Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2017; 9(4): 109-117
Published online Apr 27, 2017. doi: 10.4240/wjgs.v9.i4.109
Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study
Carlos Hoyuela
Carlos Hoyuela, Department of General and Digestive Surgery, Hospital Plató, Universitat Autònoma de Barcelona, 08006 Barcelona, Spain
Author contributions: Hoyuela C designed the study, collected and analyzed the data, wrote the paper and revised the manuscript for final submission.
Institutional review board statement: This study was reviewed and approved by the Hospital Plató Institutional Review Board.
Clinical trial registration statement: This study is registered at The registration identification is researchregistry 1580.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors have no commercial associations that might be a conflict of interest in relation to this article.
Data sharing statement: There is no additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Carlos Hoyuela, MD, Associate Professor of Surgery, Chief, Department of General and Digestive Surgery, Hospital Plató, Universitat Autònoma de Barcelona, Plató 21, 08006 Barcelona, Spain.
Telephone: +34-933-069900 Fax: +34-932-090103
Received: August 31, 2016
Peer-review started: September 2, 2016
First decision: October 20, 2016
Revised: December 11, 2016
Accepted: February 8, 2017
Article in press: February 13, 2017
Published online: April 27, 2017

To prospectively evaluate the postoperative morbi-mortality and weight loss evolution of patients who underwent a laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure during 5 years of follow-up.


Since 2006, data from patients undergoing a highly restrictive primary LSG have been prospectively registered in a database and analysed. Preoperative co-morbid conditions, operating time, hospital stay, early and late complications rate and evolution of weight loss after 5 years of follow-up were analysed.


A total of 156 patients were included, 74.3% of whom were women. The mean age was 43.2 ± 13.1 years and the mean body mass index (BMI) was 41.5 ± 7.9 kg/m2. Seventy patients (44.8%) presented a BMI under 40 kg/m2. The mortality rate was 0%. The leakage rate was 1.2%, and the total 30-d morbidity rate was 5.1% (8/156). With a mean follow-up of 32.7 ± 28.5 (range 6-112) mo, the mean percent of excess of weight loss (%EWL) was 82.0 ± 18.8 at 1 year, 76.7 ± 21.3 at 3 years and 60.3 ± 28.9 at 5 years. The mean percent of excess of BMI loss (%EBMIL) was 94.9 ± 22.4 at 1 year, 89.4 ± 27.4 at 3 years and 74.8 ± 29.4 at 5 years. Patients with preoperative BMI less than 40 kg/m2 achieved greater weight loss than did the overall study population. Diabetes remitted in 75% of the patients and HTA improved in 71.7%. CPAP masks were withdrawn in all patients with obstructive sleep apnoea.


LSG built with a narrow 34 F bougie and starting 3 cm from the pylorus proved to be safe and highly effective in terms of weight loss as a stand-alone procedure, particularly in patients with a preoperative BMI lower than 40 kg/m2.

Keywords: Sleeve gastrectomy, Morbid obesity, Bariatric surgery, Obesity surgery, Laparoscopy, Long-term results, 5-year results

Core tip: The number of laparoscopic sleeve gastrectomies (LSGs) performed worldwide as a primary bariatric procedure has grown exponentially in recent years, given the simplicity of the technique, the low complication rate and the good short- and mid-term results regarding weight loss and the resolution of co-morbidities. However, there are a limited data from long-term studies. In this study, a standardized LSG proved to be safe (no mortality and a leakage rate of 1.2%) and highly effective in terms of weight loss after 5-year of follow-up, particularly in patients with a low preoperative body mass index. This manuscript provides additional evidence supporting the role of laparoscopic sleeve gastrectomy as a stand-alone procedure for selected morbidly obese patients.