Highlights
- •In persons with Class I Obesity, LSG resulted in significant, sustained weight loss
- •Being treated with oral therapy was a significant predictor of cure of type 2 diabetes after LSG
- •Pre-existing symptoms of gastroesophageal reflux disease resolved in 80% of patients
- •Quality of life after surgery was good with no major morbidity or surgery-related mortality.
Abstract
Background
Class I obesity carries significant morbidity and mortality risk similar to higher
grades of obesity, and persons with Class I obesity have a high risk of progression
to Class II and III obesity. While bariatric surgery has made strides in safety and
efficacy, it remains inaccessible for persons with Class I obesity (Body mass index
(BMI) of 30-35 kg/m 2).
Objectives
To assess safety, weight loss durability, comorbidity resolution, and quality of life
after Laparoscopic sleeve gastrectomy (LSG) in persons with Class I obesity
Setting
Multidisciplinary medical center that specializes in obesity management
Methods
A longitudinal prospective single surgeon registry was queried for data pertaining
to persons with Class I Obesity who underwent primary LSG. Primary endpoint was weight
loss. Secondary endpoints included change in obesity-related co-morbidities, adverse
events, and post-hoc analysis of symptoms of gastroesophageal reflux disease (GERD)
and Bariatric Analysis and Reporting Outcome System (BAROS) results. Follow-up was
divided into short- (1-3 years), intermediate- (4-7 years), and long-term (8-12 years).We
evaluated % excess weight loss (%EWL) using linear mixed models adjusting for age,
sex, years since operation, and baseline BMI. Least-squares means estimates and 95%
confidence intervals were generated.
Results
Out of 13,863 bariatric procedures, a total of 1,851 patients were included. Mean
baseline BMI, age, and male:female ratio were 32.6 ± 2.1 kg/m 2 , 33.7±9.2 years, and 1:5, respectively. Adjusted mean %EWL (95% confidence interval)
at short-, intermediate-, and long-term follow-up were 111 (95%CI: 91-131)%, 110 (95%CI:
89-131)%, and 141 (57-225)%, respectively. Out of 195 patients with type 2 diabetes,
59% experienced complete remission, and out of 168 patients with hypertension, 43%
experienced complete remission. Being on oral antidiabetes medication was a significant
predictor of sustained remission compared to being on insulin or combination therapy
(p-value: <0.001). Sixty-nine patients had symptoms of GERD before surgery, which
improved in 55 (79.7%). Thirty-three patients developed de novo symptoms of GERD.
Average BAROS score was 4.5 ± 1.7, with 83% of participants rating their quality of
life after surgery as good, very good, or excellent.
Conclusion
Those with Class I obesity who undergo LSG experience normalization of weight, sustained
remission of comorbidity, and good quality of life without significant risk of morbidity
or mortality.
Keywords
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Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022;18(12):1345-1356.
Article info
Publication history
Accepted:
March 2,
2023
Received in revised form:
February 19,
2023
Received:
October 4,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of Interest
The authors declare no conflicts of interest related to this study.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.
