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Sleeve gastrectomy long-term follow-up revealed weight regain
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Long-term follow-up of individuals who underwent laparoscopic sleeve gastrectomy revealed significant weight regain and a decrease in remission rates of diabetes, according to recent study findings published in JAMA Surgery.
“The choice of bariatric procedure currently depends on the surgeon’s preference, and there are few objective data to compare the different approaches and their impact on specific comorbidities,” the researchers wrote. “This information is crucial to allow patients and physicians choose the most appropriate procedure according to the specific needs of each patient.”
Andrei Keidar , MD, of Beilinson Hospital in Israel, and colleagues evaluated 443 adults who underwent laparoscopic sleeve gastrectomy between April 2006 and February 2013 to determine the long-term effects of the surgery on weight loss, diabetes, hypertension, dyslipidemia and hyperuricemia. The main outcomes measured were excess weight loss, obesity-related comorbidities and partial and complete remission at 1, 3 and 5 years of follow-up.
More than half of participants (50.7%) had maintained complete remission of diabetes at 1 year followed by 38.2% at 3 years and 20% at 5 years. Hypertension remission was maintained in 46.3% of participants at 1 year, 48% at 3 years and 45.5% at 5 years.
Percentage of excess weight loss was greatest at 1 year (76.8%) followed by 3 years (69.7%) and 5 years (56.1%).
Significant changes in HDL cholesterol and triglycerides were found between the preoperative and postoperative levels (P < .001). LDL cholesterol also significantly decreased at 1 year (P = .04) and 3 years (P = .04), but this was no longer significant at 5 years (P = .33).
“The results of this analysis demonstrated that [percentage of excess weight loss] decreased with longer follow-up,” the researchers wrote. “Furthermore, partial and complete remission rates of [type 2 diabetes] were significantly lower when follow-up was longer. Undergoing [laparoscopic sleeve gastrectomy] induced a reduction in [percentage of excess weight loss] and a major improvement in obesity-related comorbidities in the short-term. The longer follow-up data revealed weight regain and a decrease in remission rates for [type 2 diabetes] and other obesity-related comorbidities. These data should be taken into consideration in the decision-making process for the most appropriate operative for a given obese patient.”
In an accompanying editorial, Anita P. Courcoulas, MD, MPH, of the University of Pittsburgh Medical Center, wrote that it is still unclear if current studies will address questions about long-term outcomes following bariatric surgery.
Anita P. Courcoulas
“These critical gaps in knowledge post a significant problem for people considering a potential surgical option to treat severe obesity,” she wrote. “Contributing to these deficits are the paucity of comparative trials, incomplete follow-up, a lack of standardized definitions for changes in health status (eg, diabetes mellitus remission), and the tendency to a rush to judgment in favor of surgical treatment options.” – by Amber Cox
Disclosure: Courcoulas reports various financial ties with Apollo Endosurgery, Covidien, Ethicon and Nutrisystem.
Perspective
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Sangeeta Kashyap, MD
This retrospective analysis from Israel supports that laparascopic sleeve gastrectomy in the short-term is effective for inducing excess weight loss and treatment of type 2 diabetes and hyperlipidemia in obese patients. However, the long-term durability of benefits of laparoscopic sleeve gastrectomy is a concern since the effectiveness declines from year 1 to year 5. Given this scenario, clinicians need to consider the severity of obesity and obesity related co-morbidities in choosing laparoscopic sleeve gastrectomy vs. a partially malabsorptive procedure such as Roux-en-Y gastric bypass. However, for patients with milder forms of obesity and type 2 diabetes, laparoscopic sleeve gastrectomy may be preferable to gastric bypass without having to endure lifelong nutritional deficiencies related to malabsorption from intestinal bypass procedures. Laparoscopic sleeve gastrectomy is still a reasonable option for many obese patients who are willing to accept some improvements in their comorbidities rather than remission.
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