Weight loss and conversion rate are comparable between laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) at ten years, according to researchers from Italy. Although LSG is an effective bariatric procedure in short- and medium-term with clear superiority over LAGB, at ten years the two procedures had conversion rates of 15.8% vs 18.4% (p=0.67), respectively, and the researchers claim long-term RCT are needed to better understand the conversion rate. The findings were reported in the paper, ‘Ten-Year Results of Laparoscopic Sleeve Gastrectomy: Retrospective Matched Comparison with Laparoscopic Adjustable Gastric Banding—Is There a Significant Difference in Long Term?’, published in Obesity Surgery.
Despite LSG becoming the most common bariatric procedure the long-term outcomes have been questioned in terms of postoperative gastroesophageal reflux disease (GERD) and post-LSG intestinal metaplasia (Barrett’s disease). The experienced authors noted that some years ago they experienced a wave of LAGB patients asking for removal or conversion to other interventions. Currently, they are experiencing the same wave with LSG patients more than five years ago.
Therefore, they retrospectively assessed their ten-year outcomes of LSG through a matched comparison with LAGB with special regard to rates of success (%EWL > 50), non-response (%EWL < 25), weight regain and conversion.
Data collected at baseline were sex, age, body mass index (BMI), obesity-related diseases, and GERD. Weight loss was analysed at one, five and ten years of follow-up. Removal/conversion rate and GERD improvement/worsening were evaluated at ten years. Weight loss was calculated as percentage of excess weight loss (%EWL), total weight loss percent (%TWL) and excess body mass index loss percent (%EBMIL). Success at ten years was defined as %EWL≥50; non-response was set as %EWL<25, while weight regain was set as %EWL<50 at ten years for a patient who had previously achieved %EWL>50.
Outcomes
In total, the study included 152 (52 males/100 females) patients; 76 patients underwent LSG before 2010 and were all included in this study; and a matched group of 76 out of 178 LAGB patients with ten-year follow-up.
Due to conversion or removal, follow-up at one, five and ten years was 100%, 100%, and 92.1% in the LSG group and 100%, 94.7%, and 81.6% in the LAGB group. The overall band removal rate at ten years was 19.1% (n=34); six (3.4%) were removed for complications and 28 (15.7%) for insufficient weight loss. Port/tube complications (leak or disconnection leading to infections) occurred in 14/76 (18.4%); drainage, replacement and repositioning were performed when appropriate. Removal was necessary for three (3.9%) subjects after the fifth year for severe dysphagia.
Four LAGBs were removed in the first five years due to insufficient weight loss (IWL, 25< %EWL<50) or non-response and an additional seven patients underwent removal and conversion to LSG (n= 4) or OAGB (n=3) for IWL.
In the LSG group, no patient required conversion in the first five years, but afterwards six patients were converted to one anastomosis gastric bypass/mini-bypass (OAGB) to achieve further weight loss. Ten years after the initial procedures, one patient underwent re-LSG and three were submitted to OAGB for weight regain and two (2.6%) were converted to RYGB for severe reflux.
Despite the conversion rates, the authors stress that almost half of LSG patients have conserved a successful mean weight loss (EWL > 50%) at ten years, demonstrating that sleeve gastrectomy deserves to be considered a stand-alone procedure.
“Patients with morbid obesity should be adequately counselled to LAGB or LSG. Those subjects unwilling to undergo an irreversible, even if more effective, procedure could be submitted to LAGB,” the authors concluded. “Patients selected for LSG should be informed that conversion to RYGB or OAGB may be necessary to achieve further weight loss or to treat reflux.”
Further information
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