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Long-term results (8 yr) after laparoscopic sleeve gastrectomy (LSG).
Source publication
Background
Laparoscopic sleeve gastrectomy (LSG) became the most frequent bariatric procedure performed in France (2011) and in the United States (2013), but studies reporting long-term results are still rare.
Setting
Private hospital, France.
Methods
This is a retrospective analysis of a prospective cohort of 168 patients who underwent LSG betwe...
Context in source publication
Context 1
... 2 (range 31.1-64.8), with a BMI 450 kg/m 2 in 20 patients. No significant difference was found among the serial values of the % EBMIL, respectively, at 1, 5, or 8 years (p ¼ .05). For the entire cohort, the mean % EBMIL was 81% (31-143) at 1 year, 76% (0-149) at 5 years, and 67% (4-135) at 8 years, respectively. The results were summarized in Fig. 2. Of the 116 patients with 8 years of follow-up, 82 patients had 450% EBMIL at 8 years. The median resultant BMI of these 82 patients was 28 kg/m 2 (range: ...
Similar publications
Objective:
To identify: 1. The percentage of bariatric procedures that are revisions; 2. What proportion of bariatric revision procedures in public hospitals are for patients whose primary weight loss procedure occurred in a private hospital; 3. The age, sex and level of socioeconomic disadvantage of patients needing revisions.
Methods:
An analy...
Citations
... Revisional surgery is performed in approximately 10-20% of the individuals with WR who undergo revisional surgery [103]. ...
The prevalence of obesity is increasing worldwide. It is a chronic relapsing disease. It requires a multifaceted treatment approach tailored to the individual’s needs. Treatment options include lifestyle modifications, pharmacotherapy, and surgery. Bariatric metabolic surgery offers the best option to achieve sustained weight loss, alleviation of obesity-associated comorbidities, and improved quality of life. However, these benefits are dependent on compliance with long-term lifestyle changes. Unfortunately, some patients regain a significant amount of weight after the initial weight loss. The etiology of weight regain is not fully clear. Risk factors for weight regain after bariatric surgery include behavioral factors, lack of physical activity, loss of follow-up, hormonal changes, surgical factors, mental health, and psychological disorders. Ideally, management requires a multidisciplinary team approach. Non-invasive treatments include lifestyle modifications, behavioral therapy, exercise, and pharmacotherapy. Invasive options include endoscopic interventions and revisional surgery. Non-invasive options are utilized first. The decision about invasive therapy should be individualized due to the risk of complications. Future studies should aim for early identification of high-risk patients and managing them proactively. Moreover, clinical trials must test the safety and efficacy of existing and novel pharmacotherapies in managing weight regain.
... Some patients require a revisional procedure to achieve sufficient long-term weight loss [3][4][5]. Estimates from smaller studies show that around 12% of patients who have a SG will undergo second operation specifically for insufficient weight loss (the all-cause reoperation rate is, of course, slightly higher) [6]. The kinds of reoperations these patients are getting varies widely from single-anastomosis duodenal-ileal bypass (SADI) to repeat sleeve and also includes conversion to RYGB, for which there are a paucity of long-term data. ...
Background
Sleeve gastrectomy to Roux-en-Y bypass conversion is a commonly performed procedure, yet data are limited on outcomes and their predictors. The purpose of this study is to characterize the long-term outcomes of patients after sleeve-to-bypass conversion and identify predictors of post-conversion outcomes.
Methods
We performed a retrospective cohort study of patients who underwent sleeve-to-bypass conversion for obesity across four hospitals from 06/2017 to 04/2023. Predictors of the below-average percent excess weight loss (%EWL; relative to pre-conversion weight) at 1 and 2 years following conversion were identified using multivariate logistic regression models adjusting for comorbidities, demographics, and neighborhood socioeconomic status.
