term follow-up of laparoscopic sleeve gastrectomy results in a decrease in remission rates of diabetes and, to a lesser extent, other obesity-related disorders over time, according to a study published online by JAMA Surgery. The weight loss from surgery and major improvements in comorbidities were not correlated to the percentage of excess weight loss.

Dr Andrei Keidar of Beilinson Hospital, Petah Tikva, Israel, and colleagues collected data on all patients undergoing LSGs performed by the same team at a university hospital between April 2006 and February 2013, including demographic details, weight follow-up, blood test results, and information on medications and comorbidities.

Andrei Keidar

The aim of the study was to investigate the long-term effects of LSG on weight loss, diabetes mellitus, hypertension, dyslipidaemia, and hyperuricemia. A total of 443 LSGs were performed from April 2006 to February 2013, with complete data available for 54 percent of patients at the one-year follow-up, for 49 percent of patients at the one-year follow-up, and for 70 percent of patients at the five-year follow-up.

Complete data were available for 241 of the 443 patients (54.4%) at one-year follow-up, for 128 of 259 patients (49.4%) at three-year follow-up, and for 39 of 56 patients (69.6%) at the five-year follow-up. The percentage of excess weight loss was 76.8%, 69.7%, and 56.1%, respectively. Complete remission of diabetes was maintained in 50.7%, 38.2%, and 20.0%, respectively, and remission of hypertension was maintained in 46.3%, 48.0%, and 45.5%, respectively.

Changes in high-density lipoprotein cholesterol level (mean [SD] level preoperatively and at one, three, and five years, 46.7 [15.8], 52.8 [13.6], 56.8 [16.0], and 52.4 [13.8] mg/dL, respectively) and triglyceride level (mean [SD] level preoperatively and at one, three, and five years, 155.2 [86.1], 106.3 [45.3], 107.2 [53.4], and 126.4 [59.7] mg/dL, respectively) were significant compared with preoperative and postoperative measurements (p<0.001).

The decrease of low-density lipoprotein cholesterol level was significant only at one year (p=0.04) and three years (p=0.04) (mean [SD] level preoperatively and at one, three, and five years, 115.8 [33.2], 110.8 [32.0], 105.7 [25.9], and 110.6 [28.3] mg/dL, respectively). The changes in total cholesterol level did not reach statistical significance (mean [SD] level preoperatively and at one, three, and five years, 189.5 [38.2], 184.0 [35.4], 183.4 [31.2], and 188.1 [35.7] mg/dL, respectively). No changes in comorbidity status correlated with preoperative excess weight.

Hypertriglyceridemia was the only comorbidity whose remission rates at one year of follow-up (partial/complete, 80.6%; complete, 72.2%) correlated with percentage of excess weight loss (76.8%) (p=0.005).

"The longer follow-up data revealed weight regain and a decrease in remission rates for type 2 diabetes mellitus and other obesity-related comorbidities. These data should be taken into consideration in the decision-making process for the most appropriate operation for a given obese patient," the authors write. "These critical gaps in knowledge pose a significant problem for people considering a potential surgical option to treat severe obesity. Contributing to these deficits are the paucity of comparative trials, incomplete followup, a lack of standardized definitions for changes in health status (e.g., diabetes mellitus remission), and the tendency to a rush to judgment in favor of surgical treatment options. Clinicians and prospective patients will need to discuss and weigh the evidence in a dynamic exchange driven not always by final conclusions but by the most current available data."

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