Benefits of Sleeve Gastrectomy Wane at 5 Years

[feedyoureye 3,087]

Benefits of Sleeve Gastrectomy Wane at 5 Years

http://www.medscape.com/viewarticle/849141

[Invictus 56]

The link to the article requires a login

[AngelaWilliamsMD 290]

Benefits of Sleeve Gastrectomy Wane at 5 Years

Miriam E Tucker

August 06, 2015

The weight loss and diabetes remission achieved with laparoscopic sleeve gastrectomy (LSG) appear to wane by 5 years, a new cohort study suggests.

Sleeve gastrectomy has been growing in popularity as a bariatric technique, but data on its long-term effect on obesity-related comorbidities are scarce, with most findings reported so far limited to 2-year outcomes, explain Inbal Golomb, from Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel, and colleagues, in their paper published online August 5, 2015 in JAMA Surgery.

In their retrospective analysis of a prospective cohort study of 443 patients who underwent bariatric surgery at the university hospital between 2006 and 2013, the percentage of excess body weight lost had dropped from 77% in 241 patients with available data at 1 year to 56% among 39 at 5 years.

And of the 82 diagnosed with type 2 diabetes prior to surgery, the proportions achieving complete remission — defined as a fasting glucose level of less than 100 mg/dL and HbA1c below 6% — were 51% of 71 with available data at 1 year and 20% of 10 at the 5-year mark. Total cholesterol didn't change significantly at all, and decreases in LDL cholesterol were significant at 1 year but not at 5 years.

"Undergoing LSG induced a reduction in [percent of excess weight loss] and a major improvement in obesity-related comorbidities in the short term," Mr Golomb and colleagues note. But the longer follow-up data "revealed weight regain and a decrease in remission rates for [type 2 diabetes] and other obesity-related comorbidities. These data should be taken into consideration in the decision-making process for the most appropriate operation for a given obese patient," they conclude.

In an accompanying editorial, Anita P Courcoulas, MD, of the University of Pittsburgh department of surgery, Pennsylvania, observes that there are "critical gaps in knowledge in this area," resulting from the "paucity of comparative trials, incomplete follow-up, a lack of standardized definitions for changes in health status (eg, diabetes mellitus remission), and the tendency to a rush to judgment in favor of surgical-treatment options."

Gastric Bypass Appears Better for Diabetes and Heavier Patients

Asked to comment, Philip Schauer, MD, director of the Bariatric & Metabolic Institute at Cleveland Clinic, Ohio, told Medscape Medical News, "This is a 5-year study that adds to our understanding of the durability of the sleeve gastrectomy. These authors show, like the others do, that some of that weight loss and improvement in comorbidities does retard over time."

However, added Dr Schauer, who was one of the first surgeons to perform LSG over a decade ago, "Even at 5 years, there is still significant weight loss, and even though the remission rate of diabetes drops from 50% to 20%, that's still remarkable. That's not achievable with medical treatment."

He noted that LSG typically works better — and with more durable results — for patients with a shorter duration of diabetes and for those with lower levels of obesity (ie, 50–100 pounds overweight, as opposed >100 pounds). And it has some advantages over gastric bypass: it's a shorter procedure, with less short-term comorbidity.

But, he said, there is growing evidence from his data and those of others that "when we look at longer-term and more important outcomes, we're now seeing pretty consistent reporting in favor of the gastric bypass over the sleeve, at least for diabetes and the higher-weight people, too."

Large Randomized Trial Comparing Surgical Procedures Impractical

In her editorial, Dr Courcoulas says that cost and feasibility issues will make a large randomized comparative trial among surgical procedures relatively impractical.

Therefore, she said, data on long-term outcomes will need to come from sources such as large electronic databases and "also by thoughtful inference that will be made through pooled analyses of data like that from Golomb and colleagues and from many other disparate randomized and nonrandomized studies of bariatric surgery.

"It will take time, patience, and a willingness to avoid a rush to judgment," she adds.

Dr Schauer said, "I agree with her; we have to dampen our enthusiasm a little bit until we see the longer-term results."

In the meantime, Dr Courcoulas writes, "clinicians and prospective patients will need to discuss and weigh the evidence in a dynamic exchange driven not always by final conclusions but by the most current available data."

The study authors have no relevant financial relationships. Dr Courcoulas reports receiving grants from Nutrisystem, Ethicon, and Covidien and serving as a project consultant for Ethicon and Apollo Endosurgery. D. Schauer has received grants from Ethicon, Covidien, Novo Nordisk, the National Institutes of Health, and a travel grant from Nestle and is on advisory board for Surgiquest.

JAMA Surg.Published online August 5, 2015. Abstract, Editorial

[MichiganChic 3,262]

@@feedyoureye Thanks for the post. I think the numbers are fairly consistent with what I was told to expect, and it makes sense that comorbidities would also return if people gain weight. I was one with a lot of weight to lose, and my surgeon told me the bypass would probably be better, but I was a candidate for either.

I often think I could have lost that last 10 pounds if I'd had bypass, but I'm still not sorry I made this choice (sleeve). I think the outcome would be the same in the long term for me. I am currently struggling a lot to not gain. It's getting harder and harder, and I really wasn't prepared for this. Either way, I lost over 90% of my excess weight, and at nearly three years out, I find it's 90% me, and 10% sleeve.

When I went into this, I knew long term I might settle at a 60% reduction from where I started. Now that I've lost so much and gotten to a normal size, the idea of that much regain is devastating to me. I'm going to do my best to not become a statistic!

[feedyoureye 3,087]

My doc asked me if I would be happy with a 50 pound loss... I said yes, but wanted to try for more. after 4 1/2 years, I'm at a about 74% loss.... I'm feeling a little bit more like a fat person than a normal one now... but still so happy I did it. I have made many lifestyle changes that have stuck, but a few have slipped a little.... I really don't want to get to that "50 pounds" he talked about... hope I can maintain here at a 70 pound loss.....

@@feedyoureye Thanks for the post. I think the numbers are fairly consistent with what I was told to expect, and it makes sense that comorbidities would also return if people gain weight. I was one with a lot of weight to lose, and my surgeon told me the bypass would probably be better, but I was a candidate for either.

I often think I could have lost that last 10 pounds if I'd had bypass, but I'm still not sorry I made this choice (sleeve). I think the outcome would be the same in the long term for me. I am currently struggling a lot to not gain. It's getting harder and harder, and I really wasn't prepared for this. Either way, I lost over 90% of my excess weight, and at nearly three years out, I find it's 90% me, and 10% sleeve.

When I went into this, I knew long term I might settle at a 60% reduction from where I started. Now that I've lost so much and gotten to a normal size, the idea of that much regain is devastating to me. I'm going to do my best to not become a statistic!

[nyseness 76]

@@feedyoureye Thanks for the post. I think the numbers are fairly consistent with what I was told to expect, and it makes sense that comorbidities would also return if people gain weight. I was one with a lot of weight to lose, and my surgeon told me the bypass would probably be better, but I was a candidate for either.

I often think I could have lost that last 10 pounds if I'd had bypass, but I'm still not sorry I made this choice (sleeve). I think the outcome would be the same in the long term for me. I am currently struggling a lot to not gain. It's getting harder and harder, and I really wasn't prepared for this. Either way, I lost over 90% of my excess weight, and at nearly three years out, I find it's 90% me, and 10% sleeve.

When I went into this, I knew long term I might settle at a 60% reduction from where I started. Now that I've lost so much and gotten to a normal size, the idea of that much regain is devastating to me. I'm going to do my best to not become a statistic!

I started at 306 lbs w/ my journey and currently at 280. My doctor also said both procedures would work great for me but of course the bypass would give me more weight loss. But I don't want to lose that much, I would love to get to 170/180. What made you decide to do the VSG? What type of issues do you currently have, that suggests to maintain weight?

