Long term (7 or more years) outcomes of the sleeve gastrectomy: a meta-analysis

Abstract

Background: The laparoscopic sleeve gastrectomy is now the most common bariatric operation in the United States and has become an established procedure in the armamentarium of the bariatric surgeon. However, this has happened without the strong support of long-term outcomes data, namely the rate of revision and durability of the weight loss. Newly published data from around the world are starting to show alarming trends in these 2 areas. This paper will examine the published and presented data with at least a 7-year follow-up.

Objectives: This is a meta-analysis on published data with at least 7 years of follow-up from the laparoscopic sleeve gastrectomy.

Setting: Online published articles.

Methods: We performed a meta-analysis of publications with at least 7 years of follow-up with the keywords "laparoscopic, bariatric, sleeve gastrectomy, sleeve, long-term, long, term, results, follow-up, follow up, conversion, 7 years, 8 years, 9 years, 10 years, 11 years." We queried the PubMed, MEDLINE, and ClinicalKey search engines, which included abstracts as well. The I² statistic was used to determine the heterogeneity across the studies. In presence of heterogeneity, a random effect model using the Dersimonian and Laird method was used to estimate the pooled estimates. The results were summarized using effect size along with a 95% confidence interval (CI). Meta-regression was also used to assess the effect of body mass index and follow-up years on the incidence of recidivism at ≥7 years.

Results: Nine cohort studies met the inclusion criteria, with a total of 2280 patients included initially. Only 652 patients had completed ≥7 years of follow-up. At ≥7 years, the long-term weight recidivism rate was estimated to be 27.8% (I² = .60%; 95% CI: 22.8%-32.7%) with a range of 14% to 37%. The overall revision rate was estimated to be 19.9% (I² = 93.8%; 95% CI: 11.3%-28.5%). This was broken down into 13.1% (I² = 93.8%; 95% CI: 5.6%-20.6%) due to weight regain (5 studies) and 2.9% (I² = 60.8%; 95% CI: 1%-4.9%) due to gastroesophageal reflux disease (5 studies).

Conclusions: Based on available data up to the beginning of 2017, bariatric surgeons should be aware of the long-term outcomes of the sleeve gastrectomy, especially regarding revisions and weight regain. It is incumbent on the surgeon to make sure that bariatric patients are truly informed regarding the long-term results of the sleeve gastrectomy.

Keywords: Bariatric surgery; Failure of weight loss; Long-term outcomes; Revisional bariatric surgery; Sleeve gastrectomy.