Eight-Year Results of Laparoscopic Sleeve Gastrectomy

Research Article

Ann Obes Disord. 2017; 2(1): 1020.

Eight-Year Results of Laparoscopic Sleeve Gastrectomy

Catheline JM¹*, Schoucair N¹, Dbouk R¹, Bendacha Y¹, Romero R¹, Bonnel C¹ and Cohen R²

¹Department of Surgery, Centre Hospitalier de Saint- Denis, France

²Department of Endocrinomogy, Centre Hospitalier de Saint-Denis, France

*Corresponding author: Jean-Marc Catheline, Department of Surgery, Centre Hospitalier de Saint- Denis, Service de Chirurgie Viscérale, 2 rue du Docteur Delafontaine, 93200 Saint-Denis, France

Received: September 27, 2017; Accepted: October 17, 2017; Published: October 24, 2017


Background: Our objective was to evaluate the efficacy and safety of laparoscopic Sleeve Gastrectomy (SG) at 8 years follow-up.

Methods: From May 2004 to November 2006, 64 patients underwent a SG. Percentage of excess weight loss (%EWL), % of excess BMI loss (%EBL), co-morbidities, Gastroesophageal Reflux Disease (GERD), and complications were evaluated at 2 years post-SG according to our database. Results at 8 years were evaluated according to a patient survey.

Result: A complete record was obtained for 55 patients (85.9%) including 45 patients who only had a SG and 10 who had a second bariatric procedure (7 gastric bypasses, 3 revisional SG). The mean %EWL of 55 patients was 58.4±18.1% at 2 years and 52.1±19.2% at 8 years; mean %EBL was 65.1±20.6% at 2 years, 57.2±22.7% at 8 years. Three patients (5.5%) had postoperative complications: 2 leaks (3.7%), 1 haemorrhage (1.9%). The longterm complications reported were trocar site hernias: 3 patients (5.5%). The sub-group analysis of 45 patients who only had a SG presented a mean %EWL of 59.1±16.6% at 2 years and 50.3±19.6% at 8 years; the mean %EBL was 66.1 ±18.7% at 2 years and 54.2±22.2% at 8 years. For these 45 patients we found a favorable evolution of comorbidities at 8 years follow-up: type 2 diabetes mellitus decreased of 46.2%; hypertension decreased of 47.1%; dyslipidemia decreased of 50%; sleep apnea syndrome decreased of 68%. But the frequency of GERD treated by PPI tripled.

Conclusion: Weight loss was satisfying, improvement of co-morbidities was noticed. Few surgical complications were reported, but the frequency of GERD increased.

Keywords: Morbid obesity; Sleeve gastrectomy; Long-term results; Resleeve gastrectomy; Gastric bypass


Usual weight loss cures - as diets, physical activity, behavior therapy and pharmacotherapy - have been continuously implemented but still have relatively poor long-term success and mainly scarce adherence. Bariatric surgery is to date the most effective long term treatment for morbid obesity and it has been proven to reduce obesity-related co-morbidities, among them nonalcoholic fatty liver disease, and mortality [1]. Surgical treatment of morbid obesity has significantly changed since the advent of laparoscopy. Many surgical procedures with multiple variants have been proposed and presented as the treatment of choice for morbid obesity. Laparoscopic Sleeve Gastrectomy (SG) was initially proposed as a first step in superobese patients while waiting for a definitive bariatric procedure [2]. More recently, due to promising short and medium-term results, SG has been proposed as the only and definitive treatment for morbid obesity by several authors [3-6]. SG is gaining wide spread popularity as a definitive bariatric operation that provides satisfactory and durable weight loss as well as comorbidity resolution. Weight loss and the beneficial effects on comorbidities are equivalent among elderly and younger patients. SG should be offered to elderly patients who are deemed to be appropriate candidates [7]. Few authors have reported long-term results of the SG as definitive treatment of morbid obesity [8,9]. However, since 2011, SG has become the most performed bariatric procedure in France [10]. With experienced surgeons, appropriate protocols, and a consistent operative team, SG can be performed safely in a free-standing ambulatory surgical centers on select “high acuity” patients [11]. SG is gaining popularity and has become the procedure of choice for many bariatric surgeons. Longterm weight loss failure is not uncommon. The preferred revisional procedure for these patients is still under debate [12]. Our goal was to evaluate the long-term efficacy and safety of SG at 8 years after surgery.

