Beyond the Decade: Unveiling Long-Term Weight and Co- Morbidity Outcomes up to 10 Years Post Laparoscopic Sleeve Gastrectomy

Beyond the Decade: Unveiling Long-Term Weight and Co- Morbidity Outcomes up to 10 Years Post Laparoscopic Sleeve Gastrectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Beyond the Decade: Unveiling Long-Term Weight and Co- Morbidity Outcomes up to 10 Years Post Laparoscopic Sleeve Gastrectomy Salman Al Sabah, Eliana Al Haddad, Iman Qadhi, Muneerah AlMuhaini, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5299255/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Mar, 2025 Read the published version in Langenbeck's Archives of Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract Introduction Despite its effectiveness, long-term data on the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) for morbid obesity are sparce. Methods We collected data through phone interviews and hospital records for patients who had LSG, assessing their weight outcomes, associated health conditions, and complications. Results 2982 patients (72% female) were included in the study, with a maximum follow-up reached of 13 years. The mean pre-operative age and body mass index (BMI) were 34.7 ± 11.3 years and 45.5 ± 7.7 kg/m2, respectively. The prevalence of obesity classes were as follows: Class I, 3.1%; Class II, 19.2%; and Class III, 75.9%. BMI at nadir was 32.35 Kg/m2 equating to a mean nadir excess weight loss (EWL) of 67.03%. Weight outcomes at 13 years post-LSG showed a mean BMI of 31.83 kg/m 2 and total weight loss (TWL) percentage of 31.43%. Weight loss outcomes varied according to pre-operative obesity class, with class I achieving the highest percentage EWL and class III observing the highest TWL at the end of one year. Weight regain occurred in 1.3% of the patient population, with class III experiencing the highest weight regain at 13 years. Significant reductions in comorbidities were observed, while complication rates were low, with 0.4% bleed, 0.5% leak, and 7.9% GERD. Conclusion LSG demonstrates sustained weight loss and resolution of comorbidities with low complication rates. The influence of initial obesity class on weight loss was significant only in the first 18 months post-LSG. Figures Figure 1 Figure 2 Introduction The long-term management of the obesity crisis has become one of the most important items on the health budgets of countries around the world [1–3] given the chronic nature of the disease and the comorbidities associated with it. Bariatric surgery is the most effective treatment for managing morbid obesity, leading to satisfactory long-term weight loss and a significant reduction in related comorbidities. [4]. Laparoscopic sleeve gastrectomy (LSG) was initially described either as a first step procedure for the biliopancreatic diversion duodenal switch (BPD/DS) [5] or as a primary intervention for high-risk bariatric patients scheduled to undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) [6]. Over time, LSG has become the most frequently performed bariatric/metabolic procedure worldwide, largely due to its straightforward operative technique, absence of gastrointestinal anastomoses and foreign material, minimal alteration of patient anatomy, successful short- and mid-term weight loss outcomes, low morbidity rates, and its ability to be easily converted to another bariatric procedure. [7–10]. However, despite its increasing popularity, a paucity of studies looking at long-term outcomes exist, restricting the assessment of the LSGs’ sustained effectiveness and safety [11], while the ones that do exist exhibit high incidences of weight regain [12, 13] and de-novo reflux or worsening of pre-existing gastroesophageal reflux disease [14, 15]. We herein present our long-term primary LSG results in terms of weight loss, remission of comorbidities, and complication and reoperations rates at a single institution with a maximum follow-up time of 13 years. Methods Patient Follow-Up We conducted follow-up assessments using phone interviews to gather information on long-term outcomes of LSG, which were further corroborated with data from hospital records. The study included patients