title: Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy.
abstract: OBJECTIVE
  The prevalence of laparoscopic sleeve gastrectomy (LSG) is increasing, but data on its long-term effect on obesity-related comorbidities are scarce. Because the population of bariatric patients is young, long-term results of those comorbidities are highly relevant.
  
  
  OBJECTIVE
  To investigate the long-term effects of LSG on weight loss, diabetes mellitus, hypertension, dyslipidemia, and hyperuricemia.
  
  
  METHODS
  Cohort study using a retrospective analysis of a prospective cohort at a university hospital. Data were collected from all patients undergoing LSGs performed by the same team between April 1, 2006, and February 28, 2013, including demographic details, weight follow-up, blood test results, and information on medications and comorbidities.
  
  
  METHODS
  Excess weight loss, obesity-related comorbidities, and partial and complete remission at 1, 3, and 5 years of follow-up.
  
  
  RESULTS
  A total of 443 LSGs were performed. Complete data were available for 241 of the 443 patients (54.4%) at the 1-year follow-up, for 128 of 259 patients (49.4%) at the 3-year follow-up, and for 39 of 56 patients (69.6%) at the 5-year follow-up. The percentage of excess weight loss was 76.8%, 69.7%, and 56.1%, respectively. Complete remission of diabetes was maintained in 50.7%, 38.2%, and 20.0%, respectively, and remission of hypertension was maintained in 46.3%, 48.0%, and 45.5%, respectively. Changes in high-density lipoprotein cholesterol level (mean [SD] level preoperatively and at 1, 3, and 5 years, 46.7 [15.8], 52.8 [13.6], 56.8 [16.0], and 52.4 [13.8] mg/dL, respectively) and triglyceride level (mean [SD] level preoperatively and at 1, 3, and 5 years, 155.2 [86.1], 106.3 [45.3], 107.2 [53.4], and 126.4 [59.7] mg/dL, respectively) were significant compared with preoperative and postoperative measurements (P < .001). The decrease of low-density lipoprotein cholesterol level was significant only at 1 year (P = .04) and 3 years (P = .04) (mean [SD] level preoperatively and at 1, 3, and 5 years, 115.8 [33.2], 110.8 [32.0], 105.7 [25.9], and 110.6 [28.3] mg/dL, respectively). The changes in total cholesterol level did not reach statistical significance (mean [SD] level preoperatively and at 1, 3, and 5 years, 189.5 [38.2], 184.0 [35.4], 183.4 [31.2], and 188.1 [35.7] mg/dL, respectively). No changes in comorbidity status correlated with preoperative excess weight. Hypertriglyceridemia was the only comorbidity whose remission rates at 1 year of follow-up (partial/complete, 80.6%; complete, 72.2%) correlated with percentage of excess weight loss (76.8%) (P = .005).
  
  
  CONCLUSIONS
  Undergoing LSG induced efficient weight loss and a major improvement in obesity-related comorbidities, with mostly no correlation to percentage of excess weight loss. There was a significant weight regain and a decrease in remission rates of diabetes and, to a lesser extent, other comorbidities over time.
authors.affiliation: Bariatric Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Golomb
authors.affiliation: Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Matan
authors.initials: M
authors.lastname: Ben David
authors.affiliation: Bariatric Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Glass
authors.affiliation: Department of Internal Medicine, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Tamara
authors.initials: T
authors.lastname: Kolitz
authors.affiliation: Bariatric Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel2Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Andrei
authors.initials: A
authors.lastname: Keidar
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D006937:Hypercholesterolemia / Q000517:prevention & control; D006943:Hyperglycemia / Q000517:prevention & control; D006973:Hypertension / Q000517:prevention & control; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008659:Metabolic Diseases / Q000517:prevention & control*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss