In a recent study published in the Annals of Surgical Treatment and Research, a team of researchers found that laparoscopic sleeve gastrectomy (LSG) is an effective and safe surgery procedure for patients with morbid obesity. However, results from the study indicate a longer follow-up period is necessary to understand if LSG can provide patients with durable weight loss and long-term positive clinical outcomes in comparison to more aggressive procedures.
With the advancement of laparoscopic skills, laparoscopic sleeve gastrectomy (LSG) was adopted as a component of laparoscopic biliopancreatic diversion (BPD).
In LSG, part of the stomach is removed, resulting in a smaller organ that somewhat restricts the passage of food. The gastric sleeve procedure involves removing 90 percent of the stomach, including its most elastic part, leaving a much smaller, tubularized stomach or what is known as the “sleeve.”
Laparoscopic BPD, however, is often regarded as too complicated and associated with a high risk of surgical complications when performed as a single-stage procedure in extremely heavy patients in the early laparoscopic era.
Therefore, a two-stage operative approach has gained popularity, in which LSG is performed as a bridging procedure to facilitate subsequent gastric bypass or BPD surgeries 6-12 months later in super-obese patients or in those with high surgical risk. LSG has gradually became a stand-alone procedure following several reports of excellent weight loss outcomes after only LSG.
To assess the efficacy and midterm clinical outcomes of LSG in patients with morbid obesity, in the study titled “Laparoscopic sleeve gastrectomy in obese Korean patients: up to 4-year follow-up in a single center”, Ji Yeon Park and Yong Jin Kim the Department of Surgery, Soonchunhyang University Seoul Hospital in Seoul, Korea, examined the medical records of 192 obese patients who underwent LSG from 2009 to 2012.
The results showed that the mean body mass index before surgery was 40.0 ± 7.2 kg/m2, and 120 patients (62.5%) had at least one obesity-related comorbidity.
A total of 3 patients was found to require endoscopic or surgical intervention to manage postoperative bleeding or leakage.
At baseline and after follow-ups at 1, 2, 3 and 4 years after surgery the results showed that the mean percent of excess weight loss (%EWL) were 72.6%, 80.6%, 71.1%, and 57.8%, respectively, with follow-up rates of 81%, 56%, 58%, and 30% respectively.
The results also revealed that at a mean follow-up of 25 months the overall mean %EWL reached 68.3% ± 27.2%.
Following surgery, obesity-related comorbidities were resolved in >70% of the patients, with 1 year following LSG, 25 patients revealed a %EWL of <50%; 9 required conversion to gastric bypass due to intolerable reflux symptoms, intractable diabetes or inadequate weight loss.
While the findings from this study are indeed encouraging for those who are morbidly obese and are looking for surgical solutions for weight loss, more research is needed in this patient population to determine the true long-term benefits of laparoscopic sleeve gastrectomy, and whether the clinical outcomes outpace patient risk.