Mean operative time was 61 min (range 30–140 min) with mean hospital stay of 1.37 days (range 0–4; SD ± 0.8). Nine out of 84 patients (10.7%) were subjected to previous bariatric surgery. Two patients underwent vertical gastric banding, six patients had laparoscopic adjustable gastric banding procedure, and one patient had laparoscopic sleeve gastrectomy. The linear regression model did not show any statistically significant positive or negative impact of having previous bariatric surgery on outcomes of LSG in presented series. Super morbid obesity with BMI > 50 kg/m2 was present in 21.4% (N = 18) of patients before the operation and was reduced to 3.6% (N = 3) after the operation. Of the patients, 66.7% declared having been obese since childhood and 65.5% having at least one first-degree relative suffering from obesity. Of the patients, 81% declared having changed their diet with significant calories and carbohydrates intake reduction following the surgery. Thirty-three percent declared increase of physical activity (more than three times a week) and 56% of patients did not commence any physical activity postoperatively according to self-reported data.
Initial mean BMI of 44.6 kg/m2 has reduced every 6 months to 36.8, 35.2, 35.9, 35.3, and 32.2 kg/m2 consecutively at 6, 12, 18, 24, and 30 months after surgery (Table 1).
This corresponded with the mean 36.8% EWL in the first 6 months and 43.6% EWL at 12 months, 45.4% EWL at 18 months, 46.6% EWL at 24 months, and 51.1% of EWL at 30 months following surgery. Figure 1 shows changes of the percentage of excess weight loss in time.
Of the patients, 23.75%, 33%, 36.4%, 38.5%, and 50% lost more than 50% of EWL at 6, 12, 18, 24, and 30 months after surgery, respectively.
Eight most common comorbidities were assessed and they were present in 59.5% (N = 50) of patients before surgery. Complete resolution of one comorbid condition was observed in 23 cases and improvement or significant improvement was observed in 21 cases. As the most common, arterial hypertension improved or resolved in 62% of cases, and diabetes mellitus improved or resolved in 68.3% of affected patients. Changes in all present comorbid conditions have been presented in Table 2.
Results of the Moorehead–Ardelt Quality of Life Questionnaire are shown in Table 3. The self-esteem and physical activity aspects of QoL have improved most significantly with interest in sex remaining in more than 50% of patients at the same level.
All surgical and medical complications were stratified as major and minor as well as early and late according to the Oria and Moorehead classification and were summarized in Table 4.
There was one conversion (1.2%) to the open technique due to the massive bleeding that could have not been stopped with the laparoscopic approach and there were no reoperations in the first 30 postoperative days. During the follow-up period, three patients underwent another bariatric operation due to unsatisfactory weight loss (1× resleeve, 2× Roux-en-Y gastric bypass).
Based on all the above factors, the global BAROS outcomes were calculated. Excellent outcome was achieved in 11 (13%) patients, very good in 25 (30%), good in 29 (34.5%), fair in eight (9.5%), and failure in 11 (13%) patients.
Further analysis has shown that females achieved significantly better outcomes than males (Table 5) with the mean 46.5% of EWL versus 35.3% of EWL at 12 months (p = 0.02). There was no statistically significant difference in outcomes in correlation to education (p = 0.17), smoking (p = 0.06), obesity of the first-degree relative (p = 0.13), childhood obesity (0.47), having had previous bariatric surgery (p = 0.59), declared increased physical activity (p = 0.96), and declared decreased calories intake and diet modification (p = 0.6).
The outline of the BAROS system excludes patients lost to follow-up or the ones who died during the operation or shortly postoperatively. Among 112 patients initially eligible for inclusion to the study, one female patient (0.9%) died due to the pulmonary artery embolism on the fifth postoperative day therefore was excluded from final analysis.