Sleeve gastrectomy for morbid obesity. Long-term results, comorbidities and quality of life

Abstract

Background and Objectives: Sleeve Gastrectomy (SG) has emerged in the last years as a single procedure for the treatment of morbid obesity. In spite of showing good results in weight loss and comorbidities, improvement on a short- and mid-term follow-up basis, data are still lacking regarding long-term outcomes. We retrospectively reviewed the results of SG in our Institution in terms of complications and therapeutic success (percentage of excess weight loss, percentage of excess body mass index and comorbidities improvement). We measured the quality of life using the quality-of-life assesment (QOL) included in the Bariatric Analysis and Reporting Outcome System (BAROS). Materials and Methods: We reviewed patients’ clinical charts and database of 81 patients (72.84% women) with morbid obesity, submitted to sleeve gastrectomy in our Institution between the 1st January 2005 and 31st October 2011. Twenty three patients had previously been treated with a bariatric procedure (28.39%): nine intragastric balloon and 14 gastric banding. In 79 a laparoscopic approach was used and supraumbilical median laparotomy in two. The mean age was 49 ± 4.24 years and the mean body mass index was 54.8 ± 13.1 Kg/m2. Concerning comorbidities, 18 had diabetes, 50 hypertension, 21 dyslipidemia, 11 obstructive sleep apnea, 22 joint pathology and 23 depression. The measurement of BAROS of 72 patients was completed trough a phone inquiry in February 2012. Results: There was no mortality. One procedure was converted to laparotomy because of adhesions. Early and late complication rate was 11.1% (leak, abscess, bleeding, respiratory insufficiency, wound infection and stricture, gastroesophageal reflux, B12 vitamin deficiency neuropathy and incisional hernia). The mean percentage of excess weight loss or of excess body mass index was 25.69 ± 9.72 in the 1st month, 59.87 ± 25.51 in the 12th month, 61.87 ± 24.93 in the 18th month, 54.08 ± 39.87 in the 24th month, 51.8 ± 44.64 in the 36th month, 55.49 ± 26.45 in the 48th month, 49.34 ± 31.31 in the 60th month and 45.98 ± 30.86 in the 72nd month after surgery. Comorbiditites were resolved and/or improved in 71.7% of the operated patients. The values of BAROS divided the population in five groups: Failure – 4.17% (n=3), Fair – 19.44% (n=14), Good, Very Good and Excellent – 76.39% (n=27, 20 e 8 respectively). Conclusion: Sleeve Gastrectomy is a safe procedure, which gives excellent results in terms of percentage of excess weight loss, comorbidities improvement and quality of life. SG is easier to perform than a Gastric Bypass, and is also safely feasible by the laparoscopic approach, with less morbidity. There seems to be a tendency for weight regain after four years, but more long term studies are needed to confirm this tendency.