Metabolic Effects of Laparoscopic Sleeve Gastrectomy

Study Questions:

What are the long-term effects of laparoscopic sleeve gastrectomy (LSG) on weight loss, diabetes mellitus, hypertension, dyslipidemia, and hyperuricemia?

Methods:

This was a cohort study using a retrospective analysis of a prospective cohort at a university hospital. Data were collected from all patients undergoing LSGs performed by the same team between April 1, 2006, and February 28, 2013, including demographic details, weight follow-up, blood test results, and information on medications and comorbidities. The main outcomes and measures were excess weight loss, obesity-related comorbidities, and partial and complete remission at 1, 3, and 5 years of follow-up.

Results:

A total of 443 LSGs were performed. Complete data were available for 241 of the 443 patients (54.4%) at the 1-year follow-up, for 128 of 259 patients (49.4%) at the 3-year follow-up, and for 39 of 56 patients (69.6%) at the 5-year follow-up. The percentage of excess weight loss was 76.8%, 69.7%, and 56.1%, respectively. Complete remission of diabetes was maintained in 50.7%, 38.2%, and 20.0%, respectively, and remission of hypertension was maintained in 46.3%, 48.0%, and 45.5%, respectively. Changes in high-density lipoprotein cholesterol level (mean [SD] level preoperatively and at 1, 3, and 5 years, 46.7 [15.8], 52.8 [13.6], 56.8 [16.0], and 52.4 [13.8] mg/dl, respectively) and triglyceride level (mean [SD] level preoperatively and at 1, 3, and 5 years, 155.2 [86.1], 106.3 [45.3], 107.2 [53.4], and 126.4 [59.7] mg/dl, respectively) were significant compared with preoperative and postoperative measurements (p < 0.001). The decrease of low-density lipoprotein cholesterol level was significant only at 1 year (p = 0.04) and 3 years (p = 0.04) (mean [SD] level preoperatively and at 1, 3, and 5 years, 115.8 [33.2], 110.8 [32.0], 105.7 [25.9], and 110.6 [28.3] mg/dl, respectively). The changes in total cholesterol level did not reach statistical significance (mean [SD] level preoperatively and at 1, 3, and 5 years, 189.5 [38.2], 184.0 [35.4], 183.4 [31.2], and 188.1 [35.7] mg/dl, respectively). No changes in comorbidity status correlated with preoperative excess weight. Hypertriglyceridemia was the only comorbidity whose remission rates at 1 year of follow-up (partial/complete, 80.6%; complete, 72.2%) correlated with percentage of excess weight loss (76.8%) (p = 0.005).

Conclusions:

The authors concluded that undergoing LSG induced efficient weight loss and a major improvement in obesity-related comorbidities, with mostly no correlation to percentage of excess weight loss.

Perspective:

This analysis reports that undergoing laparoscopic sleeve gastrectomy induced a reduction in percentage of excess weight loss (%EWL) and a major improvement in obesity-related comorbidities in the short-term. 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 findings should be taken into consideration in the decision-making process for the most appropriate operation for a given obese patient and incorporate lifestyle modification with initial weight loss. Available data suggest that the presence of obesity-related comorbidities should play a major role when choosing the appropriate procedure for a specific patient.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Hypertension

Keywords: Body Weight, Cholesterol, Diabetes Mellitus, Type 2, Dyslipidemias, Gastrectomy, Hypertension, Hypertriglyceridemia, Hyperuricemia, Lipoproteins, HDL, Lipoproteins, LDL, Metabolic Syndrome X, Obesity, Primary Prevention, Triglycerides, Weight Loss


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