[Christinamo7 4,042]

I suppose the good news is if needed I could always have bypass later.

but, I am hoping that my habits will be changed and my weight significantly lower. I was not morbidly obese before I started a sedentary job, and within 5 years I hope I will be back to being a homemaker full time and therefore more active just in the daily routines of my life. Time will tell. I think it all boils down to what do you really want?

and THANK YOU for posting the whole article. I appreciate not having to go look somewhere else.

Edited April 4, 2016 by Christinamo7

[2goldengirl 2,076]

Part of the major issue with these studies is that long-term statistics are only as good as the followup. If patients are successful long term, or not, if they don't keep up with their surgeons, where does the data come from?

[VSGAnn2014 12,992]

I'm betting that in this particular study the non-response error was negligible. The study was conducted in Israel on Israeli patients by Israeli bariatric surgeons.

I figure Mossad hauled in the ones who didn't voluntarily come in for their follow-up interviews.

[Valentina 2,642]

Take this and chew on it:

I will be 5yrs out on June 6th. I did not acknowledge my WLS until this past Jan.

I have discovered that my sleeve is still viable and working now that I am mentally prepared to work with it.

I have lost 30# since Feb 20th.-- not as rapid a weight loss as most sleevers lose at first, I am delighted that my sleeve and I are working in harmony--at last.

I truly believe that a sleeve with work with a body and long as the mind is also prepared to work with it.

[ocgirl15 667]

Take this and chew on it:

I will be 5yrs out on June 6th. I did not acknowledge my WLS until this past Jan.

I have discovered that my sleeve is still viable and working now that I am mentally prepared to work with it.

I have lost 30# since Feb 20th.-- not as rapid a weight loss as most sleevers lose at first, I am delighted that my sleeve and I are working in harmony--at last.

I truly believe that a sleeve with work with a body and long as the mind is also prepared to work with it.

Very cool. Gives hope to newbies when we hear the sleeve is still viable 5 years out. You still have the restriction and just needed to make the choice to follow the program. Everyone says this is a tool and we need to address mental reason for overeating and making bad food choices. You are the living proof positive!

[Valentina 2,642]

Take this and chew on it:

I will be 5yrs out on June 6th. I did not acknowledge my WLS until this past Jan.

I have discovered that my sleeve is still viable and working now that I am mentally prepared to work with it.

I have lost 30# since Feb 20th.-- not as rapid a weight loss as most sleevers lose at first, I am delighted that my sleeve and I are working in harmony--at last.

I truly believe that a sleeve with work with a body and long as the mind is also prepared to work with it.

Very cool. Gives hope to newbies when we hear the sleeve is still viable 5 years out. You still have the restriction and just needed to make the choice to follow the program. Everyone says this is a tool and we need to address mental reason for overeating and making bad food choices. You are the living proof positive!

The very bottom of my heart thanks you.--and every other bit too! You probably will never know how much your words mean to me.

I kinda like the idea of being a living example of something positive.

Thank you again, my friend.

[CowgirlJane 14,259]

I will be 5 years in Dec.. I intend to check in. So far maintaining a hefty weight loss but it isn't so easy...

Sent from my KFJWI using the BariatricPal App

[Kindle 8,667]

Please consider the statistical validity of this one study and its conclusions before getting your panties in a wad.....

"In their retrospective analysis of a prospective cohort study of 443 patients who underwent bariatric surgery at the university hospital between 2006 and 2013, the percentage of excess body weight lost had dropped from 77% in 241 patients with available data at 1 year to 56% among 39 at 5"

Which means they are basing their "findings" on just 39 out of 443 patients from ONE hospital. That's not even a 10% followup rate of their own patients. What happened to the other 90% at 5 years out? Tens of thousands of people have had VSG and they are telling us what happened to 39 of them! It's more than laughable as far as statistically relevant conclusions are concerned.

[Gaylene Davison 43]

I find this information interesting. However I am trying to decide whether to convert to sleeve or bypass. I had a band in 2008 and lost over 60lb. I have regained 40[emoji30][emoji30]

Because I am afraid of future erosion from the band I want it out. I doubt I can lose what I have gained without help of sleeve or bypass. I am currently leaning towards bypass. Am seeing a surgeon in May to discuss.