LAPAROSCOPIC SLEEVE GASTRECTOMY: LONG-TERM OUTCOMES ON WEIGHT LOSS, GERD AND DIABETES

Background: Laparoscopic Sleeve Gastrectomy (LSG) is an effective and relatively safe bariatric procedure, but long-term results are still rare. Our aim was to evaluate the efficacy of LSG on weight loss, gastroesophageal reflux symptoms and Type 2 Diabetes. Methods: Medical records of all 105 patients undergoing SG at our Institution between 2006 and 2009 were retrospectively examined. Long-term outcomes were analyzed in terms of BMI, %TWL, %EWL, comorbidities resolution and revisional surgery. According to the preoperative BMI, patients were divided in two groups: Group 1 (n=61) BMI<50kg/m2 and Group 2 (n=44) BMI≥50Kg/m2. We considered as surgical success the achievement of a BMI<35kg/m2 for Group 1 and of a BMI<40kg/m2 for group 2. Results: Group 1 (72% female, mean age 39.9 years old) presented a mean preoperative BMI of 41.2±4.7kg/m2 and Group 2 (52% female, mean age 38.5 years old) a BMI of 57.2±3.6kg/m2 . No difference was found in the preoperative prevalence of hypertension, dyslipidemia, T2DM, GERD symptoms between the two groups. The follow-up rate was 94.2% after 5 years (n=99). At 5th year, Group 1 showed a mean BMI 30.1±4.8kg/m2 , a %TWL of 26.6±10, and %EWL of 58.4±21.8. Group 2 had a mean BMI of 37.8±8.3kg/m2 , %TWL 33.4±12.9, %EWL 53.9±22.4. Surgical success was achieved in 85% of patients of Group 1 and 63% of patients of Group 2. Comorbidities improved considerably: resolution of hypertension was achieved in 64% of patients, of dyslipidemia in 69% of patients, resolution (complete or partial) of T2DM in 90% of patients. At 5 years of follow-up, diabetic patients showed a significantly lower weight loss when compared to non-diabetic patients (%EWL: 44±19, p=0.007 vs non-diabetic subjects). GERD symptoms improved in 73.3% of patients of Group 1 and in 44.4% of patients of Group 2, with a new onset of GERD in 15% of patients of Group 1 and 7.7% of patients of Group 2. Nine patients (9,1%) underwent revisional surgery for poor weight loss outcomes or severe GERD symptoms. Conclusion: SG is an effective procedure in terms of weight loss outcomes and remission of comorbidities, more evident in patients with a preoperative BMI