Sleeve Gastrectomy as Sole and Definitive Bariatric Procedure: 5-Year Results for Weight Loss and Ghrelin
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- Bohdjalian, A., Langer, F.B., Shakeri-Leidenmühler, S. et al. OBES SURG (2010) 20: 535. doi:10.1007/s11695-009-0066-6
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Due to excellent efficacy for weight loss in the short-term follow-up, sleeve gastrectomy (SG) has gained enormous popularity as bariatric procedure, not only as first step in high-risk or super-obese patients but mainly as a sole and definitive operation in morbidly obese. In contrast to a large number of short and intermediate-term results, no series of SG with a follow-up of 5 years or more has been published so far.
We report on the weight loss results of our first consecutive 26 patients with a complete follow-up of 5 years. Furthermore in a subgroup of 12 patients, plasma ghrelin levels were measured preoperatively, and up to 5 years following SG.
Weight loss defined as mean percent excess weight loss (%EWL) was found as 57.5 ± 4.5, 60.3 ± 5.0, 60.0 ± 5.7, 58.4 ± 5.4, and 55.0 ± 6.8 (not converted, n = 21) for the first 5 years. Weight regain of more than 10 kg from nadir was observed in five (19.2%) of the 26 patients. Four of the patients (15.4%) were converted to gastric bypass due to severe reflux (n = 1, 3.8%) and weight loss failure (n = 3, 11.5%). A total of eight patients (30.8%) were at chronic need for proton pump inhibitor medication due to severe reflux. Plasma ghrelin levels were reduced from 593 ± 52 to 219 ± 23 pg/ml 12 months postoperatively, with a slightly, non-significant increase toward the 5-years values of mean 257 ± 23 pg/ml.
At 5-year follow-up, a mean EWL of 55.0 ± 6.8% was achieved, indicating that SG leads to stable weight loss. Beside significant weight regain, severe reflux might necessitate conversion to gastric bypass or duodenal switch. After an immediate reduction postoperatively, plasma ghrelin levels remained low for the first 5 years postoperatively.