who had their initial LSG procedure at our facility. All participants met the standard criteria for bariatric surgery, which include having a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher accompanied by obesity-related health conditions [16]. We conducted telephone interviews that included comprehensive questions about weight changes, obesity-related health issues such as hypertension, type 2 diabetes mellitus (T2DM), and obstructive sleep apnea, as well as post-surgical complications like bleeding, leaks, and gastroesophageal reflux disease (GERD). The interviews also addressed whether patients required abdominoplasty after LSG or any subsequent bariatric surgery. Pre-Operative Evaluation Comprehensive pre-operative evaluation was performed on all patients as indicated by our previously performed studies (Long term adolescents). LSG Procedure Technique The LSG procedure involved the use of five laparoscopic ports while the patient was in the standard split-leg French position. The greater curvature of the stomach was devascularized starting 4 to 6 cm from the pylorus and extending to the angle of His. A 36-Fr calibrating bougie was then inserted from the stomach to the duodenum to guide the sleeve creation. Using a linear laparoscopic stapler, the stomach was divided along the bougie, ensuring the staple lines were placed 0.5 to 2 cm lateral to the esophagus. The bougie was subsequently removed, and a leak test was performed by injecting 100 ml of methylene blue. No intra-abdominal drains were used. If a hiatal hernia was detected during the operation, it was repaired concurrently with the sleeve gastrectomy. To prevent venous thromboembolism, prophylactic measures were started within 12 hours post-surgery and continued for two weeks [17]. A bariatric dietitian provided detailed dietary instructions for recovery [18] and patients were advised to attend regular follow-up appointments with their multidisciplinary bariatric team. Definition of Co-morbidities – Diabetes Diabetes was defined as either the Impaired glycaemia or impaired glucose tolerance and/or the need for insulin treatment and/or the need for oral antidiabetics (OAD) & insulin treatment and/or the need for oral hypoglycemics. Definition of Co-morbidities – GERD Gastro-esophageal reflux disease (GERD) was defined for patients based on their use of medication or symptoms: 1) Daily use of H2 receptor antagonists (H2RA) or proton pump inhibitors (PPI); 2) Intermittent use of medication; or 3) Intermittent symptoms without the need for medication. All patients scheduled for sleeve gastrectomy at our institution were pre-operatively evaluated for reflux. For patients with Grade A or lower reflux, the sleeve gastrectomy proceeded, as obesity was considered the primary cause. For those with Grade B reflux, further evaluation was conducted, and patients were placed on a PPI regimen as described previously [19]. If the reflux resolved, the sleeve gastrectomy was performed. Persistent reflux led to the recommendation of a Roux-en-Y gastric bypass instead. Definition of Co-morbidities – Hypertension (HTN) Hypertension was categorized as either: 1) Treated hypertension; or 2) Untreated hypertension. Definition of Co-morbidities – Obstructive Sleep Apnea (OSA) If the reflux resolved, the sleeve gastrectomy was performed. Persistent reflux led to the recommendation of a Roux-en-Y gastric bypass instead. [20]. Apneas were identified by a ≥ 90% reduction in airflow for at least two breaths. Obstructive apneas were characterized by the presence of respiratory effort throughout the apnea event. Postoperative Evaluation Follow-up assessments were scheduled at 1, 3, 6, and 12 months post-surgery, and annually thereafter for up to 13 years post-LSG. Weight loss was measured in terms of BMI changes, percentage of excess weight loss (%EWL), and percentage of total weight loss (%TWL). The patient follow-up attrition is illustrated in Fig. 1 . Statistical Analysis SPSS software version 22 was used to carry out statistical analysis of the data. A two-tailed unpaired Student’s t-test was used to evaluate the significance of the difference between two values. For all data