Sleeve gastrectomy for morbid obesity: weight loss trajectory and failure predictors over a decade

Sleeve gastrectomy (SG) is an effective treatment for morbid obesity, promoting weight loss and resolving related comorbidities.

This prospective, observational study involved 100 patients undergoing SG at Farhat Hached Hospital, Sousse, between February 2009 and December 2019.

Patients had a mean age of 34 ± 9.9 years and a mean BMI of 46.2 ± 7.8 kg/m². Preexisting conditions included type 2 diabetes (16%), hypertension (18%), dyslipidemia (13%), and obstructive sleep apnea (OSA) (29%). Eating disorders were prevalent (98%), notably binge eating (87%). Mortality was 0%, with 12% early morbidity. Maximum of Excess weight loss (EWL) reached 59 ± 19% at 24 months (with a maximum Total Weight Loss (%TWL) of 30 ± 7.9%) but declined to 30% by 10 years. Comorbidity remission rates were significant: 68.7% for diabetes, 27.7% for hypertension, and 46% for dyslipidemia. OSA improved in 86% of cases. The overall success rate (EWL >50%) was 61%, with 39% experiencing insufficient weight loss or regain. Predictors of failure identified through multivariate analysis included hypertension, diabetes, age >40 years, preoperative BMI > 40 kg/m², postoperative dietary lapses, and a sedentary lifestyle.

Our findings demonstrate that sleeve gastrectomy offers substantial initial weight loss, with the maximum Excess Weight Loss (EWL) achieved at 2 years. However, this weight loss diminishes over the long term, with long-term data (up to a decade) requiring cautious interpretation due to high attrition. A comprehensive understanding of factors influencing long-term success is vital for improving patient care.