Results
150 Patients undergoing sleeve-to-bypass conversion were identified. 99 had 1-year data and 63 had 2-year data. Mean %EWL at 1- and 2-years following conversion were 40.2% and 37.4%, respectively. EWL > 40% after sleeve gastrectomy was an independent predictor of the below-average %EWL 1-year post-conversion (OR 10.0, 95% CI 2.2–63.0, p < 0.01), and BMI > 40 kg/m² at the time of conversion was an independent predictor of both 1- and 2-year below-average %EWL post-conversion (p = 0.01 and 0.05, respectively). Insignificant predictors of the below-average %EWL after conversion included: weight regain after sleeve, time between sleeve and conversion, alimentary limb length, and any bariatric surgery prior to sleeve gastrectomy.
Conclusion
Patients should be counseled that the typical expected %EWL for sleeve-to-bypass conversion is less than the 50% EWL benchmark of success for index bariatric operations. The main predictors of a suboptimal conversion outcome are > 40% EWL after sleeve or > 40 BMI kg/m² at the time of conversion. Most variables in our analysis were not predictors of post-conversion %EWL, including weight regain between sleeve and conversion, alimentary limb length, and time interval between procedures, which suggests that these factors should not play a large role when considering sleeve-to-bypass conversion.
... Golomb et al. 7 The study revealed that the initial year HT remission rate was 46.3%, while the rate was 55.4% in the conducted study by Noel et al. . 8 The findings we obtained align with the research carried out by Boza et al. 6 The study demonstrated a 62.5% rate of remission of hypertension one year after laparoscopic sleeve gastrectomy, which significantly differed from the outcomes of previous studies. A study conducted by Srinivasa et al. 9 The study revealed that 83% of the individuals achieved a 29% reduction in symptoms and a 48% enhancement in hypertension after one year after receiving LSG (laparoscopic sleeve gastrectomy) and D'Hondt et al. 10 An individual reported a 95% resolution or improvement in their hypertension status one year after undergoing laparoscopic sleeve gastrectomy (LSG). ...
... 14.8% of patients had partial remission, 37.1% exhibited improvement, and 3.7% had no change in their diabetes status. The literature revealed a first-year remission rate of 50.7% by Golomb et al. 7 and 43.4% by Noel et al. 8 Our study found a substantial decrease in HbA1C levels three, six, and twelve months after the surgery. The median HbA1C values at three, six, and twelve months were 6.3, 5.9, and 5.6, respectively, compared to a median preoperative value 6.7. ...
... Several studies have shown the outcome of LSG as a standalone procedure in terms of weight loss sustainability over an extended follow-up period. In 5 years from LSG, Noel and colleagues reported a %EBMIL of 76%, and Sieber et al. reached a %EBMIL of 57.4% [45,46]. Recent studies are reporting a long-term outcome of LSG with a sustainable %EBMIL rate of 54.4% [47]. ...
Background
Controversy regarding the timing of pregnancy and its implications is present in the literature.
Objective
To evaluate the midterm outcome of weight loss in women who have undergone laparoscopic sleeve gastrectomy (LSG) followed by pregnancy at two different times.
Methods
We retrospectively reviewed 53 women who matched the inclusion criteria and included them in the analysis. Demographics and anthropometric measurements were collected. Women who conceived within 12 months of LSG were labeled as early group (EG), and who conceived after 12 months were noted as late group (LG).
Results
There were no differences between the groups regarding obesity-associated disease and number of pregnancies before. EG had higher weight (P = 0.0001) and body mass index (BMI) (P = 0.002) at LSG. The mean interval time for EG was 6.7 ± 3.2 months, and LG was 20 ± 5.2 months. Gestational weight gain (GWG) was lower in the EG (P = 0.001). There were no differences in the number of small for gestational age (SGA) births or gestational weight. In the first 2 years after LSG, LG had a higher percentage of total weight loss (%TWL) and percentage of body mass index loss (%EBMIL) (P < 0.0001). After 5 years of follow-up, %TWL (P = 0.4) and %EBMIL (P = 0.1) were not statistically significant between both groups.
