Skip to main content

Long-term Effects of Laparoscopic Sleeve Gastrectomy: What Are the Results Beyond 10 Years?

A Correction to this article was published on 10 May 2021

This article has been updated

Abstract

Purpose

Laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed bariatric procedure worldwide. Newer studies providing long-term follow-up show a high incidence of weight regain and a high incidence of reflux. The study’s objective was to present 5 to 15-year follow-up results regarding weight loss, comorbidities, reoperation rate, and a potential learning curve.

Methods

This is a retrospective analysis of prospectively collected data. Patients who underwent LSG between August 2004 and December 2014 were included.

Results

A total of 307 patients underwent LSG either as a primary bariatric procedure (n = 262) or as a redo operation after failed laparoscopic gastric banding (n = 45). Mean body mass index at the time of primary LSG was 46.4 ± 8.0 kg/m2, and mean age at operation was 43.7 ± 12.4 years with 68% females. Follow-up was 84% and 70% at 5 and 10 years, respectively. The mean percentage excess body mass index loss (%EBMIL) for primary LSG was 62.8 ± 23.1% after 5 years, 53.6 ± 24.6% after 10 years, and 51.2 ± 20.3% after 13 years. Comorbidities improved considerably (e.g., type 2 diabetes mellitus 61%), while the incidence of new-onset reflux was 32.4%. Reoperation after LSG was necessary in almost every fifth LSG-patient: 24 patients (7.8%) were reoperated due to insufficient weight loss, 12 patients (3.9%) due to reflux, 23 due to both (7.5%).

Conclusions

LSG provides a long-term %EBMIL from 51 to 54% beyond 10 years and a significant improvement of comorbidities. On the other hand, a high incidence of insufficient weight loss and de novo reflux was observed, leading to reoperation and conversion to a different anatomy in 19.2%.

Graphical abstract

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

Change history

References

  1. 1.

    Arroyo-Johnson C, Mincey KD. Obesity epidemiology worldwide. Gastroenterol Clin N Am. 2016;45(4):571–9.

    Article  Google Scholar 

  2. 2.

    Schauer P, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376(7):641–51.

    Article  Google Scholar 

  3. 3.

    Gagner M, Inabnet W, Pomp A. Laparoscopic sleeve gastrectomy with second stage biliopancreatic diversion and duodenal switch in the superobese. In: Inabnet W, DeMaria E, Ikramuddin S, editors. Laparoscopic bariatric surgery. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 143–50.

    Google Scholar 

  4. 4.

    Felberbauer FX, Langer F, Shakeri-Manesch S, et al. Laparoscopic sleeve gastrectomy as an isolated bariatric procedure: intermediate-term results from a large series in three Austrian centers. Obes Surg. 2008;18(7):814–8.

    Article  Google Scholar 

  5. 5.

    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279–89.

    CAS  Article  Google Scholar 

  6. 6.

    D’Hondt M, Vanneste S, Pottel H, et al. Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc. 2011;25(8):2498–504.

    Article  Google Scholar 

  7. 7.

    Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity. JAMA. 2018;319(3):255–65.

    Article  Google Scholar 

  8. 8.

    Felsenreich DM, Langer FB, Kefurt R, et al. Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass: 10-year results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(9):1–8.

    Article  Google Scholar 

  9. 9.

    Felsenreich DM, Ladinig LM, Beckerhinn P, et al. Update: 10 years of sleeve gastrectomy—the first 103 patients. Obes Surg. 2018;28(11):3586–94.

    Article  Google Scholar 

  10. 10.

    Stenard F, Iannelli A. Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol. WJG Press. 2015;21:10348–57.

  11. 11.

    Felsenreich DM, Kefurt R, Schermann M, et al. Reflux, sleeve dilation , and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Multicenter Study. 2017:3092–101.

  12. 12.

    Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017 Apr;13(4):568–74.

    Article  Google Scholar 

  13. 13.

    Wölnerhanssen B, Peterli R, Hurme S, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: 5-year outcomes of merged data from two randomized clinical trials (SLEEVEPASS and SM-BOSS). Br J Surg. 2021;108:49–57.

    Article  Google Scholar 

  14. 14.

    Zacharoulis D, Sioka E, Papamargaritis D, et al. Influence of the learning curve on safety and efficiency of laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(3):411–5.

    Article  Google Scholar 

  15. 15.

    Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.

    Article  Google Scholar 

  16. 16.

    Felsenreich DM, Langer FB, Prager G. Weight loss and resolution of comorbidities after sleeve gastrectomy: a review of long-term results. Scand J Surg. SAGE Publications Inc. 2019;108:3–9.

  17. 17.

    Arman GA, Himpens J, Dhaenens J, et al. Long-term (11+years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2015;12(10):1778–86.

    Article  Google Scholar 

  18. 18.

    Gadiot RPM, Biter LU, van Mil S, et al. Long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results. Obes Surg. 2016;27:1–5.

    Google Scholar 

  19. 19.

    Sarela AI, Dexter SPL, O’Kane M, et al. Long-term follow-up after laparoscopic sleeve gastrectomy: 8-9-year results. Surg Obes Relat Dis. 2012;8(6):679–84.

    Article  Google Scholar 

  20. 20.

    Casella G, Soricelli E, Giannotti D, et al. Learning curve for laparoscopic sleeve gastrectomy: role of training in a high-volume bariatric center. Surg Endosc. 2016;30(9):3741–8.

    Article  Google Scholar 

  21. 21.

    Abdallah E, El Nakeeb A, Yousef T, et al. Impact of extent of antral resection on surgical outcomes of sleeve gastrectomy for morbid obesity (a prospective randomized study). Obes Surg. 2014;24(10):1587–94.

    Article  Google Scholar 

  22. 22.

    Eid GM, Brethauer S, Mattar SG, et al. Laparoscopic sleeve gastrectomy for super obese patients: forty-eight percent excess weight loss after 6 to 8 years with 93% follow-up. Ann Surg. 2012;256(2):262–5.

    Article  Google Scholar 

  23. 23.

    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 3-year outcomes. N Engl J Med. 2014;370:1–12.

    Article  Google Scholar 

  24. 24.

    Chiu S, Birch DW, Shi X, et al. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011;7(4):510–5.

    Article  Google Scholar 

  25. 25.

    Daes J, Jimenez ME, Said N, et al. Improvement of gastroesophageal reflux symptoms after standardized laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(4):536–40.

    Article  Google Scholar 

  26. 26.

    Boza C, Daroch D, Barros D, et al. Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure. Surg Obes Relat Dis. 2014;10(6):1129–33.

    Article  Google Scholar 

  27. 27.

    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.

    Article  Google Scholar 

  28. 28.

    Bevilacqua LA, Obeid NR, Yang J, et al. Incidence of GERD, esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma after bariatric surgery. Surg Obes Relat Dis. 2020;16(11):1828–36.

    Article  Google Scholar 

  29. 29.

    Weiner RA, Theodoridou S, Weiner S. Failure of laparoscopic sleeve gastrectomy - further procedure? Obes Facts. 2011;4(Suppl 1):42–6.

    PubMed  PubMed Central  Google Scholar 

  30. 30.

    Kraljević M, Süsstrunk J, Köstler T, et al. Short or long biliopancreatic limb bypass as a secondary procedure after failed laparoscopic sleeve gastrectomy. Obes Surg. 2020;31:170–8.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Marko Kraljević.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent does not apply as this is a database analysis.

Conflict of Interest

MK, VS, TP, MS, and BW declare no competing interests. RS reports grants from the University of Basel, grants from University Hospital Basel, Department of Surgery, grants from SFCS, grants from Gebauer Stiftung, and grants from Freiwillige Akademische Gesellschaft Basel, outside the submitted work. RP reports grants and personal fees from Ethicon Endo-Surgery, outside the submitted work.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Keypoints

A retrospective study of 307 obese patients who underwent LSG as a primary or revisional procedure

LSG provides a mean %EBMIL from 51 to 54% beyond 10 years and a significant improvement of comorbidities.

The incidence of de novo reflux after LSG was 32.4% in the long-term.

Reoperation and conversion from LSG to different anatomy was necessary in almost every fifth patients.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kraljević, M., Cordasco, V., Schneider, R. et al. Long-term Effects of Laparoscopic Sleeve Gastrectomy: What Are the Results Beyond 10 Years?. OBES SURG 31, 3427–3433 (2021). https://doi.org/10.1007/s11695-021-05437-3

Download citation

Keywords

  • Sleeve gastrectomy
  • Long-term results
  • Weight loss
  • Reflux
  • Learning curve