Although laparoscopic sleeve gastrectomy yielded weight loss and improvements in obesity-related comorbidities in patients who underwent the procedure, researchers observed significant weight regain and a drop in diabetes remission rates over time.

“Bariatric procedures are reportedly the most effective strategy to induce weight loss compared with nonsurgical interventions. Laparoscopic sleeve gastrectomy is a common and efficient bariatric procedure with increasing popularity in the Western world during the last few years,” the researchers wrote in JAMA Surgery.

However, intermediate and long-term data on the procedure are scarce. Because the patient population undergoing bariatric surgery is relatively young, the absence of this information is important, they added.


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For the study, the researchers performed a retrospective analysis of a prospective cohort on all patients (n=443) undergoing laparoscopic sleeve gastrectomy at a university hospital from April 2006 to February 2013.

Main outcome measures included excess weight loss, obesity-related comorbidities and partial and complete remission at 1, 3 and 5 years of follow-up.

At 1, 3 and 5 years, complete data were available for 54.4%, 49.4% and 69.6% of patients, respectively, according to the researchers.

Results showed that the percentage of excess weight loss was 76.8% at 1 year, 69.7% at 3 years and 56.1% at 5 years after laparoscopic sleeve gastrectomy.

In terms of obesity-related comorbidities, the researchers observed improvements in remission of diabetes and hypertension that decreased over time. Specifically, at 1, 3 and 5 years, complete remission of diabetes was maintained in 50.7%, 38.2% and 20.0% of patients, and remission of hypertension was maintained in 46.3%, 48.0% and 45.5%.

Data also indicated that decreases in LDL cholesterol were significant at 1 and 3 years (P=.04 for both) but not at 5 years (P=.33), while total cholesterol was not significant at 1, 3 or 5 years.

The researchers found that changes in comorbidity status did not correlate with preoperative excess weight with the exception of hypertriglyceridemia whose partial and complete remission rates (80.6% and 72.2%, respectively) correlated with the percentage of excess weight loss (76.8%; P=.005).

“The longer follow-up data revealed weight regain and a decrease in remission rates for type 2 diabetes mellitus and other obesity-related comorbidities. These data should be taken into consideration in the decision-making process for the most appropriate operation for a given obese patient,” the researchers wrote.

In an invited commentary, Anita P. Courcoulas, MD, MPH, of the University of Pittsburgh Medical Center, noted that data are lacking on long-term outcomes of bariatric surgery, including sustainability of weight loss and comorbidity control and long-term complication rates. 

Courcoulas also highlighted issues that complicate the study of these long-term outcomes.

“These critical gaps in knowledge pose a significant problem for people considering a potential surgical option to treat severe obesity. Contributing to these deficits are the paucity of comparative trials, incomplete follow-up, a lack of standardized definitions for changes in health status (e.g., diabetes mellitus remission), and the tendency to a rush to judgment in favor of surgical treatment options,” Courcoulas wrote.

“Clinicians and prospective patients will need to discuss and weigh the evidence in a dynamic exchange driven not always by final conclusions but by the most current available data.”

References

  1. Golomb I et al. JAMA Surg. 2015;doi:10.1001/jamasurg.2015.2202.
  2. Courcoulas AP. JAMA Surg. 2015;doi:10.1001/jamasurg.2015.2222.