comparisons, statistical significance was defined as p < 0.05. %EWL was calculated using an ideal body weight equivalent to a BMI of 25 kg/m2. Results Baseline Characteristics Our study analyzed data from 2982 patients who had laparoscopic sleeve gastrectomy as a initial procedure, with 2147 (72%) being female. At the time of surgery, the average age was 34.69 years old (± 11.25), the average pre-operative weight was 122.66 Kg (± 24.60), resulting in an average BMI of 45.50 Kg/m 2 (± 7.73) (Table 1 ). Of those patients, 93 (3.1%) were classified in the Class 1 obesity group (BMI = 30–35 Kg/m 2 ), 573 patients (19.2%) in the Class 2 group (BMI = 35–40 Kg/m 2 ), and 2264 patients (75.9%) in the Class 3 group (BMI > 40 Kg/m 2 ). There were no significant differences in baseline characteristics across the different obesity classes. Table 1 Patient Demographics Pre-Operatively Demographics Overall Obesity Class I Obesity Class II Obesity Class III Number of Patients 2982 93 (3.12%) 573 (19.2%) 2264 (75.9%) Age at Surgery (Years) 34.69 (11.25) 37.62 (11.50) 36.09 (10.40) 34.20 (11.38) Gender Male Female 835 (28%) 2147 (72%) Weight (Kg) 122.66 (24.60) 94.57 (10.15) 103.30 (11.22) 128.99 (23.84) BMI (Kg/m 2 ) 45.50 (7.73) 33.53 (1.18) 37.94 (1.39) 48.00 (7.08) The most prevalent pre-operative weight-related medical illness observed was diabetes (n = 309), followed by hypertension (n = 298) and obstructive sleep apnea (n = 127). The mean follow-up period was 8.60 (± 3.05) years. Weight Outcomes Mean weight at 13 years was 84.57 Kg (Table 2 ), corresponding to a mean BMI of 31.83 Kg/m 2 (Table 3 ), an EWL% of 69.6% (Table 4 ) and TWL% of 31.43% (Table 5 ). The highest excess weight loss was achieved at 4 years post-op (EWL = 74.35%), while the highest total weight loss percentage was achieved at 18 months post-op (TWL = 32.96%) (Fig. 2 ). This corresponded to a %EWL of 101.72% in patients that were classified in the Class I obesity group pre-operatively, 78.34% in Class 2, and 71.73% in Class 3, respectively; and a %TWL of 34.12% in Class 1, 30.87% in Class 2, and 33.54% in Class 3, respectively. Table 2 Weight Change with time post-operatively; divided between the three obesity classes Weight Post-LSG (Kg) All Patients P-Value Obesity Class I Obesity Class II Obesity Class III P-Value 2 weeks (n = 1490) 3 months (n = 1084) 6 months (n = 708) 1 year (n = 929) 18 months (n = 174) 2 years (n = 183) 3 years (n = 143) 4 years (n = 91) 5 years (n = 53) 6 years (n = 33) 7 years (n = 44) 8 years (n = 58) 9 years (n = 122) 10 years (n = 10) 11 years (n = 29) 12 years (n = 19) 13 years (n = 28) 113.92 (24.00) 104 (22.13) 95.51 (21.08) 91.08 (39.34) 84.37 (18.42) 82.13 (18.52) 81.60 (18.02) 81.57 (17.00) 88.81 (16.00) 82.81 (18.42) 89.49 (18.54) 88.48 (19.66) 89.90 (10.72) 92.20 (24.86) 92.17 (21.66) 94.47 (20.26) 84.57 (16.49) 0.000 0.000 0.000 0.000 0.040 - 0.855 - - - - - - - - - 86.64 (10.00) 79.63 (6.96) 73.08 (6.76) 72.00 (10.08) 56.00 65.75 (14.38) 62.00 (2.64) 69.00 (6.32) 87.00 (4.24) 81.00 83.00 - 79.33 (16.77) 75.00 81.00 72.00 95.00 94.75 (11.92) 86.79 (10.79) 78.43 (10.04) 76.69 (11.24) 73.90 (13.58) 72.40 (13.48) 81.29 (12.41) 76.83 (12.47) 78.67 (13.62) 80.38 (20.97) 83.86 (14.29) 77.44 (10.64) 83.43 (14.78) 72.67 (8.74) 88.71 (20.83) 84.25 (6.55) 70.40 (10.14) 119.69 (23.40) 108.73 (21.78) 99.74 (20.84) 93.47 (19.54) 85.98 (18.53) 85.38 (18.79) 82.32 (19.07) 85.48 (18.70) 93.46 (15.67) 83.15 (14.77) 91.44 (19.29) 90.51 (20.32) 91.78 (21.75) 104.83 (24.54) 93.86 (22.65) 99.00 (21.57) 87.32 (16.41) 0.000 0.000 0.000 0.000 0.000 0.693 0.458 0.857 0.775 0.131 0.885 0.127 0.141 0.699 0.178 0.171 0.925 Table 3 BMI Change with time post-operatively; divided between the three obesity classes BMI Post-LSG (Kg/m 2 ) All Patients P-Value Obesity Class I Obesity Class II Obesity Class III P-Value 2 weeks (n = 1490) 3 months (n = 1084) 6 months (n = 708) 1 year (n = 929) 18 months (n = 174) 2 years (n = 183) 3 years (n = 143) 4 years (n = 91) 5 years (n = 53) 6 years (n = 33) 7 years (n = 44) 8 years (n = 58) 9 years (n = 122) 10 years (n = 10) 11 years (n = 29) 12 years (n = 19) 13 years (n = 28) 42.58 (7.96) 38.94 (7.55) 35.74 (7.21) 33.97 (13.33) 