Patients and Methods

Patients and study design

From May 2004 to November 2006, 64 consecutive obese patients not wishing to have gastric banding or Gastric Bypass (GBP), while these techniques were performed in our unit, wished and had a SG as a definitive treatment for morbid obesity. At this time, SG was a relatively new procedure in France. All procedures were performed by the same surgeon (JMC), with large experience in bariatric surgery. In all cases, the surgical decision was made in collaboration with a multidisciplinary group as later recommended by the « Haute Autorité de Santé » (HAS) [13].

Preoperative evaluation and results at 2 years after SG were evaluated according to a retrospective study using our prospectively collected database. The evaluation at 8 years after SG was carried out according to a patient survey from April 2013 to December 2014. Patients were asked to complete a questionnaire and to state their weight during an office and/or telephone consultation.

Surgical technique

SG was performed according to the previously described laparoscopic technique [14], systematically using a 36 French calibration tube. The left crus of the diaphragm were consistently visualized during the freeing of the greater curvature of the stomach. Gastric division was started at the gastric antrum at 6cm from the pylorus, and was continued parallel to the calibrating boogie positioned along the lesser curvature of the stomach, until reaching the angle of Hiss.

Evaluation and evolution of weight loss, co-morbidities, and gastroesophageal reflux disease (GERD)

For each patient, the weight used was that recorded after 2 full years post-SG (weight during the third year after SG), and that recorded after 8 completed years post-SG (weight during the 9th year after SG). The evaluation of weight loss was conducted based on changes in BMI, changes in the percentage of excess weight loss (%EWL), and the percentage of excess BMI loss (%EBL). A calculated method was used for the determination of the ideal body weight [11]. % EBL uses BMI 25 as the limit of normal, and it is not quite the same as % EWL based on the Metropolitan Tables which uses the mid-point of the medium fram as their ideal weight [15].

The presence or absence of co-morbidities preoperatively, and their persistence or resolution at 2 years and at 8 years, were defined by the need for medication to treat Type 2 Diabetes Mellitus (T2DM), hypertension, and dyslipidemia. The absence of T2DM was confirmed, or not, by a glycated hemoglobin inferior to 6.5% without any treatment. All patients had one general practitioner referent that watched the evolution of co-morbidities and prescribed or not the long-term medical treatment. The preoperative presence of Sleep Apnea Syndrome (SAS) was diagnosed by polysomnography for all patients. Long-term resolution of SAS was affirmed by discontinuation of C-PAP or, for patients not using C-PAP, by the bed partner’s observation that apnea did not occur during sleep, and/or by good quality restorative sleep combined with absence of daytime somnolence. Persistence, development or resolution of GERD was confirmed by the need for PPI medication, diagnostic confirmation by endoscopy, and/or GERD-associated symptoms (heartburn, retrosternal burning and nocturnal cough).

Data were analyzed with SPSS 13.0 software (SPSS Inc., Chicago, IL, USA). The results were expressed as mean ± Standard Deviation (SD).The comparison of means of continuous variables was performed using the Student t test for paired data. A p value <0.05 was considered statistically significant. The evolution of co-morbidities and GERD were evaluated by Chi² test for trends.


Patient characteristics

From May 2004 to November 2006, 64 patients underwent SG. A complete collected data with a follow-up at 8 years was obtained for 55 patients (85.9%). Patient characteristics are summarized in Table 1.