Article 6
LONG-TERM RESULTS OF LAPAROSCOPIC SLEEVE GASTRECTOMY FOR OBESITY
CITATION
Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2012;252(2):319–324.
PURPOSE OF THE STUDY
The purpose of this study is to determine the mid- and long-term efficacy and possible side effects of laparoscopic sleeve gastrectomy (LSG) as treatment for morbid obesity.
METHODS
• Between November 2001 and October 2002, 53 patients with morbid obesity were qualified for restrictive surgery and were selected for LSG.
• Percentage of excess weight loss (EWL) was assessed at 3 and 6 years postoperatively.
• A retrospective review of a prospectively collected database was performed for evaluation after 3 years: Weight loss was registered as change in BMI and %EWL.
• Quality of life (QOL), possible side effects, and efficacy for weight loss at least 6 years after LSG were evaluated.
• QOL was evaluated using the Bariatric Analysis and Reporting Outcome System (BAROS) score. The BAROS evaluates the results
of obesity treatments by analyzing 3 psychomedical aspects: weight loss, changes in comorbidities, and QOL.
RESULTS
Full cooperation was obtained in 41 out of the 53 patients, a response rate of 78%. Of the 41 patients, 30 were stand-alone LSG and 11 were LSG and duodenal switch (DS). After 3 years, a mean %EWL of 72.8% was
documented, and after 6 years %EWL had dropped to 57.3% for the overall population (Figure 1). Analyzing the results of the subgroup of 30 patients receiving only LSG, there was a 3-year %EWL of 77.5% and 6+ year %EWL of 53.3%. The differences between the third and sixth postoperative year were statistically significant. The major complications related to sleeve gastrectomy included leak (2/41), stenosis (1/41), bleeding (1/41), and incisional hernia (1/41). Patient acceptance of LSG remained good after 6+ years despite the fact that late, new
gastroesophageal reflux complaints appeared in 21% of patients between the third and sixth postoperative year. Weight regain can be managed
FIGURE 1. Difference in mean %EWL between 3 and 6 years postoperatively for overall population (stand- alone LSG and LSG + DS). Reproduced with permission. Himpens J, Dobbeleir J, Peeters G. Long- term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2012;252(2):319–324.
successfully by completion of a DS procedure at a later stage. Gastroesophageal reflux and weight regain might have been prevented in some patients by continued follow- up office visits after the third postoperative year.
CONCLUSION
Based on the data collected from these studies, LSG has a substantial effect on morbid obesity and type 2 diabetes mellitus, by providing improvement or resolution in most cases.
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Bariatric Times • June 2012 • Supplement