Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy.

Abstract

Obesity is one of the major health challenges throughout the world. The association between obesity and diabetes is well established because 90% of patients with type 2 diabetes mellitus (T2DM) show excess body weight. The aim of the study was to evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on morbid obesity and type 2 diabetes (T2DM) in the long-term follow-up. One hundred ninety-five obese patients, 78 with T2DM, were evaluated before and after LSG up to 10years, to identify complete diabetes remission (FPG < 100mg/dl, A1c < 6.0%), partial remission (FPG 100-125mg/dl, A1c < 6.5%), or relapse. Before surgery, body weight and BMI were 123 ± 21kg and 44.6 ± 6.8kg/m2 respectively; at a mean follow-up of 7years (range 4-10), body weight was 104.9 ± 18kg and BMI 37 ± 6kg/m2. Minimum weight was reached after 2years. T2DM remission was observed in 66, 57, and 52% at short (< 2years), medium (2-5years), and long-term (> 5years) follow-up respectively. Furthermore, 45.2% maintained complete remission for at least 5years and about 36% showed a persistent but improved diabetes. None of the patients cured from diabetes had a duration disease greater than 8years and a glycemic control requiring insulin. The prevalence of hypertension and dyslipidemia significantly decreased from 49 to 35% and from 51 to 40% respectively. LSG significantly improves body weight, diabetes, hypertension, and dyslipidemia in long-term follow-up.