Sleeve gastrectomy: 5-year outcomes of a single institution

doi:10.1016/j.soard.2012.08.014

Surgery for Obesity and Related Diseases

Volume 9, Issue 1, January–February 2013, Pages 21-25

https://doi.org/10.1016/j.soard.2012.08.014 Get rights and content

Abstract

Background

Laparoscopic sleeve gastrectomy (SG) is the most recent bariatric surgical procedure to gain universal acceptance by providers and payers. Long-term clinical data on outcomes is limited at this time.

Methods

We retrospectively examined 5-year outcomes (weight loss, complications, and resolution of co-morbid conditions) of patients undergoing SG at our institution.

Results

Our initial SG was performed in 2005, and we operated on 55 consecutive patients who are 5 years out from surgery. Six patients were excluded from the long-term results. Four patients underwent conversion to a duodenal switch, and 2 patients died in the first year outside the perioperative period. Average starting body mass index was 65 kg/m². Five-year average percent excess weight loss was 86% (range 50%–103%). Percentage of co-morbidities resolved: hypertension (95%), type 2 diabetes mellitus (100%), hyperlipidemia (100%), and obstructive sleep apnea (100%). Gastroesophageal reflux disease (GERD) was resolved in 53%, and new GERD symptoms developed in 11% of patients. There was 1 staple line leak (1.9%), no strictures, no gastrointestinal bleeding, and no perioperative deaths.

Conclusion

In this study, SG is a well-tolerated and effective bariatric surgical procedure with good long-term weight loss and resolution of co-morbid medical conditions.

Section snippets

Methods

We performed a retrospective chart review of patients who underwent SG starting in 2005 and report our 5-year clinical outcomes (weight loss, complications, and resolution of co-morbid conditions). All patients consented preoperatively to the collection of data in a prospective database, which was analyzed retrospectively. The study was submitted to the hospital institutional review board for approval before analysis of data.

The diagnosis of arterial hypertension was defined by a blood

Results

We started performing SG in 2005 and have 55 patients who are 5 years out from surgery. This encompasses operating dates from January 2005 to December 2006. As of October 2011, we have performed a total of 276 SG procedures, although only patients who are 5 years out from surgery were included in this study. No patients were lost to follow-up . Six patients were excluded from the data; 4 were converted to duodenal switch at 2 years, and 2 died outside the perioperative period in the first year

Discussion

The most recent compilation of data regarding SG was collected and published in 2011 by Deitel et al. [5]. The mean %EWL at 5 years was 60%; however, this comprised only 4 studies with long-term data. Those studies, by Santoro [6], Weiner et al. [7], Bohdjalian et al. [8], and Himpens et al. [9], as well as those published more recently by D’Hondt et al. [10], Serela et al. [11], and Strain et al. [12], are summarized in Table 2.

Our cohort of patients had a much higher starting BMI compared

Conclusion

In our experience, SG is an effective bariatric surgical procedure with good long-term (5 year) weight loss (86% EWL) and resolution of co-morbid medical conditions with a low and acceptable safety profile.

Disclosure

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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Cited by (141)

