In the recent 2019 publication, Felsenreich and colleagues do a thorough job examining all of the long term reported studies and data regarding sleeve gastrectomy outcomes. The results paint a picture of a very safe and very effective procedure, with a few limitations.
From the Report
First of all, the average overall weight loss beyond five years among the four studies with the longest followup shows an average of 60% of the excess weight loss maintained off. And a high rate of remission of type 2 diabetes, hypertension and sleep apnea are achieved. Among the ten longest studies, type 2 diabetes remission is around 55%. But everyone would agree that we would like to see everyone maintain 80-90% of the excess weight off for the long term, and 100% of people in remission from diabetes. But how is that achieved?
Long term weight loss and weight maintenance remain an elusive goal. While sleeve gastrectomy in published studies is the safest, least invasive weight-loss intervention, the magnitude of weight lost appears less than the more aggressive duodenal switch. The sleeve procedure has become safer in hospital data than many very common and safe procedures including gallbladder removal, hysterectomy and ventral hernia repair. So it makes sense to stick with sleeve as the primary procedure, and approximately 65% of bariatric operations are now sleeve procedures. But for those who do not achieve sufficient weight loss and resolution of comorbid conditions, aggressive counseling, diet intervention, exercise, psychology interventions and coaching, prescription weight-loss medications, and revisional surgery should be offered.
In fact, revisional surgery in combination with the above strategies leads to significantly more weight loss among subjects who did not experience great long term success after the sleeve.
