Matthew A Strode, DO, Rebekah Johnson, MD, Pamela Burgess, MD, Bradley Bandera, MD, Preston Sparks, DO, Faler Byron, MD, Balikrishna Prasad, PhD, Yong Choi, MD. Dwight D. Eisenhower Army Medical Center
Obesity has been clearly linked to the development of type II diabetes mellitus (T2DM) contributing significantly to the substantial cost of healthcare in the United States. Medical management modalities have fallen short in the treatment of this disease process and prevention of its sequelae. Sustained weight loss is a known effective treatment of T2DM and has been further aided by the development of weight loss surgery. Among surgical therapies, laparoscopic roux-en-y gastric bypass (LRYGB) has established itself as the benchmark in bariatric surgery in terms of weight loss and treatment of T2DM. Although initially thought of as a preliminary weight loss procedure in the super obese, the laparoscopic sleeve gastrectomy (LSG) has evolved as another standalone surgical modality to treat obesity. We examined our 5 year experience with LSG on the effects of weight loss and T2DM.
The study is a retrospective analysis of patients receiving LSG at our institution. Our bariatric database was queried for all LSG procedures performed in 2008. These patients were then followed for up to five years after surgery. Total body weight, BMI, hemoglobin A1c, and number of anti-diabetic medications were recorded pre-operatively and post-operatively.
During 2008, 74 patients underwent LSG at our institution. Five year follow-up data was available for 58 of these patients. Of the 58 patients, 22 were reported to have T2DM preoperatively with an average HbA1c of 7.16. The average HbA1c at five years after surgery decreased to 6.3 in these patients. In addition, 67% of these patients stopped at least one or more diabetic medication. The percent excess weight loss (EWL%) of all patients was found to be 29.2, 41.2, and 39.7 at 1, 3, and 5 years, respectively. Mean BMI decrease was an average of 10.3, 9.1 and 8.8 during the same time intervals.
Our data suggests that LSG can be an effective standalone bariatric procedure by achieving adequate weight loss. In addition to sustained weight loss, there is evidence that the improvement in T2DM is comparable to patients undergoing LRYGB. Further research will be needed with LSG to better define its place in the bariatric surgeon’s armamentarium.