Background: A large body of evidences have demonstrated that metabolic surgery is associated with significant and durable weight loss as well as a significant improvement of obesity-related comorbidities. The aim of our study was to evaluate the long term impact of gastric sleeve on metabolic parameters in morbidly obese patients.
Materials and methods: We evaluated 95 (67 women) severely obese patients (mean age 43.4±10.69 years) before and approximately 5 years after sleeve gastrectomy performed in a highly specialised centre. Anthropometric parameters, lipid profile, glucose and insulin levels were measured. We also determined the change in metabolic syndrome prevalence and looked for predictors of MetS long term remission.
Results: 5 years after gastric sleeve, mean BMI decreased from 44.6±8.1 kg/m2 to 34.2±6.25 kg/m2, P<0.00. Excess BMI loss (EBL) ranged from 0 to 135%, with a mean value of 55.3%. 51.5% of our patients maintained an EBL > 50% at the 5 years follow-up. The best results on weight loss were observed in young patients, not affected by MetS, with lower initial BMI. Mean levels of HOMA-IR decreased from 5.5 ± 4.9 to 2.5 ± 2.4, P< 0.001. HOMA-IR % variation positively correlated with BMI % variation (r=0.317, P=0.006) and waist circumference % variation (r=0.461, P<0.001) but we found no relationship between HOMA-IR % variation and baseline BMI. We observed a significant improvement in triglycerides and HDL-cholesterol levels, but not in total or LDL-cholesterol. Metabolic syndrome prevalence decreased from 64.9% to 22.7%. In multivariate analysis, % EBL and baseline HOMA-IR were the significant predictors of MetS remission.
Conclusions: 5 years after sleeve gastrectomy we recorded maintenance of a significant weight loss and improvement in insulin resistance, lipids metabolism, and metabolic syndrome prevalence, independent of the baseline BMI.