Original article
Five-year results of laparoscopic sleeve gastrectomy

https://doi.org/10.1016/j.soard.2013.06.024Get rights and content

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity, but studies reporting long-term results are still rare. The objective of this study was to present the 5-year outcome concerning weight loss, modification of co-morbidities, and late complications.

Methods

This is a retrospective analysis of a prospective cohort with a minimal follow-up of 5 years. A total of 68 patients underwent LSG 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 body mass index (BMI) was 43.0±8.0 kg/m2, the mean age 43.1±10.1 years, and 78% were female. The follow-up rate was 100% at 1 year postoperatively, 97% after 2 years, and 91% after 5 years; the mean follow-up time was 5.9±0.8 years.

Results

The average excessive BMI loss was 61.5%±23.4% after 1 year, 61.1%±23.4% after 2 years, and 57.4%±24.7% after 5 years. Co-morbidities improved considerably; a remission of type 2 diabetes could be reached at 85%. The following complications were observed: 1 leak (1.5%), 2 incisional hernias (2.9%), and new-onset gastroesophageal reflux in 11 patients (16.2%). Reoperation due to insufficient weight loss was necessary in 8 patients (11.8%).

Conclusions

LSG was effective 5.9 years postoperatively with an excessive BMI loss of almost 60% and a considerable improvement or even remission of co-morbidities.

Section snippets

Patients and methods

In our institution, LSG as a stand-alone bariatric procedure was initially established in the context of a prospective study. Inclusion criteria were relative contraindications for LRYGB (i.e., huge abdominal hernia or history of extensive abdominal surgery), super-obesity (allowing for the possibility of expansion into a more aggressive option, such as BPD/DS), or a history of failed laparoscopic adjustable gastric banding (LAGB) (instead of BPD/DS, which until then was the first choice of a

Patient characteristics

In 41 patients, LSG was performed as a primary obesity surgical procedure (group 1), and 27 patients received LSG as secondary treatment after failed gastric banding (group 2). Regarding patient characteristics, such as weight, body mass index, and age, the 2 groups had similar starting values (Table 1).

In group 2, reasons to convert to a second bariatric intervention were band intolerance (chronic reflux symptoms and/or intolerance for certain nutrients without radiologic signs for pouch

Discussion

This is a small but well-documented series on LSG as a stand-alone procedure as primary and redo bariatric procedure with a 5-year follow-up rate of 91%. The trial was designed in the context of a pilot study more than 9 years ago. In the mean time, we could improve and standardize the operative technique, which led to even better mid-term results [13].

Although sleeve gastrectomy was initially only carried out as the first part of a 2-step procedure, we could show that a rather small percentage

Conclusions

LSG was effective 5.9 years postoperatively with an EBMIL of almost 60% and a considerable improvement or even remission of co-morbidities.

Disclosures

Markus Gass received an honorarium from Ethicon Endo-Surgery Europe, GmbH, as a hands-on workshop instructor. Ralph Peterli received an honorarium and a consulting fee from Ethicon Endo-Surgery Europe, GmbH, as a speaker and instructor for workshops, as well as a research grant as the principal investigator. The other authors have no commercial associations that might be a conflict of interest in relation to this article.

Acknowledgments

The authors thank P. Hendrickson and B. Wölnerhanssen for carefully reading the manuscript and for data management.

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