Conclusion
Conception within 12 months from LSG might hinder the weight loss process in the short term but have no significant effect over 5 years of follow-up.
Graphical Abstract
... Together with the updated recommendations, increasing numbers of SGs performed raise discussions on longterm outcomes and weight relapse after surgery. While a considerable number of short-and mid-term follow-up studies highlight the effectiveness of SG in terms of weight management, there remains a scarcity of long-term outcome studies available in the scientific literature [9]. The primary aim of this study is to report on long-term SG outcomes by reporting weight loss/surgery response rates after a follow-up period of at least 5 years. ...
... The heterogeneity in response after SG can be partially explained by the variability in measurements and definitions of weight loss and weight recurrence [9]. In conformity with the multiple validated definitions of weight recurrence and non-responders [12], we used the pre-established definition reported by King et al. which defined surgical non-response as <20% of %TBWL over total follow-up period and weight recurrence as >20% weight regain from nadir postoperative weight [13]. ...
... In our cohort, even though both groups demonstrated weight increase after nadir, patients in the no WR/NR group achieved a %TBWL plateau at the second postoperative year, whereas WR/NR group patients achieved a plateau after 5 consecutive years of mean %TBWL steady increase. Similarly, in a systematic review conducted by Lauti et al., the authors recorded increasing weight recurrence rates from nadir, ranging from 5.7% at 2 years to 75.6% at 6 years [17], an outcome also shown by other studies [9,16]. Our results demonstrated a significant association between %TBWL at 1 year and %TBWL at last follow-up. ...
Introduction
Sleeve gastrectomy (SG) is an effective procedure with remarkable weight loss and low complication rates. However, up to 30% of cases require revisional surgery in non-responders or patients who experience weight recurrence. We aim to report the rate of weight recurrence/non-responders (WR/NR) in patients who underwent SG and had more than 5 years of follow-up.
Methods
We performed a multicenter retrospective study of patients who underwent initial SG from 2008 to 2017. Patient demographics and weight loss outcomes up to 12 years after SG were collected. Surgical non-responders were defined as 20% weight regain compared to maximum weight loss. A chi-square test for categorical variables and a two-sample t-test for continuous variables were used. Data are summarized as mean ± standard deviation.
Results
From a total of 1263 patients, we included 339 patients (78% female, age 47.3 ± 11.2 years; baseline weight 125.8 ± 27.6 kg) with at least 5 years of follow-up (mean follow-up of 7.1 ± 1.8 years) (Table 1). Surgical non-response was demonstrated in 15.9% of patients (n=54) and 64.0% (n=217) had weight recurrence after SG (Fig. 1). There was a statistically significant difference in history of hypertension (p=0.046) and diabetes (p=0.032) as well as %TBWL at 1 year (p=0.005) and at longest follow-up (p<0.001) between patients who experienced WR/NR and those who did not.
Conclusions
Only 20% of patients who underwent SG and followed up for more than 5 years were able to maintain appropriate weight loss.
Graphical Abstract
... Otra revisión sistemática publicada en Cochrane 15 comparó las dos técnicas quirúrgicas con respecto a la pérdida de peso, y se encontró que en los 7 estudios analizados no existieron diferencias estadísticamente significativas a favor o en contra de una de las dos técnicas, resultados congruentes con los obtenidos en nuestra serie. Sin embargo, creemos que se debe interpretar con precaución este hallazgo debido al tiempo de seguimiento, ya que varios estudios con seguimiento a largo plazo (mayor de 5 años) han evidenciado que la pérdida de peso con el BGYR es más duradera comparada con la de los pacientes de MG, quienes presentan mayor reganancia de peso [16][17][18] . El 45 % de los pacientes con BGYR y el 37,9 % de los pacientes con MG resolvieron la HTA, lo cual es superior a lo reportado en la revisión sistemática realizada por Puzziferri en 2014 19 , donde se reportó una mejoría del 38,2 % en el grupo BGYR y 17,4 % en el MG. ...