31.78 (6.63) 30.39 (6.05) 30.43 (6.73) 29.84 (5.44) 32.09 (7.51) 31.47 (6.12) 33.09 (6.64) 32.91 (6.78) 32.73 (6.96) 33.12 (6.33) 33.74 (6.66) 35.95 (7.85) 31.83 (6.27) 0.000 0.000 0.000 0.000 0.050 - 0.675 - - - - - - - - - 30.87 (1.67) 28.52 (1.93) 26.78 (2.71) 25.52 (3.00) 22.15 26.02 (6.21) 24.84 (1.32) 25.32 (3.19) 28.96 (4.69) 29.04 31.24 - 30.79 (5.46) 28.93 24.45 25.82 29.65 35.05 (2.24) 32.01 (2.49) 29.07 (2.81) 28.15 (3.65) 25.96 (4.80) 26.42 (4.02) 29.66 (5.01) 27.80 (3.69) 28.58 (3.96) 29.00 (3.31) 31.82 (4.38) 28.74 (2.93) 30.61 (4.13) 28.20 (3.96) 30.54 (5.29) 30.47 (3.92) 26.35 (3.89) 44.83 (7.46) 40.73 (7.27) 37.39 (6.92) 35.07 (6.67) 32.66 (6.44) 31.70 (5.99) 30.74 (7.07) 31.53 (5.78) 33.77 (8.28) 33.49 (7.24) 33.65 (7.04) 33.67 (7.02) 33.30 (7.45) 36.28 (5.98) 35.25 (6.58) 38.24 (7.68) 33.18 (6.19) 0.000 0.000 0.000 0.000 0.000 0.693 0.458 0.857 0.775 0.131 0.885 0.127 0.141 0.699 0.178 0.171 0.925 Table 4 Percent EWL with time post-operatively; divided between the three obesity classes EWL % All Patients P-Value Obesity Class I Obesity Class II Obesity Class III P-Value 2 weeks (n = 1490) 3 months (n = 1084) 6 months (n = 708) 1 year (n = 929) 18 months (n = 174) 2 years (n = 183) 3 years (n = 143) 4 years (n = 91) 5 years (n = 53) 6 years (n = 33) 7 years (n = 44) 8 years (n = 58) 9 years (n = 122) 10 years (n = 10) 11 years (n = 29) 12 years (n = 19) 13 years (n = 28) 18.01(11.08) 37.71 (15.53) 54.58 (19.42) 61.94 (45.87) 71.89 (30.08) 74.99 (28.00) 72.94 (33.67) 74.35 (29.22) 65.12 (30.28) 61.26 (30.63) 59.55 (30.66) 63.26 (26.58) 59.96 (31.55) 60.47 (21.04) 56.60 (33.38) 50.76 (24.27) 69.60 (27.66) 0.000 0.000 0.000 0.003 0.066 - 0.639 - - - - - - - - - 31.85 (15.67) 60.08 (19.05) 82.59 (30.15) 98.16 (38.52) 133.04 91.50 (65.44) 101.82 (14.09) 101.72 (45.64) 59.35 (47.63) 44.38 29.69 - 39.54 (53.39) 59.53 108.54 88.77 48.45 22.86 (13.25) 45.94 (17.46) 69.44 (21.28) 76.60 (27.66) 94.32 (38.40) 89.64 (30.80) 63.59 (38.77) 78.34 (27.86) 70.92 (35.53) 67.43 (28.26) 47.33 (33.87) 72.81 (21.84) 54.79 (35.81) 72.38 (32.93) 55.07 (45.26) 59.82 (26.81) 91.85 (28.82) 16.39 (9.51) 35.36 (13.78) 50.73 (15.98) 59.29 (20.33) 69.69 (21.85) 71.13 (22.17) 74.72 (32.42) 71.73 (22.83) 63.94 (27.63) 61.59 (32.72) 61.44 (29.23) 61.51 (27.19) 61.84 (29.79) 54.67 (15.40) 54.63 (28.39) 45.46 (21.97) 65.51 (25.86) 0.000 0.000 0.000 0.000 0.000 0.693 0.458 0.857 0.775 0.131 0.885 0.127 0.141 0.699 0.178 0.171 0.925 Table 5 Percent TWL with time post-operatively; divided between the three obesity classes TWL % All Patients P-Value Obesity Class I Obesity Class II Obesity Class III P-Value 2 weeks (n = 1490) 3 months (n = 1084) 6 months (n = 708) 1 year (n = 929) 18 months (n = 174) 2 years (n = 183) 3 years (n = 143) 4 years (n = 91) 5 years (n = 53) 6 years (n = 33) 7 years (n = 44) 8 years (n = 58) 9 years (n = 122) 10 years (n = 10) 11 years (n = 29) 12 years (n = 19) 13 years (n = 28) 7.63 (4.26) 16.25 (5.81) 23.82 (6.96) 27.49 (9.28) 32.96 (11.61) 31.79 (10.83) 32.02 (15.01) 30.14 (10.65) 27.38 (12.80) 25.46 (13.04) 25.62 (14.07) 27.94 (12.15) 26.31 (14.79) 24.42 (8.06) 23.55 (13.26) 20.85 (9.16) 31.43 (13.16) 0.000 0.000 0.000 0.000 0.054 - 0.954 - - - - - - - - - 8.07 (4.04) 14.80 (4.07) 20.68 (6.40) 23.89 (7.26) 34.12 25.13 (17.16) 27.60 (3.79) 24.49 (6.85) 16.11 (12.57) 10.00 7.78 - 10.18 (14.20) 16.67 22.11 20.00 12.84 7.70 (4.39) 15.50 (5.81) 23.62 (6.88) 25.97 (9.02) 30.87 (11.65) 30.72 (10.45) 21.43 (13.21) 26.32 (9.62) 24.02 (11.82) 22.73 (9.80) 15.82 (10.94) 25.14 (6.73) 19.17 (12.58) 23.97 (12.14) 17.43 (13.43) 19.94 (7.65) 31.35 (8.24) 7.58 (4.25) 16.46 (5.85) 23.98 (6.99) 27.94 (9.33) 33.54 (11.08) 32.59 (10.43) 34.22 (14.69) 33.05 (11.00) 29.37 (13.11) 28.30 (15.14) 28.36 (13.78) 28.46 (12.88) 28.52 (14.56) 25.93 (6.55) 25.66 (13.20) 21.16 (10.11) 32.29 (13.88) 0.001 0.972 0.140 0.000 0.192 0.155 0.648 0.363 0.405 0.419 0.296 0.281 0.333 0.401 0.378 0.400 Mean nadir weight achieved, measured 10 months onwards post-LSG, was 86.86 Kg (± 19.53), corresponding to a nadir BMI of 32.35 Kg/m 2 (± 6.91). This weight loss equated to a mean nadir excess weight loss (EWL) of 67.03% (± 27.65). Overall, 31 patients (17.8% of patients with data at 18 months; 1.04% of total patient population) attained insufficient weight loss, defined as an excess weight loss percentage of < 50% 18 months post-LSG [21], while a total of 40 patients (1.3% of total patient population) experienced weight regain, defined as progressive weight regain that occurred after achieving an initial successful weight loss (defined as an EWL > 50%) [21] (Table 6 ). Table 6 Morbidity and Co-morbidity Resolution Comorbidity Pre-op (% of total patient population) Resolved (% from pre-op) p-value OSA Obesity Class I Obesity Class II Obesity Class III 127 (4.7%) 2 (2.2%) 26 (4.5%) 91 (4.0%) 93 (73.2%) 2 (100%) 21 (80.8%) 63 (69.2%) 0.000 HTN Obesity Class I Obesity Class II Obesity Class III 298 (10.0%) 9 (9.7%) 58 (10.1%) 220 (9.7%) 80 (26.8%) 3 (33.3%) 14 (24.1%) 59 (26.8%) 0.000 DM Type 1 Obesity Class I Obesity Class II Obesity Class III 309 (10.4%) 31 (1.0%) 15 (16.1%) 66 (11.5%) 221 (9.8%) 119 (38.5%) 4 (12.9%) 7 (46.7%) 28 (42.4%) 83 (37.6%) 0.000 Baseline characteristics of patients that did not experience weight regain (WR) vs patients that experienced weight regain (WR) did not show statistical differences (p > 0.005): age at LSG 36.78 years old (± 11.34) vs 26.00 years old (± 1.41), respectively; pre-operative weight 125.67 Kg (± 23.67) vs 143.00 Kg (± 19.80), respectively; pre-operative BMI 45.33 Kg/m 2 (± 7.47) vs 42.70 Kg/m 2 (± 0.10), respectively. There was a significant difference between starting obesity class and TWL at 2w (p = 0.001; obesity class 1 with the highest TWL) and 1y (p = 0.000; obesity class 3 with the highest, followed by class 2, and class 1). There was also a significant difference between starting obesity class and weight regain at 13 years (p = 0.011; obesity class 3 with the highest weight regain, followed by obesity class 1, then class 2). Interestingly, we noted a significant difference between starting obesity class and weight (p = 0.000) at 2w, 3m, 6m, 1y and 18m. Comorbidity Outcomes and Complications Patients suffering from hypertension, obstructive sleep apnea and diabetes mellitus (DM) demonstrated significant reductions of these comorbidities from baseline (p < 0.001 for all parameters) (Table 6 ). Of the patients that were diagnosed with type 1 DM pre-operatively, 4 patients experienced remission post-LSG (12.9%), defined as a decrease in insulin requirements. Complications encountered post-LSG included bleed in 13 patients (0.4%), and leak in 16 patients (0.5%). Gastroesophageal reflux disease (GERD) was encountered in 237 (7.9%) of patients post-LSG, with the majority classified as Grade 1 GERD (235; 7.7%) (Table 7 ). Table 7 Occurrence of post-op complications Bleed Leak GERD Revisional Procedure Undertaken Reason for Revision Grade 1 Grade 2 Grade 3 Resleeve Bypass OAGB Time until Revision (years) Insufficient Weight Loss Weight Regain Overall 13 (0.4%) 16 (0.5%) 235 (7.7%) 1 (0.1%) 1 (0.1%) 9 (0.3%) 20 (0.7%) 5 (0.2%) 5.27 (2.64) 31 (1.04%) 40 (1.3%) Obesity Class I 1 (1.1%) - 8 (8.6%) - - - 2 (10%) - 7.45 (4.04) - 2 (2.1%) Obesity Class II 3 (0.5%) 2 (0.3%) 60 (10.5%) - - 2 (22.2%) 5 (25%) - 7.18 (4.01) 2 (6.5%) 8 (1.4%) Obesity Class III 9 (0.4%) 14 (0.6%) 158 (6.9%) 1 (0.1%) 1 (0.1%) 7 (77.8%) 13 (65%) 5 (100%) 7.47 (5.42) 29 (93.5%) 29 (1.3%) Revisional bariatric procedures were undertaken by 34 patients post-LSG (1.1%) after an average of 5.3 years, with the majority undergoing a revisional Roux-en-Y gastric bypass (n = 20; 0.7%). The reasons behind the need for revisional surgery were weight regain (n = 22; 64.7%), development of GERD (n = 8; 23.5%), insufficient weight loss (n = 2; 5.9%) and the development of hypoglycemic episodes (n = 2; 5.9%). Discussion When the use of sleeve gastrectomy’s began to rise in 2014, overtaking all other bariatric surgeries being performed at the time, no long-term data had existed on it’s weight loss outcomes, making quantification of success difficult to predict when recommending this procedure. Our study aimed to report the long-term weight loss and comorbidity outcomes of patients who underwent laparoscopic sleeve gastrectomy as a primary bariatric procedure. The main findings of our study were to provide an insight on the successful long-term weight loss achieved after LSG, as well as the control of comorbidities associated with untreated obesity. Primary LSG resulted in a sustained excess weight loss (EWL) of over 50% throughout the 13 year follow-up period, which is consistent with other studies examining long-term outcomes after LSG [22–24]. However, until recently, finding studies reporting on > 7 year outcomes were rare, with the majority being published between the years of 2018–2021 [24–32]. A meta-analysis conducted by Clapp et al.