title: Laparoscopic sleeve gastrectomy in Asia: Long term outcome and revisional surgery.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is a popular stand-alone bariatric surgery, despite a paucity of long-term data. Hence, this study is to report the long-term outcome of LSG as primary bariatric procedure and the result of revisional surgery.
  
  
  METHODS
  With retrospective analysis of a prospective bariatric database, participants who defaulted clinic follow-up were interviewed by telephone. A total of 667 LSG was performed as primary bariatric procedure (2006-2012) with mean age of 34.5 ± 9.7 years old, female 74.7%, mean body mass index (BMI) 37.3 ± 8.1 kg/m(2). A 36-F bougie was used for all cases.
  
  
  RESULTS
  There were 61 patients available with long-term data. The weight loss outcome at 1 year, 2 years, 3 years, 4 years, and 5 years showed a mean BMI 26.3, 25.2, 25.3, 27.1, and 26.2 with mean excess weight loss (EWL) 76.0%, 79.6%, 77.3%, 73.4%, and 72.6% respectively. However, 17% patients developed de novo gastro-esophageal reflux disease (GERD). Eighteen patients (2.2%) needed surgical revisions due to weight regain (n = 6), persistent type 2 diabetes mellitus (T2DM; n = 2), stricture (n = 2), and GERD (n = 8). The revision resulted in an additional mean excess weight loss of 23.8% with mean BMI 24.9 kg/m(2) at 6 months postoperatively. There was a 23.7% mean reduction of HbA1c with one patient who was in complete diabetic remission at 1 year.
  
  
  CONCLUSIONS
  Our results showed LSG is a durable bariatric procedure with > 70% EWL at 5 years despite a high incidence of GERD. The need for revision of LSG is low and mainly for GERD.
authors.affiliation: Department of Surgery, University Malaya Medical Center, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: ehpok@um.edu.my.
authors.forename: Eng-Hong
authors.initials: EH
authors.lastname: Pok
authors.affiliation: Department of Surgery, Min-Sheng General Hospital, Taiwan.
authors.forename: Wei-Jei
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Surgery, Min-Sheng General Hospital, Taiwan.
authors.forename: Kong-Han
authors.initials: KH
authors.lastname: Ser
authors.affiliation: Department of Surgery, Min-Sheng General Hospital, Taiwan.
authors.forename: Jung-Chien
authors.initials: JC
authors.lastname: Chen
authors.affiliation: Department of Surgery, Min-Sheng General Hospital, Taiwan.
authors.forename: Shu-Chun
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Department of Surgery, Min-Sheng General Hospital, Taiwan.
authors.forename: Ju-Juin
authors.initials: JJ
authors.lastname: Tsou
authors.affiliation: Department of Surgery, University Malaya Medical Center, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Kin-Fah
authors.initials: KF
authors.lastname: Chin
mesh_terms: D000328:Adult; D001208:Asia; D005260:Female; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
keywords: gastro-esophageal reflux; long-term outcome; morbid obesity; revision; sleeve gastrectomy