Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

Abstract

Aim: To prospectively evaluate the postoperative morbi-mortality and weight loss evolution of patients who underwent a laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure during 5 years of follow-up.

Methods: Since 2006, data from patients undergoing a highly restrictive primary LSG have been prospectively registered in a database and analysed. Preoperative co-morbid conditions, operating time, hospital stay, early and late complications rate and evolution of weight loss after 5 years of follow-up were analysed.

Results: A total of 156 patients were included, 74.3% of whom were women. The mean age was 43.2 ± 13.1 years and the mean body mass index (BMI) was 41.5 ± 7.9 kg/m². Seventy patients (44.8%) presented a BMI under 40 kg/m². The mortality rate was 0%. The leakage rate was 1.2%, and the total 30-d morbidity rate was 5.1% (8/156). With a mean follow-up of 32.7 ± 28.5 (range 6-112) mo, the mean percent of excess of weight loss (%EWL) was 82.0 ± 18.8 at 1 year, 76.7 ± 21.3 at 3 years and 60.3 ± 28.9 at 5 years. The mean percent of excess of BMI loss (%EBMIL) was 94.9 ± 22.4 at 1 year, 89.4 ± 27.4 at 3 years and 74.8 ± 29.4 at 5 years. Patients with preoperative BMI less than 40 kg/m² achieved greater weight loss than did the overall study population. Diabetes remitted in 75% of the patients and HTA improved in 71.7%. CPAP masks were withdrawn in all patients with obstructive sleep apnoea.

Conclusion: LSG built with a narrow 34 F bougie and starting 3 cm from the pylorus proved to be safe and highly effective in terms of weight loss as a stand-alone procedure, particularly in patients with a preoperative BMI lower than 40 kg/m².

Keywords: 5-year results; Bariatric surgery; Laparoscopy; Long-term results; Morbid obesity; Obesity surgery; Sleeve gastrectomy.

Figure 1

Specimen after sleeve gastrectomy. The whole fundus had to be removed. Stapler firings must be properly aligned to avoid excessive narrowing of the sleeve and functional obstruction due to rotation.

Figure 2

Evolution of body mass index, excess weight loss and excess body mass index loss during the follow-up. BMI: Body mass index; %EWL: Percent of excess weight loss; %EBMIL: Percent of excess body mass index loss.

Figure 3

Excess weight loss evolution and excess body mass index loss evolution according to preoperative body mass index. Patients with a preoperative BMI under 40 kg/m² achieve better results after 5-year of follow-up. BMI: Body mass index; %EWL: Percent of excess weight loss; %EBMIL: Percent of excess body mass index loss.