[11] in 2018 was able to demonstrate successful weight loss achieved by patients at 7 + years post LSG, with 72.2% achieving a %EWL of > 50%, while a systematic review conducted by Juodeikis et al. [33] was able to report a mean %EWL of 54.8% at 8 years post operatively. This has been emulated by our current study, with EWL standing in the range of 50.76–69.60 at 7 + years post-LSG. Weight regain was defined as progressive weight regain occurring after an initial successful weight loss (EWL > 50%), while insufficient weight loss was defined as an excess weight loss percentage of < 50% at 18 months post-LSG [21], however, it is important to note that there is yet to be a standardized definition for these factors [34–37], making reporting outcome comparison complicated. Nonetheless, by the definition we use at our institute, the rates of weight regain and insufficient weight loss was 1.3% and 1.04%, respectively. These numbers were significantly lower than those encountered by previous studies such as that of Clapp et al., with a pooled weighted mean proportion of weight regain demonstrated to be 27.8% (range = 14–37%) [11]. However, it should be taken into consideration that our follow up percentage declined with time, with results obtained from 50% of patients at 2 weeks post-op, 31% of patients at 1 year post-op, and from 4% of patients at 9 years post-LSG, which could have affected follow-up results collected. A study conducted by Capoccia et al. [26] defined weight regain of ≥ 15 - 30% was defined as severe. According to this definition, 61 of our patients (2%) experienced mild weight regain and 79 patients (2.6%) experienced severe weight regain post operatively. When using the definition created by Sakran et al. [38], patients that regained < 25% of maximum weight lost were classified as having experienced mild weight regain, while those that regained ≥ 25% were classified as having experienced significant weight regain. According to this definition, 650 of our patients (22%) experienced mild weight regain, while 98 patients (3.3%) experienced significant weight regain. Further, our current study’s cohort had a mean percentage weight regain of maximum weight loss of 32.89%, slightly lower than that reported by Sakran et al. (33.4%), while being slightly higher than that reported by Capoccia et al. (31.5%) [26]. Although the success of laparoscopic sleeve gastrectomy is no longer disputed, complications and failures following this procedures still exist, with weight regain and the recurrence of obesity being one of the major worries for patients and surgeons alike. This is where revisional/secondary bariatric procedures come into play. Revisional bariatric surgery post primary LSG have increased as of recent years, making it a focal research topic [39, 40]. However, the results of our long-term analysis was able to demonstrate a need for a revisional procedure in only 1.1% of our cohort, with the majority needing to be converted to a Roux-en-Y gastric bypass. This is quite small a number when compared to previous studies looking at long-term outcomes. For example, the study conducted by Felsenreich et al. [27] followed their patients for greater than 15 years, demonstrating a %EWL of 61% at the end of the study period, however, this was encountered with a high revision rate of 49.1%. Arman et al reported a reoperation rate of 31.7% [41] and Kowalewski et al. demonstrated a revision rate of 16% after an 8 year follow-up period [42]. When it came to looking at resolution of comorbidities associated with obesity, we were able to demonstrate positive results, with