Laparoscopic sleeve gastrectomy for super obese patients: forty-eight percent excess weight loss after 6 to 8 years with 93% follow-up.

OBJECTIVES: In this study, we report long-term outcomes of high-risk, high-BMI (body mass index) patients who underwent laparoscopic sleeve gastrectomy (LSG). BACKGROUND: Short- and medium-term data appear to support the effectiveness of LSG, but long-term data to support its durability are sparse. METHODS: A prospective database was reviewed on all high-risk patients who underwent LSG as part of a staged approach for surgical treatment of severe obesity between January 2002 and February 2004. We included only patients who did not proceed to second-stage surgery (gastric bypass). Analyzed data included demographics, BMI, comorbidities, and surgical outcomes. All partial gastrectomies were performed using a 50F bougie. RESULTS: Seventy-four patients underwent LSG, and follow-up data were available on 69 of 74 patients (93%). The mean age was 50 years (25-78) and the mean number of co-morbidities was 9.6. Perioperative mortality (<30 days) was zero, and the incidence of short- and long-term postoperative complications was 15%. The mean overall follow-up time period was 73 months (38-95). Mean excess weight loss (EWL) at 72, 84, and 96 months after LSG was 52%, 43%, and 46%, respectively, with an overall EWL of 48%. The mean BMI decreased from 66 kg/m(2) (43-90) to 46 kg/m(2) (22-73). Seventy-seven percent of the diabetic patients showed improvement or remission of the disease. CONCLUSIONS: This study reports the longest follow-up of LSG patients thus far and supports the effectiveness, safety, and durability of laparoscopic sleeve gastrectomy as a definitive therapeutic option for severe obesity, even in high-risk, high-BMI patients.

Long-term outcomes of laparoscopic Roux-en-Y gastric bypass in US veterans.

BACKGROUND: The objective of this study is to evaluate the long-term outcomes following laparoscopic Roux-en-Y gastric bypass (LREYGB) in veteran patients. The VA bariatric population differs from its counterpart in the private sector by the predominance of a male population, a higher percentage of patients from a lower socioeconomic background, a higher mean age, and a higher rate of obesity-related comorbidities. METHODS: A retrospective review with prospectively collected data was used to analyze postoperative changes of comorbidities and percent of excess weight loss (% EWL) in consecutive patients who underwent LREYGB between August 2003 and September 2006. RESULTS: Among 70 patients, 73% were men with a mean age of 52 years (29-66 years). Average preoperative weight and body mass index were 310 lbs (224-397 lbs) and 46 kg/m(2) (36-60 kg/m(2)), respectively. The incidence of major and minor complications was 1.4% and 15.7%, respectively. There were no mortalities. Follow-up (f/u) was possible in all patients. At a mean f/u rate of 39 months, % EWL was 56%. At 1, 3, and 5 years, % EWL was 61%, 53%, and 59%, respectively. Thirty-five patients (50%) had type 2 diabetes mellitus (T2DM). Glycosylated hemoglobin concentrations returned to normal levels in 91% of patients and improved in an additional 6% of T2DM cases. Only 7% of patients are still maintained on antidiabetic medications. In patients with more than 1 year f/u, most other comorbidities were improved or resolved. CONCLUSIONS: Long-term f/u of LREYGB in veteran patients demonstrated significant and durable weight loss (56% EWL) with marked improvements in comorbidities especially T2DM.