Long-Term Outcomes of Laparoscopic Sleeve Gastrectomy—a
Single-Center, Retrospective Study
Introduction Sleeve gastrectomy (LSG) is one of the most
popular bariatric procedures. We present our long-term results
regarding weight loss, comorbidities, and gastric reflux
Material and Methods We identified patients who underwent
LSG in our institution between 2006 and 2009. We revised the
data, and the patients with outdated contact details were
tracked with the national health insurance database and social
media (facebook). Each of the identified patients was asked to
complete an online or telephone survey covering, among
others, their weight and comorbidities. On that basis, we calculated the percent total weight loss (%TWL) and percent
excess weight loss (%EWL), along with changes in body mass
index (ΔBMI). Satisfactory weight loss was set at >50% EWL
(for BMI = 25 kg/m2
). We evaluated type 2 diabetes (T2DM)
and arterial hypertension (AHT) based on the pharmacological therapy. GERD presence was evaluated by the typical
symptoms and/or proton pump inhibitor (PPI) therapy.
Results One hundred twenty-seven patients underwent LSG
between 2006 and 2009. One hundred twenty patients were
qualified for this study. Follow-up data was available for 100
participants (47 female, 53 male). Median follow-up period reached 8.0 years (from 7.1 to 10.7). Median BMI upon qualification for LSG was 51.6 kg/m2
. Sixteen percent of patients
required revisional surgery over the years (RS group), mainly
because of insufficient weight loss (14 Roux-Y gastric bypass—LRYGB; one mini gastric bypass, one gastric banding).
For the LSG (LSG group n = 84), the mean %EWL was
51.1% (±22.3), median %TWL was 23.5% (IQR 17.7–
33.3%), and median ΔBMI was 12.1 kg/m2 (IQR 8.2–17.2).
Fifty percent (n = 42) of patients achieved the satisfactory
%EWL of 50%. For RS group, the mean %EWL was 57.8%
(±18.2%) and median %TWL reached 33% (IQR 27.7–
37.9%). Sixty-two percent (n = 10) achieved the satisfactory
weight loss. Fifty-nine percent of patients reported improvement in AHT therapy, 58% in T2DM. After LSG, 60%
(n = 60) of patients reported recurring GERD symptoms and
44% were treated with proton pomp inhibitors (PPI). In 93%
of these cases, GERD has developed de novo.
Conclusions Isolated LSG provides fairly good effects in a
long-term follow-up with mean %EWL at 51.1%. Sixteen
percent of patients require additional surgery due to insufficient weight loss. More than half of the subjects observe improvement in AHT and T2DM. Over half of the patients complain of GERD symptoms, which in most of the cases is a de
Laparoscopic sleeve gastrectomy (LSG) was introduced as
preliminary bariatric procedure for superobese patients, whose
BMI exceeded 50 kg/m2 . Its purpose was to achieve substantial weight loss, therefore lowering the rate of possible complications during the second, more extensive procedure,
such as Duodenal Switch or Laparoscopic Roux-en-Y Gastric
Bypass . Yet the results of LSG concerning excessive
weight-loss, co-morbidities, and postoperative shift in the
American Society of Anesthesiologists (ASA) physical classification score have changed bariatric surgeons’ approach to
LSG as a sole bariatric procedure [3–5]. The worldwide popularity of LSG increased from 4.5% of all bariatric procedures
in 2008 to 37% in 2013, and it became the most popular
operation in the USA in 2015 [6–8]. First results regarding
the long-term outcomes of LSG are being published, yet there
is still a need for longer follow-up (exceeding 5 years) with
smaller lost-to-follow up ratio [9, 10]. Since our institution is
the leading center for bariatric surgery in the country, with
over 300 operations performed each year , we would like
to present our results regarding long-term outcomes of LSG.
The aim of this study was to evaluate long-term clinical outcomes of laparoscopic sleeve gastrectomy regarding weight
loss, comorbidities, physical activity, and complaints of gastroesophageal reflux disease (GERD).
Materials and Methods
The study was approved by our Institution’s Review Board.
Our institution database was revised for the records of patients
who underwent LSG as a one-stage procedure between 2006
(when we started our sleeve gastrectomy program) and 2009.
We gathered the data on their weight, body mass index (BMI),
and co-morbidities. The patients who did not fulfill their
check-ins and whose personal data was outdated were tracked
using the national health insurance database, or found and
contacted privately using social media (Facebook) and its support groups. The rest of the patients were contacted by phone.
Every participant filled out a questionnaire regarding their
current weight, medical history, physical activity habits—
expressed by regular (minimum three times-a-week), over
30-min exercise routine, and sedentary behavior, assessed by
hours spent siting down on a daily basis.
Evaluation of the Outcomes
To measure the effectiveness of the procedure, we calculated
the percentage total weight loss (%TWL), percentage excess
weight loss (%EWL), and change in body mass index
To obtain the excess weight (EW), we subtracted ideal
body weight (IBW) for BMI of 25 kg/m2 from the weight
before surgery. Satisfactory weight loss after the surgery was
defined by the %EWL greater than 50%.
GERD presence was evaluated by the typical symptoms
and/or proton pump inhibitor (PPI) therapy, according to the
latest guidelines . The questions regarding typical symptoms (such as postprandial heartburn, regurgitation, chronic
cough) were included in the survey.
We evaluated type 2 diabetes (T2DM) and arterial hypertension (AHT), the two major obesity related comorbidities,
based on the pharmacological therapy—whether it was ceased
after the surgery, the doses or number of drugs administered
changed, or no changes were observed.
Based on our results, LSG may be considered a fairly effective
bariatric procedure, with mean %EWL of 51.1% at an 8-year,
long-term follow-up. Forty-two percent of patients achieved
the satisfactory weight loss of over 50% EWL only after LSG
(rev. 2 note 3) and 16% of the patients required conversion to
other procedure due to insufficient weight loss. This fact may
urge on a more thorough and meticulous follow up. Fifty-nine
percent of patients reported improvement in AHT therapy,
58% in T2DM. We conclude that there is a high rate of
GERD symptoms after LSG, which requires further studies
and may alter our perspective on patient selection and the