Original articles|Articles in Press

Long-Term Outcomes of Laparoscopic Sleeve Gastrectomy in Those with Class I Obesity: Safety, Efficacy, and Quality of Life


      • 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.



      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).


      To assess safety, weight loss durability, comorbidity resolution, and quality of life after Laparoscopic sleeve gastrectomy (LSG) in persons with Class I obesity


      Multidisciplinary medical center that specializes in obesity management


      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.


      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.


      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.


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