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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.
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.”
