FROM JAMA SURGERY
Five years after laparoscopic sleeve gastrectomy, patients will have, on average, about half of their preop excess weight, according to an Israeli investigation published online Aug. 5 in JAMA Surgery.
Things went better at first for the 443 patients in the study; at 1 year follow-up, they had lost, on average, 76.8% of their excess weight, but then it started to come back. At 3 years, patients were free of 69.7% of their excess weight, and at 5 years, just 56.1%. The failure rate – the number of patients with a percentage of excess weight loss less than 50% – increased from 13.3% at 1 year to 21.1% at 3 years and 38.5% at 5 years (JAMA Surg. 2015 Aug. 5. doi:10.1001/jamasurg.2015.2202).
The story was similar for obesity-related comorbidities; early gains eroded with time. Complete remission of diabetes, for instance, was maintained by 50.7% of patients at 1 year, 38.2% at 3 years, and just 20.0% at 5 years. Likewise, a drop in LDL cholesterol from baseline was significant at years 1 and 3, but not 5. Meanwhile, laparoscopic sleeve gastrectomy (LSG) didn’t significantly improve total cholesterol over baseline, and triglyceride improvements began to fade after year 1.
“In our opinion, the presence of obesity-related comorbidities should play a major role when choosing the appropriate procedure for a specific patient. For example, performing an operation that yields a low resolution rate of hyperlipidemia translates into lifelong medical treatment in a young patient with significant hyperlipidemia. In that case, a malabsorptive procedure might be more beneficial than LSG. If the recurrence of obesity is known to be followed by the remittance of an existing comorbidity in a specific procedure, an alternative procedure should be considered. The weight loss durability failure of almost 40% at 5 years of follow-up of LSG should be one of the deciding factors in such cases,” said senior investigator and bariatric surgeon Dr. Andrei Keidar of Beilinson Hospital in Petah Tikva, Israel, and his colleagues.
LSG is becoming more popular in part because it’s easier to learn and less disruptive than gastric bypass, but there are not enough data on long-term outcomes; the investigators sought to fill the gaps.
The average age in the study was 42.2 years; mean body mass index was 43.9 kg/m2, and mean preop excess weight was 51.2 kg. The majority of subjects were women. The operations were performed from 2006 to 2013, and there was considerable loss to follow-up during the project.
Baseline triglycerides followed overall trends with a drop from a mean of 155.2 mg/dL to 106.3 mg/dL at year 1, followed by a tick upward to 107.2 mg/dL at year 3 and 126.4 mg/dL at year 5.
The mean preop HDL cholesterol of 46.7 mg/dL rose to 52.8 mg/dL at year 1 and remained at about that level at 5 years. Improvements in hypertension were fairly durable, as well, with remission in 46.3% of patients at 1 year, 48.0% at 3 years, and 45.5% at 5 years.
“Surprisingly, our results showed that none of the changes in obesity-related comorbidity status correlated with” the amount of “excess weight prior to the surgery,” the investigators noted.
The authors didn’t compare LSG to other bariatric surgeries, but did note that in 2012, the American Society for Metabolic and Bariatric Surgery found that short-term weight loss and improvement in comorbidities was better with LSG than with Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric bypass. On the other hand, RYGB has been found to beat LSG on lipid fraction improvements and short term control of type 2 diabetes.
The investigators had no disclosures.