a 73.2% resolution rate of patients with obstructive sleep apnea, a 26.8% resolution rate of hypertension, and a 38.5% resolution rate of type 2 diabetes mellitus. These numbers are lower than those seen by the study conducted by Kraljevic et al., with 60.5% resolution rates of hypertension and 61% resolution rates of DM [43]; as well as those encountered by Sakran et al. [38], with 51.7% resolution of hypertension, and a 72.2% resolution rate of DM encountered. On the other hand, complications encountered following the sleeve procedure were small in number with bleed encountered in 0.4% of patients post-op and a leak diagnosed in 0.5% of the patient population. This is comparable to other studies with post-operative leak rate for LSG varying between 1 and 3% for a primary procedure [44, 45], while incidence of bleeding following LSG’s has been reported to range between 1.16–4.94% [33]. Gastroesophageal reflux disease has recently become a major concern following the performance of sleeve gastrectomy due to the association that has linked the two together. There have been multiple mechanisms proposed to explain this phenomena, and those include the large compliant stomach being transformed into a long and narrow tube. This implies a lack of gastric compliance, with an increased intraluminal pressure that correlates inversely with the diameter of the gastric tube and is increased when the pylorus is closed. Other factors are related to dismantling of the anatomical anti-reflux mechanisms, including disruption to the Hiss angle and resection of the sling fibers in the distal part of the lower sphincter, which results in low esophageal-sphincter pressure. The final shape of the sleeve also plays a role as it may favor GERD and regurgitation when it is funnel-shaped. The role of the gastric antrum has not been fully clarified but it is thought that extensive resection of the antrum may impair gastric emptying and favor GERD [46]. However, previous studies have been inconsistent with the effect that sleeves have on GERD. A national analysis conducted by DuPree et al. was able to show that 84.1% of patients that had pre-existing GERD continued to have GERD symptoms post LSG, while 8.6% developed GERD postoperatively [47]. The mechanisms in which GERD may improve after undergoing LSG include the decrease in intra-abdominal pressure due to weight loss, reduced acid production related to resection of the acid-producing gastric fundus, accelerated gastric emptying, and reduced gastric volume [14, 48]. Our study was able to demonstrate low de novo GERD rates, with only 7.9% of patients developing GERD, 99% of which classified as Grade 1. This is significantly lower than the number demonstrated by Kowalewski et al. (44% de novo GERD), Kraljevic et al. (32.4%) and Hauters et al. (43%) [30, 43], but closer to the percentage seen in Juodeikis et al.’s study (10%) [33], as well as Garg et al. [49] and Melissas et al. [50]. Even though this study looked at a large cohort of patients that underwent LSG over a long-term follow-up period of 13 years, it is not without it’s limitations. Firstly, the data was collected via phone calls, entailing a potential for information, recall, and response bias. We attempted to increase the validity of our data by collecting the majority of the information we could by utilizing hospital charts, and when needed, data were verified by a telephone interview. Secondly, due to the long follow-up period of the study, we have lost a significant number of patients to follow-up, making it difficult to quantify the full potential of our results. Further, the data was collected retrospectively without the presence of a control group, possibly contributing to selection bias. However, it is one of the fewest published in this region with a long follow-up period in a geographic location which is heavily burdened by obesity. Finally, the study lacked objective measurements such as a medication list, blood test results, and imaging test results, and we could only base our results on presented symptoms and declared pharmacotherapy. Conclusion Our results indicate that LSG is an effective bariatric procedure for weight