Long-term results after sleeve gastrectomy: A systematic review

Sleeve gastrectomy (SG) has become one of the most commonly used bariatric procedures worldwide. However, data regarding long-term results remain insufficient. The aim of this study was to review the long-term results after SG. We conducted a comprehensive literature search of Medline and the Cochrane Library for articles published until May 2016 on the long-term results (>5 yr) after SG. Studies representing outcomes of SG were included if they reported≥5-year results that contained at least one outcome of interest-weight loss, co-morbidities, long-term complications, or quality of life-and SG was performed as a primary procedure. Of the 297 initially identified articles, 277 studies met the exclusion criteria, and 20 met the inclusion criteria. SG was performed on 2713 patients and 1626 patients reached the≥5-year follow-up point. Among the patients, 71.3% were women and 28.7% were men. The mean preoperative body mass index was 46.9 kg/m2. The duration of follow-up ranged 5 to 11 years. The mean 5-year follow-up rate was 66% (range, 57%-100%). The mean percentage excess weight loss was 58.4%, 59.5%, 56.6%, 56.4%, and 62.5% at 5, 6, 7, 8, and 11 years, respectively. Five years after SG, the resolution or improvement of type 2 diabetes was observed in 77.8% of patients, and arterial hypertension, dyslipidemia, obstructive sleep apnea, gastroesophageal reflux disease, and degenerative joint diseases had improved or resolved in 68.0%, 65.9%, 75.8%, 30.6%, and 55.7% of patients, respectively. This systematic review suggests that SG can lead to substantial and lasting excess weight loss and significant improvement in obesity-related co-morbidities. However, the lack of randomized clinical trials, low follow-up rates, and poorly reported data regarding co-morbidities and quality of life in many of the studies indicate that these findings should be interpreted with caution.