A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/69304
EXPERT COMMENTARY MAJOR FINDINGS This is one of the first studies to provide long-term results about LSG outcomes. The study shows a successful weight loss (above 50% EWL) at 3 and 6 years of follow up. Weight loss was better at the 3-year mark, and a percentage of weight regain was documented. A secondary finding of major importance is that comorbidities are effectively controlled in an important percentage of patients. STUDY LIMITATIONS At the time of the interventions, LSG was just being defined as a stand-alone procedure, and there were more questions than answers in terms of technical details. Although authors describe the use of a 34Fr bougie and the preservation of the antrum, more information about the technique is required to define recommendations using this particular report. An important number of patients were lost to follow up, and another group of them required additional bariatric operations. These facts make the first group of patients more important, since one can argue that those patients did well with the stand-alone LSG. Another limitation is that this paper is a retrospective review. REMAINING QUESTIONS TO BE ADDRESSED • Can LSG maintain a sustained EWL effect over time enough as to NATAN ZUNDEL, MD, FACS Clinical Professor of Surgery, Florida International University College of Medicine, Miami, Florida be a stand-alone operation for morbid obesity? Although weight regain can be found with most bariatric techniques, the tendency in this study is high and may be a call for caution at time of patient selection. • How does the long-term weight loss compare to laparoscopic Roux-n-Y gastric bypass (RYGB) and laparoscopic adjustable gastric band (LAGB) and how do morbidity and mortality influence results? • What are the technical steps needed to be conducted to achieve the best results with less complications? • How should long-term follow-up and support be structured by the multidisciplinary team to improve outcomes? • Although not compared to the LAGB in this study, numbers seem to indicate that there are significant advantages in mid- and long-term results. WHY IS THIS STUDY IMPORTANT TO THE FIELD? LSG is a safe and effective stand- alone procedure for patients with morbid obesity, since it achieves more than 50% EWL in most patients and has a positive effect on comorbidities, such as T2DM and hypertension. It should prompt researchers to define the best technical steps, comparison with other techniques, and in which specific group of patients the procedure is indicated as compared to other bariatric procedures. Patients need to be informed that there will be some weight regain that may vary according to eating and exercise behavioral changes, gastroesophageal reflux disease (GERD) symptoms, and complications that may need treatment. The LSG procedure should be performed inside a multidisciplinary program and have a close follow-up program like any other bariatric procedure.That may prevent the weight regain and help with GERD. June 2012 • Supplement • Bariatric Times 15S