Gastroesophageal reflux after sleeve gastrectomy: The dimension of the problem
2023, Cirugia Espanola
La gastrectomía vertical (GV) es una técnica segura y eficaz que ha demostrado excelentes resultados en relación con la pérdida ponderal y la resolución o mejoría de las comorbilidades más comunes asociadas a la obesidad a largo plazo. Sin embargo, una de las mayores preocupaciones en torno a ella es su presumible condición reflujogénica, no del todo tipificada. Cuestiones como «¿cuál es la historia natural del reflujo gastroesofágico (RGE) en el paciente intervenido de un sleeve gástrico?», «¿cuántos pacientes tras una GV desarrollarán RGE?» y «¿cuántos empeoraran su reflujo previo tras la realización de esta técnica?» pretenden ser abordadas en el presente artículo. Se ha efectuado una revisión sistemática siguiendo las recomendaciones Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), utilizando diversas bases de datos, para intentar dar una respuesta a las anteriores preguntas.
Sleeve gastrectomy is a safe and effective bariatric surgery in terms of weight loss and long-term improvement or resolution of comorbidities. However, its achilles heel is the possible association with the development with the novo and/or worsening of pre-existing gastroesophageal reflux disease. The anatomical and mechanical changes that this technique induces in the esophagogastric junction, support or contradict this hypothesis. Questions such as «what is the natural history of gastroesophageal reflux in the patient undergoing gastric sleeve surgery?», «how many patients after vertical gastrectomy will develop gastroesophageal reflux?» and «how many patients will worsen their previous reflux after this technique?» are intended to be addressed in the present article.
Reflux and Barrett's esophagus after sleeve gastrectomy: analysis of a statewide database
2023, Surgery for Obesity and Related Diseases
Recent studies have suggested that sleeve gastrectomy (SG) is associated with the development of Barrett esophagus (BE) even in the absence of gastroesophageal reflux disease (GERD) symptoms.
The aim of this study was to assess the rates of upper endoscopy and incidence of new BE diagnoses in patients undergoing SG.
This was a claims-data study of patients who underwent SG between 2012 and 2017 while enrolled in a U.S. statewide database.
Diagnostic claims data were used to identify pre- and postoperative rates of upper endoscopy, GERD, reflux esophagitis, and BE. Time-to-event analysis using a Kaplan-Meier approach was performed to estimate the cumulative postoperative incidence of these conditions.
We identified 5562 patients who underwent SG between 2012 and 2017. Of these, 1972 patients (35.5%) had at least 1 diagnostic record of upper endoscopy. The preoperative incidences of a diagnosis of GERD, esophagitis, and BE were 54.9%, 14.6%, and .9%, respectively. The predicted postoperative incidences of GERD, esophagitis, and BE, respectively, were 18%, 25.4%, and 1.6% at 2 years and 32.1%, 85.0%, and 6.4% at 5 years.
In this large statewide database, rates of esophagogastroduodenoscopy remained low after SG, but the incidence of a new postoperative esophagitis or BE diagnosis in patients who underwent esophagogastroduodenoscopy was higher than in the general population. Patients undergoing SG may have a disproportionately high risk of developing reflux complications including BE after surgery.
Impact of concurrent hiatal hernia repair during laparoscopic sleeve gastrectomy on patient-reported gastroesophageal reflux symptoms: a state-wide analysis
2023, Surgery for Obesity and Related Diseases
Concurrent hiatal hernia repair (HHR) during laparoscopic sleeve gastrectomy (LSG) may improve gastroesophageal reflux disease (GERD) symptoms. However, patient-reported outcomes are limited, and the influence of surgeon technique remains unclear.
To assess patient-reported GERD severity before and after LSG with and without concomitant HHR.
Teaching and non-teaching hospitals participating in a state-wide quality improvement collaborative.
Using a state-wide bariatric-specific data registry, all patients who underwent a primary LSG between 2015 and 2019 who completed a baseline and 1 year validated GERD health related quality of life (GERD-HRQL) survey were identified (n = 11,742). GERD severity at 1 year as well as 30-day risk-adjusted adverse events was compared between patients who underwent LSG with or without HHR. Results were also stratified by anterior versus posterior HHR.
A total of 4015 patients underwent a LSG-HHR (34%). Compared to patients who underwent LSG without HHR, LSG-HHR patients were older (47.8 yr versus 44.6 yr; P < .0001), had a lower preoperative body mass index (BMI) (45.8 kg/m² versus 48 kg/m²; P < .0001) and more likely to be female (85.2% versus 77.6%, P < .0001). Patients who underwent a posterior HHR (n = 3205) experienced higher rates of symptom improvement (69.5% versus 64.0%, P = .0014) and lower rates of new onset symptoms at 1 year (28.2% versus 30.2%, P = .0500). Patients who underwent an anterior HHR (n = 496) experienced higher rates of hemorrhage and readmissions with no significant difference in symptom improvement.
Concurrent posterior hiatal HHR at the time of sleeve gastrectomy can improve reflux symptoms. Patients undergoing anterior repair derive no benefit and should be avoided.
Long-term comparative effectiveness of gastric bypass and sleeve gastrectomy on use of antireflux medication: a difference-in-differences analysis
2022, Surgery for Obesity and Related Diseases
