番茄社区

Obese patients who have laparoscopic sleeve gastrectomy keep the weight off in the long run, researchers found.

In a single-center study, patients who underwent the procedure lost an average 57.4% of excessive body mass index (BMI) over 5 years, Ralph Peterli, MD, of Claraspital in Basel in Switzerland, and colleagues reported online in the journal Surgery for Obesity and Related Diseases.

Laparoscopic sleeve gastrectomy, first developed about a decade ago, "was initially intended to be a primary intervention in high-risk patients before laparoscopic Roux-en-Y gastric bypass or as the first step of biliopancreatic diversion duodenal switch," the authors noted in their introduction. But evidence has been mounting that sleeve gastrectomy itself is an effective surgery for weight loss.

Indeed, joint guidelines from the American Association of Clinical Endocrinologists, the Obesity Society, and the American Society for Metabolic and Bariatric Surgery were upgraded to reflect the utility of the procedure.

But there is still a dearth of long-term evidence for its benefit -- one reason Peterli and colleagues conducted a retrospective analysis of a cohort from their facility that had a minimum of 5 years' follow-up.

A total of 68 patients had laparoscopic sleeve gastrectomy at their center as either a primary bariatric procedure or as a re-operation after failed laparoscopic gastric banding between August 2004 and December 2007.

At the time of sleeve gastrectomy, mean BMI was 43 and 78% of patients were female. They had a mean follow-up of 5.9 years.

Overall, Peterli and colleagues found that the average excessive BMI lost after 1 year was 61.5%, and then 61.1% after 2 years.

By 5 years, average excessive BMI lost was 57.4%, they reported.

Those losses correspond with a BMI reduction of 12.6 kg/m², 12.4 kg/m², and 11.2 kg/m², respectively.

"The main weight loss occurred in the first postoperative year and appeared in the following years for the most part stable," they wrote.

However, 34.3% of patients who had sleeve gastrectomy as their primary procedure and 50% of those who'd had it after a failed gastric banding still had a BMI above 35 kg/m² after 5 years.

"Patients with a prior [gastric banding] show worse results concerning weight loss," they wrote, noting, however, that international consensus considers Roux-en-Y gastric bypass [RYGB] surgery as the best option following failed banding, not sleeve gastrectomy.

The study also showed that comorbidities improved considerably, with remission of type 2 diabetes in most of the patients who had the disease before the procedure.

Among four insulin-dependent patients, only one still needed insulin therapy 5 years after laparoscopic sleeve gastrectomy. Two were able to switch to oral antidiabetic therapy, while one remained in full remission at 5 years, they reported.

In terms of complications, one patient had a leak, two had incisional hernias -- which were deemed unrelated to treatment -- and 11 patients had new onset gastroesophageal reflux disease, which typically resolved with proton pump inhibitor therapy.

Over 5 years of follow-up, 77.9% of patients developed vitamin D deficiency, 41.2% had iron deficiency, 39.7% had zinc deficiency, 39.7% had a vitamin B12 deficiency, 25% had a folic acid deficiency, and 10.3% developed anemia.

These deficiencies occurred "despite routine supplementation, in a higher rate than we had expected," the researchers wrote.

They also found that re-operation due to insufficient weight loss was needed in eight patients, or 11.8% of the study population.

But they concluded that sleeve gastrectomy is effective nearly 6 years after the initial operation, with nearly 60% of excessive BMI still gone and a "considerable improvement or even remission" of comorbidities.

"Although sleeve gastrectomy was initially only carried out as the first part of a two-step procedure," they wrote, "we could show that a rather small percentage needed a second-line procedure ... for treatment of insufficient weight loss."

Comment