Introducción.
La cirugía bariátrica es una estrategia válida de tratamiento en obesidad severa. El objetivo de este estudio fue evaluar la reducción de peso y la resolución de comorbilidades comparando dos técnicas quirúrgicas, baipás gástrico en Y de Roux y manga gástrica.
Métodos.
Estudio descriptivo de tipo analítico que incluyó pacientes con obesidad grados II y III. Se analizaron variables demográficas y perioperatorias, y las comorbilidades asociadas a la obesidad. La reducción del peso se evaluó con el porcentaje de pérdida del exceso de peso. Se realizó un análisis descriptivo univariado, usando medianas, rangos intercuartílicos, frecuencias y proporciones. Se usaron las pruebas de U de Mann-Whitney y Chi cuadrado para el análisis de grupos. Un valor de p<0,05 fue considerado estadísticamente significativo.
Resultados.
Fueron incluidos 201 pacientes. La mediana del porcentaje de pérdida del exceso de peso a 18 meses fue de 77,4 % para el grupo de baipás gástrico en Y de Roux vs 69,5 % para el grupo de manga gástrica (p=0,14). La mayoría de los pacientes presentaron resolución o mejoría de la hipertensión arterial (76 %), diabetes mellitus (80 %), dislipidemia (73 %), apnea del sueño (79 %) y artropatías (94 %), sin diferencia significativa según la técnica quirúrgica empleada. La tasa de complicaciones mayores fue del 1,9 %. No se presentó mortalidad. La mediana de seguimiento fue 28 meses.
Conclusión.
El baipás gástrico en Y de Roux y la manga gástrica son procedimientos muy seguros y efectivos para la reducción del exceso de peso y la resolución de las comorbilidades asociadas a la obesidad.
... Currently, 10 to 20% of patients undergo revisional surgery for WR [15]. The results of revisional surgery, such as gastric pouch resizing or changes to bile or alimentary loop lengths, are relatively disappointing with variable weight loss results. ...
Bariatric surgery (BS) is currently the most effective treatment for obesity, with long-lasting weight loss and improvement of related co-morbidities [...]
... In terms of long-term follow-up, no RCTs on the remission/improvement of T2DM have been published till date; however, several long-term cohort studies are available. For example, in a study by Noel et al. [20] including 168 patients, 8 years after SG, 43.4% had T2DM remission. Castagneto Gissey et al. [21] reported a remission rate of 64.7% in 144 patients and a low conversion rate of only 2% to another bariatric procedure in a 10-year follow-up. ...
... Kikkas et al. [36] reported 61.5% of OSA remission after 5 years of SG; however, the sample size was very low in this study as only 15.1% of the total collective had OSA preoperatively. A mid-to longterm outcome study of SG by Noel et al. [20] reported a 72.4% remission rate after 8 years. ...
Obesity is one of the commonest diseases worldwide and tends to increase year by year. Several obesity-related comorbidities are typical conditions of the “metabolic syndrome”: type-2 diabetes mellitus (T2DM), arterial hypertension, hyperlipidemia, obstructive sleep apnea (OSA), nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH), and diseases of bones and joints. Various carcinomas are also associated with obesity. Metabolic surgery, as the most effective therapy for permanent weight loss, has a major part in the improvement and remission of the abovementioned comorbidities. This chapter will discuss the outcomes of comorbidities in short-, mid-, and long-term follow-up periods after sleeve gastrectomy (SG). The available data regarding T2DM remission after SG seems valid due to a number of existing randomized controlled trails. Overall, the remission rate ranges from 30% to 70% in the existing studies. Also, studies focusing on the remission of arterial hypertension, hyperlipidemia, and OSA after SG report constant results from short-, over mid-, to long-term studies. SG also helps to rapidly improve NAFLD, NASH, and even fibrosis; however, bariatric surgery (especially strong malabsorptive procedures) in patients with progressed liver disease (e.g., fibrosis) may induce further liver damage with severe liver failure in rare cases. Symptoms related to the bones and joints, such as pain or constrained movement, improve after SG; nevertheless, once damaged, joints cannot regenerate. Some studies have reported that hormone-related cancers as well as some other types of cancer may decrease with SG. Only a small number of studies are available with a follow-up of >10 years; thus, further results on long-term outcomes must be awaited.
