Laparoscopic sleeve gastrectomy in Asia: Long term outcome and revisional surgery

• Main Authors: Eng-Hong Pok, Wei-Jei Lee, Kong-Han Ser, Jung-Chien Chen, Shu-Chun Chen, Ju-Juin Tsou, Kin-Fah Chin
• Format: Article
• Language: English
• Published: Elsevier 2016-01-01
• Series: Asian Journal of Surgery
• Subjects: gastro-esophageal reflux; long-term outcome; morbid obesity; sleeve gastrectomy; revision
• Online Access: http://www.sciencedirect.com/science/article/pii/S1015958415000378

Background: Laparoscopic sleeve gastrectomy (LSG) is a popular stand-alone bariatric surgery, despite a paucity of long-term data. Hence, this study is to report the long-term outcome of LSG as primary bariatric procedure and the result of revisional surgery. Methods: With retrospective analysis of a prospective bariatric database, participants who defaulted clinic follow-up were interviewed by telephone. A total of 667 LSG was performed as primary bariatric procedure (2006–2012) with mean age of 34.5 ± 9.7 years old, female 74.7%, mean body mass index (BMI) 37.3 ± 8.1 kg/m2. A 36-F bougie was used for all cases. Results: There were 61 patients available with long-term data. The weight loss outcome at 1 year, 2 years, 3 years, 4 years, and 5 years showed a mean BMI 26.3, 25.2, 25.3, 27.1, and 26.2 with mean excess weight loss (EWL) 76.0%, 79.6%, 77.3%, 73.4%, and 72.6% respectively. However, 17% patients developed de novo gastro-esophageal reflux disease (GERD). Eighteen patients (2.2%) needed surgical revisions due to weight regain (n = 6), persistent type 2 diabetes mellitus (T2DM; n = 2), stricture (n = 2), and GERD (n = 8). The revision resulted in an additional mean excess weight loss of 23.8% with mean BMI 24.9 kg/m2 at 6 months postoperatively. There was a 23.7% mean reduction of HbA1c with one patient who was in complete diabetic remission at 1 year. Conclusion: Our results showed LSG is a durable bariatric procedure with > 70% EWL at 5 years despite a high incidence of GERD. The need for revision of LSG is low and mainly for GERD.