Abstract
Introduction
Bariatric surgery has been shown to be a safe and durable intervention for patients struggling with obesity and metabolic syndrome, including hypertension. Buchwald et al. reported hypertension resolution rates in 67.1% and improvement in 78.5% following aggregate bariatric surgery. The laparoscopic sleeve gastrectomy (LSG) is becoming increasingly utilized as a primary bariatric surgery, but lacks long-term outcome data. There are a growing number of studies reporting outcome data beyond 5 years.
Objective
This study aims to systematically evaluate the efficacy of laparoscopic sleeve gastrectomy on hypertension amongst obese patients.
Materials and methods
A comprehensive literature search was conducted through Medline, Embase, Scopus, Web of Science, Dare, Cochrane library, and HTA database. The search terms used were broad: sleeve gastrectomy AND hypertension OR blood pressure. Adult patients undergoing LSG with follow-up hypertension outcome results of at least 5 years were included. Revisional surgeries were excluded. Two independent reviewers were used.
Results
Fourteen studies were included in this systematic review, which included 3550 subjects in total. Mean age was 41.1 ± 10.7 years. Mean pre-operative BMI and weight were 47.7 ± 8.83 kg/m2 and 272.8 ± 48.4 lb, respectively. Pre-operative prevalence of hypertension was 36.5% (range 6.7–91%) which dropped to 14.79% (range 0–33.3%) at approximately 5-year follow-up. Hypertension resolved in 62.17% (range 0–100%) of patients and improved in 35.7% (range 13.3–76.9%) at a mean of 5.35 years of follow-up.
Conclusion
From this systematic review, LSG is an effective intervention for bariatric patients with hypertension. In addition to the observed reduction in the incidence of hypertension, it is likely that LSG may lead to additional health system benefits such as cost savings due to reductions in antihypertensive medications. Further prospective studies should include estimates of cost savings associated with reductions in chronic antihypertensive medication usage.
Graphical abstract
Similar content being viewed by others
References
Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G (2010) Mechanisms of obesity-induced hypertension. Hypertens Res 33:386–393
Deitel M, Gagner M, Erickson A, Crosby R (2011) Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis 7:749–759.
Nguyen NT, Vu S, Kim E et al (2016) Surg Endosc 30:2723. https://doi.org/10.1007/s00464-015-4535-9
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–37
Aminian A, Brethauer SA, Andalib A, Punchai S, MacKey J, Rodriguez J, Rogula T, Kroh M, Schauer PR (2016) Can sleeve gastrectomy “cure” diabetes? Long-term metabolic effects of sleeve gastrectomy in patients with type 2 diabetes. Ann Surg 264(4):674–681
Casella G, Soricelli E, Giannotti D, Collalti M, Maselli R, Genco A, Redler A, Basso N (2016) Long-term results after laparoscopic sleeve gastrectomy in a large monocentric series. Surg Obes Relat Dis 12(4):757–762
Saleh M, Cheruvu MS, Moorthy K, Ahmed AR (2016) Laparoscopic sleeve gastrectomy using a synthetic bioabsorbable staple line reinforcement material: post-operative complications and 6 year outcomes. Ann Med Surg 10:83–87
Ruiz-Tovar J, Martinez R, Bonete JM, Rico JM, Zubiaga L, Diez M, Llavero C, Obelche G (2016) Long-term weight and metabolic effects of laparoscopic sleeve gastrectomy calibrated with a 50-Fr bougie. Obes Surg 26(1):32–37
Rawlins L, Rawlins MP, Brown CC, Schumacher DL (2013) Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis 9(1):21–25
Golomb I, Ben David M, Glass A, Kolitz T, Keidar A (2015) Long-term metabolic effects of laparoscopic sleeve gastrectomy. JAMA Surg 150(11):1051–1057
Gadiot R, Biter U, Van Mil S, Zengerink H, Mannaerts G (2017) Long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results. Obes Surg 27(1):59–63
Jammu GS, Sharma R (2016) A 7-year clinical audit of 1107 cases comparing sleeve gastrectomy, roux-en-y gastric bypass, and mini-gastric bypass, to determine an effective and safe bariatric and metabolic procedure. Obes Surg 26(5):926–932
Kehagias I, Spyropoulos C, Karamanakos S, Kalfarentzos F (2013) Efficacy of sleeve gastrectomy as sole procedure in patients with clinically severe obesity (BMI ≤ 50 kg/m2). Surg Obes Relat Dis 9(3):363–369
Neagoe RM, Muresan M, Bancu S, Balmos I, Baisan V, Voidazan S, Sala D (2017) Results of laparoscopic sleeve gastrectomy-5-year follow-up study in an eastern European emerging bariatric center. Obes Surg 27(4):983–989
Nocca D, Loureiro M, Skalli EM, Nedelcu M, Jaussent A, Deloze M, Lefebvre P, Fabre JM (2016) Five-year results of laparoscopic sleeve gastrectomy for the treatment of severe obesity. Surg Endosc 31:3251–3257
Orfanos S, Alexandrou A, Mpaili E, Vailas M, Diamantis T, Sxizas D, Liakakos T (2016) Robotic sleeve gastrectomy for morbid obesity: report of a 5 year experience. Int J Med Robot 12(2):283–287
Zachariah SK, Chang PC, Ooi ASE, Hsin MC, Wat JY, Huang CK (2013) Laparoscopic sleeve gastrectomy for morbid obesity: 5 years experience from an Asian center of excellence. Obes Surg 23(7):939–946
Lemanu DP, Singh PP, Rahman H, Hill AG, Babor R, MacCormick AD (2015) Five-year results after laparoscopic sleeve gastrectomy: a prospective study. Surg Obes Relat Dis 11(3):518–524
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Graham, Switzer, Reso, Armstrong, Church, Mitchell, Debru, and Gill have no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Graham, C., Switzer, N., Reso, A. et al. Sleeve gastrectomy and hypertension: a systematic review of long-term outcomes. Surg Endosc 33, 3001–3007 (2019). https://doi.org/10.1007/s00464-018-6566-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-018-6566-5