... The growing number of weight loss operations all over the world, according to IFSO survey in 2016 total number of procedure, was 700,000 [46], provide enormous data about Bariatric procedures and patients. However, weight regain after bariatric surgery is one of the related topics with a relatively limited number of publications [47]. Long-term results of bariatric patient series reveal that after 2 years postoperatively, patients' rate of losing weight tends to decelerate [48]. ...
Weight regain (WR) after bariatric surgery (BS) is emerging as a common clinical problem due to the increase in the number of procedures performed worldwide. Weight regain is defined as regain of weight that occurs few years after the bariatric procedure and successful achievement of the initial weight loss. Causes of WR following BS are multifactorial and can be categorized into two main groups: patient and surgical-specific causes. Several mechanisms contribute to WR following BS. These include hormonal mechanisms, nutritional non-adherence, physical inactivity, mental health causes, maladaptive eating, surgical techniques, and the selection criteria for the weight loss procedure. Higher preoperative BMI seems to be associated with WR and worse weight loss results in a long term. Patients with baseline BMI ≥ 50 kg/m2 are more likely to have significant WR, while those with BMI < 50 are likely to continue losing weight at 12 months post-surgery. The aim of the chapter is to discuss and reveal all main factors, which may contribute to weight regain after bariatric surgery and emphasize how multifactorial assessment and long-term support/follow-up of patients by key medical professionals can diminish the side effects of weight regain.
... Weight regain after SG is multi-factorial, but a major role is possibly played by the elasticity of gastric tissue, which eventually results in distension and dilatation ultimately approximating normal stomach size. Gastric banding is performed by placing a semi-horizontal band that causes a partial obstruction of the gastric lumen and requires intense follow-up, adjustments, and maintenance for success, which is reported to be much lower compared to other procedures [7,8]. ...
PurposeSleeve gastrectomy, the most commonly performed bariatric surgery procedure, carries limitations both short term including postoperative complications such as hemorrhage and gastric fistula and long term such as weight regain and gastroesophageal reflux. A new procedure has been proposed to overcome many of these limitations: laparoscopic vertical clip gastroplasty (LVCG) with BariClip.Materials and Methods
Fifty patients were offered LVCG and enrolled for a feasibility study in two referral bariatric centers. Indication was given as for sleeve gastrectomy, after a multidisciplinary path evaluating age, gender, BMI, comorbidities, eating behaviors, and gastroesophageal reflux. The primary outcome was major postoperative complications. Secondary outcomes included weight loss, incidence of de-novo GERD, and comorbidity resolution.ResultsPatients had a mean age of 44 years and mean BMI of 37 kg/m2 ± 6.2. All procedures were performed successfully in laparoscopy, with no conversion or intraoperative adverse events. The overall major postoperative complication rate was 6%. Re-operation was required in three patients for slippage. No mortality occurred. Excess weight loss, excess BMI loss, and total weight loss at 6 months were 36%, 57%, and 22%, respectively. There was no instance of de-novo GERD. Resolution of hypertension occurred in 50% of cases, OSAS in 65% of cases, and DMII in 80% of cases.Conclusion
The safety of LVCG procedure has been reproduced in a multicentric, multi-surgeon study. Weight loss outcomes appear promising. A randomized trial is needed to fully assess the benefits of LVCG.Graphical Abstract