Gastroesophageal reflux (GERD) is common among patients with obesity who undergo bariatric surgery. Although gastric bypass and sleeve gastrectomy are the most common bariatric operations performed in the United States, their long-term comparative effectiveness on GERD medication use is unknown.
To compare the long-term effectiveness of gastric bypass and sleeve gastrectomy on use of antireflux medication.
Setting: National cohort undergoing inpatient bariatric surgery.
This is a retrospective study of Medicare beneficiaries undergoing gastric bypass and sleeve gastrectomy between January 1, 2012, and December 31, 2017. A difference-in-differences analysis was conducted to evaluate the differential change in antireflux medication use between groups before and after surgery.
A total of 16,640 patients underwent gastric bypass, and 26,724 patients underwent sleeve gastrectomy. Before surgery, GERD medication use was higher among patients who underwent gastric bypass (62.4%; 95% confidence interval [CI]: 62.0%–63.7%) compared with patients who underwent sleeve gastrectomy (60.1%; 95% CI: 59.3%–60.9%). Five years after surgery, GERD medication use was lower in patients who underwent gastric bypass (47.8%; 95% CI: 46.3%–49.3%) compared with patients who underwent sleeve gastrectomy (53.7%; 95% CI: 50.5%–56.9%). The differential decrease from baseline GERD medication use was greater for patients who underwent gastric bypass at 2 years (–4.1 percentage points [pp]; 95% CI: –1.7 to –6.5 pp), 3 years (–4.3 pp; 95% CI: –1.6 to –7.0 pp), 4 years (–6.9 pp; 95% CI: –4.1 to –9.6 pp), and 5 years (–8.3 pp; 95% CI: –3.7 to 12.8 pp) after surgery.
Though use of antireflux medication decreased following both procedures, gastric bypass was associated with a greater reduction in antireflux medication use 5 years after surgery compared with sleeve gastrectomy. Understanding the long-term comparative effectiveness of these common bariatric operations may better inform treatment decisions among patients and surgeons.
The new onset of GERD after sleeve gastrectomy: A systematic review
2022, Annals of Medicine and Surgery
The main adverse effect is gastroesophageal reflux disease (GERD), with concern on the development of Barrett's esophagus and esophageal adenocarcinoma in the long term. However, the relationship between SG and GERD is complex. The aim of this study is to systematically evaluate all published data existing in the literature to evaluate the effect of sleeve gastrectomy on GERD, esophagitis, BE in order to clarify the long-term clinical sequelae of this procedure.
This systematic review was conducted in accordance with the guidelines for Preferred Reporting Items for Systematic Review. The work has been reported in line with the PRISMA criteria [19]. We evaluated the quality and risk of bias of this Systematic Review using AMSTAR 2 checklist [20]. Published studies that contained outcome data for primary sleeve gastrectomy associated with the primary and secondary outcomes listed below were included. The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05178446 for the Organization UFoggia.
49 articles were eligible for inclusion that met the following criteria: publications dealing with patients undergoing laparoscopic SG, publications describing pre- and postoperative GERD symptoms and/or esophageal function tests, articles in English, human studies and text complete available.
We have controversial data on LSG and GERD in the literature as there is a multifactorial relationship between LSG and GERD. The most recent studies have shown satisfactory control of postoperative reflux in most patients and low rates of de novo GERD. These data are leading to wider acceptance of LSG as a bariatric procedure even in obese patients with GERD.
Assessment and management of gastroesophageal reflux disease following bariatric surgery
2021, Surgery for Obesity and Related Diseases
Gastroesophageal reflux disease (GERD) is a common disease in patients with obesity. The incidence of de novo GERD and the effect of bariatric surgery on patients with pre-existing GERD remain controversial. Management of GERD following bariatric surgery is complicated and can range from medical therapy to non-invasive endoscopic options to invasive surgical options. To address these issues, we performed a systematic review of the literature on the incidence of GERD and the various modalities of managing GERD in patients following bariatric surgery. Given the increased number of laparoscopic sleeve gastrectomy (LSG) procedures being performed and the high incidence of GERD following LSG, bariatric surgeons should be familiar with the options available to manage GERD following LSG as well as other bariatric procedures.

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Original articleSleeve gastrectomy: 5-year outcomes of a single institution

Abstract

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Disclosure

Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications

Surg Endosc

Laparoscopic sleeve gastrectomy for morbid obesity

Am J Surg

Two-step laparoscopic duodenal switch for superobesity: a feasibility study

Surg Endosc

International Sleeve Gastrectomy Expert Panel. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of>12,000 cases

Surg Obes Relat Dis

Third International Summit: current status of sleeve gastrectomy

Surg Obes Relat Dis

Technical aspects in sleeve gastrectomy

Obes Surg

Laparoscopic sleeve Gastrectomy—influence of sleeve size and resected gastric volume

Obes Surg

Sleeve Gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin

Obes Surg

Longterm results of laparoscopic sleeve gastrectomy for obesity

Ann Surg

Original article
Sleeve gastrectomy: 5-year outcomes of a single institution