Laparoscopic vertical sleeve gastrectomy, long and short-term impact on weight loss and associated co-morbidities

Abstract

The laparoscopic vertical sleeve gastrectomy (LVSG) has become the most popular operation for the treatment of morbid obesity in the United States. Being a purely restrictive procedure, the LVSG works to reduce the caloric intake of patients as well as decrease appetite through removal of ghrelin producing cells. Initially developed as the first part of a combined two step restrictive and malabsorptive procedure, the LVSG developed as a standalone procedure when patients lost significant weight with the restrictive portion of the operation alone. Short term outcomes have been promising in terms of weight loss and resolution of comorbid conditions. Long term outcomes are still evolving, but do demonstrate durable weight loss for a significant number of patients. Concerns with the LVSG in the long term revolve around development or worsening of gastroesophageal reflux disease or weight regain. The LVSG has been demonstrated to be a useful tool in the surgical management of morbid obesity.

Surgical Treatment of Obesity. Special Mention to Roux-en-Y Gastric Bypass and Vertical Gastrectomy

“…The introduction of the laparoscopic vertical sleeve gastrectomy (LVSG) has seen a marked rise in usage, even overtaking Rouxen-Y Gastric Bypass (RYGB) (23,24); in fact, it has become the most popular operation for the treatment of morbid obesity in the United States and worldwide due to its technical simplicity and palatability to patients (25,26).…”

“…LVSG also causes physical loss of principal producer of ghrelin, classically attributed to the fundus gastric (28). Being a purely restrictive procedure, the LVSG works to reduce the caloric intake of patients and decrease appetite through removal of ghrelin producing cells (25).…”

“…The long-term data for outcomes from LVSG is still being developed (25). Even though data were insufficient for a metaanalysis of the sleeve gastrectomy developed in 2019, it showed that it generated a weighted mean of 57% EWL from the two small studies that were included in the systematic review (21).…”

Variables Associated with Short-Term Weight Loss in a Cohort of Patients with Morbid Obesity According to Age and Three Types of Bariatric Surgery

“…While some reviews show similar %EWL with SG and RYGB at short and long-term [43], other reviews show better results with RYGB [44], with a greater treatment failure after six years for SG [44]. Most of the studies demonstrated and maintained weight loss through follow-up at five years and even for longer intervals (up to 11 years) [43]. However, a slow weight gain between the second and third years of postsurgery follow-up is found, increasing up to 5 years postsurgery [45].…”

“…Studies for short-and long-term weight-loss show different results. While some reviews show similar %EWL with SG and RYGB at short and long-term [43], other reviews show better results with RYGB [44], with a greater treatment failure after six years for SG [44]. Most of the studies demonstrated and maintained weight loss through follow-up at five years and even for longer intervals (up to 11 years) [43].…”