Full text: Laparoscopic sleeve gastrectomy as the first-line surgical option for morbid obesity

And here is an article that appeared in a separate journal written as a Research Highlight for the original article.

Surgery: Laparoscopic sleeve gastrectomy as the first-line surgical option for morbid obesity

Vicky Heath
Nature Reviews Endocrinology 6, 534 (October 2010) | doi:10.1038/nrendo.2010.139

The results of a study published in the Annals of Surgery suggest that laparoscopic sleeve gastrectomy should be regarded as the procedure of choice in a selected group of patients with morbid obesity. "The main implication as to the future of obesity surgery is that laparoscopic sleeve gastrectomy must be considered as the first step to a duodenal switch in 50% of cases," states investigator Jacques Himpens (Dendermonde, Belgium).

Numerous surgical procedures are now available to treat obesity. Laparoscopic sleeve gastrectomy introduces a vertical division of the stomach to create a narrow pouch; the excess stomach is then removed. The aim is to restrict the amount of food eaten, without altering absorption of vitamins and minerals. Promising short-term data had previously indicated that this procedure might potentially represent the definitive operation for people with obesity. The aim of the current study was to evaluate the long-term efficacy and safety of laparoscopic sleeve gastrectomy as the intended first (and final) surgical intervention in patients with morbid obesity.

The researchers evaluated 53 consecutive patients (median BMI 39 kg/m2) selected for restrictive surgery according to the 1991 NIH guidelines and an empirically established algorithm. Eligible participants were nondiabetic, large-volume eaters, who were not subject to marked episodes of acid reflux. All participants underwent laparoscopic sleeve gastrectomy and were assessed postoperatively at years 3 and 6.

The percentage of excess weight loss after surgery was 72.8% at 3 years; however, this measure had dropped to 57.3% after 6 years. In addition, postoperative morbidity, such as the incidence of self-reported acid reflux, increased over time. By year 6, several participants had been lost to follow-up and 11 patients had undergone a second procedure (duodenal switch) or a 'resleeve' operation. Overall objective failure rates of laparoscopic sleeve gastrectomy were 47% and 64% at years 3 and 6, respectively.

"I think it is important surgeons realize that the first bariatric operation in a patient very likely will not be the last one, and therefore the first operation (for example, band gastroplasty) should not jeopardize a possible second procedure," Himpens concludes. "With our present knowledge, laparoscopic sleeve gastrectomy fulfils this prerequisite."

While these numbers aren't very encouraging, I wonder what the bougie sizes were.  I think that makes a big difference long term.

Thanks for sharing the articles!

In the original article (posted in a separate post below this one), it said that it was a 34F bougie. Yes, I agree that the numbers aren't very encouraging, but every little study does help. But since I'm a scientist as well...I'll criticize the study on sample size alone. There's no telling how many "several patients lost to follow up" really is. and when you have small numbers in the first place, percentages really get skewed.

But then again, I don't know what typical surgery studies have for numbers. Does anyone know how many subjects will be included in Dr. C's study?

and always happy to retrieve articles! I have access to most journals, unless they are super obscure ones so I'm more than willing to get whatever. :)

A 34 bougie is pretty small, I know everyone was hoping they used a 40 and that explained the regain.

Honestly I predict this is going to be standard for the sleeve, with most people regaining about half of their weight. Everyone goes gaga over the first year results, but those have nothing to do with long term.

Still, just because MOST people have regain doesn't mean WE have to regain. Hopefully with the support on this forum we can work harder than most people, and have better results.

thankyou for posting this, i agree that the results dont look great, which makes us have to be vigalent. it also indicated that lack of follow up may have been part of the problem

I just read the full text and it's even worse than I thought. In my mind I was thinking these were more heavyweights, but the average BMI was only 39.

Also the failure rate for those who did not get the second stage DS was actually 76%.

Lightweights with a small bougie and a failure rate of 76% that's terrible.

On the other hand, without surgery your chance of maintaining weight loss long term with diet and exercise is only 3%. 97% of people gain their weight back.

So by having the sugery, my chance of maintaining a normal weight went from  1-in-30 to 1-in-4. Sure that still means most are going to fail, but 1-in-4 is at least odds that I can work with.

It is important to remember that this is only one study and a small sample size. This study adds to the pool of information and reminds us that weight regain is a complex issue and cannot be attributed to one or two factors. One of the most important things that research has shown, is that follow-up and support groups are very important and contribute to the success rate.

The failure rate for the RNY is at least 30%, but that means that 70% of people do well. The statistics seem terrible for the sleeve, as demonstrated by this article, but the sample size is small and is just one study. The sleeve is a tool to get us to a healthier weight and BMI, but it is up to us to maintain that loss. Support is an invaluable part of being successful.

I think that any knowledge we can share is great.  I for one appreciate any study I can get my hands on.

I know that the numbers are discouraging, but I think this helps me stay on track more.  It shows me that you can't rely on the surgery only. 

That said, I can also say that I'm approaching the 3 year mark, I lost over 100% of my excess weight, and I've been keeping it off for over 2 years.  My surgeon says that regain, if you are going to regain starts after the 2 year mark.  he said that if I had kept it off by then, I would be a safe bet to keep it off.  I have two friends that had their surgery with the same surgeon, one is at 5 years, one is at 3-1/2 years, and both are holding steady too.  I know that gives me hope

Thanks for the info!