loss, with a sustained %EWL up to 13 years post-operatively. Further, insufficient weight loss and weight regain were minimal within our cohort. Resolution of comorbidities was also seen to be satisfactory, and low complication rates were encountered within our cohort. Starting obesity class only significantly affected weight loss in the first 18 months post-operatively. However, increased patient engagement in follow-up routines is crucial for collecting long-term data following bariatric procedures. Declarations Ethical Approval and consent to Participate : Ethical approval to conduct the study was obtained from the Ministry of Health and Kuwait Institute for Medical Specialization Ethical Approval Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent for study participation was obtained from all subjects (if subjects are under 16, from a parent and/or legal guardian). Consent for Publication : Not Applicable Competing Interests: The authors declare that they have no conflict of interest. Funding: The authors declare no source of funding for the completion of this study. Author Contribution Conceived Project: S.AS.Designed research: S.AS., E.AH.Collected data: I.Q., M.AM., A.AA., A.AQ., A.AK., A.S., M.B.Performed research: S.AS., E.AH.Analyzed data: E.AH.Wrote paper: E.AH.Edited paper: S.AS., E.AH. Acknowledgement We would like to thank Kuwait University Research Sector for their support in producing this data. 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Cite Share Download PDF Status: Published Journal Publication published 31 Mar, 2025 Read the published version in Langenbeck's Archives of Surgery → Version 1 posted Editorial decision: Revision requested 17 Jan, 2025 Reviews received at journal 15 Jan, 2025 Reviewers agreed at journal 12 Jan, 2025 Reviewers agreed at journal 06 Jan, 2025 Reviewers agreed at journal 14 Nov, 2024 Reviewers invited by journal 06 Nov, 2024 Editor assigned by journal 21 Oct, 2024 Submission checks completed at journal 21 Oct, 2024 First submitted to journal 20 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5299255","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":368491149,"identity":"43da1cb3-6317-4cda-9a49-c1c36942708a","order_by":0,"name":"Salman Al Sabah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABC0lEQVRIie3PMUvDQBTA8RcC53Ix65VS+hUuHETEqF/F4yBTnNvNgPgma7+AH8JJOl4JmKXYNeEWszjZtdChYNo66HBtR4f7T++GH+8dgMv1D+vnfr4dTgEIeHnCNw8GcGMlXHs7QnYkPYLAX1IcQU6mDy+rCfRJWHx+rCZzwbU/NRRSmdv+8iixHs0gQpaeRaOZibkm6oJCZiWgJVYBgocMYhagSbimcZfC8NZK5g3Wa4RrDMtlZ43vLQmX+0kl0bRbJEIWdwPU7WGUtCSzEl41aHrIFLJsIHqoRKcg4vyZp3fW74/VW73A5HIclq/NAq+ip/K+qb6GStju+on9mv3t9gPA5XK5XHv7BvzQWOolkseuAAAAAElFTkSuQmCC","orcid":"","institution":"Kuwait University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Salman","middleName":"Al","lastName":"Sabah","suffix":""},{"id":368491150,"identity":"042745f7-2416-4a1c-b384-dacde4057f56","order_by":1,"name":"Eliana Al Haddad","email":"","orcid":"","institution":"McGill University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Eliana","middleName":"Al","lastName":"Haddad","suffix":""},{"id":368491151,"identity":"09997156-627b-46cb-939c-2cae38d53dc6","order_by":2,"name":"Iman Qadhi","email":"","orcid":"","institution":"Al Amiri Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Iman","middleName":"","lastName":"Qadhi","suffix":""},{"id":368491152,"identity":"81db6ee7-dc60-4173-97f5-19ad8a1cdbbf","order_by":3,"name":"Muneerah AlMuhaini","email":"","orcid":"","institution":"Mubarak AlKabeer Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Muneerah","middleName":"","lastName":"AlMuhaini","suffix":""},{"id":368491153,"identity":"db621aed-6121-48c8-8702-633855d0c907","order_by":4,"name":"Abrar AlAwtan","email":"","orcid":"","institution":"Mubarak AlKabeer Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abrar","middleName":"","lastName":"AlAwtan","suffix":""},{"id":368491154,"identity":"24b38f12-e76e-4507-baf1-60e0c26aaffe","order_by":5,"name":"Omar A. AlQabandi","email":"","orcid":"","institution":"Al Amiri Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Omar","middleName":"A.","lastName":"AlQabandi","suffix":""},{"id":368491155,"identity":"3575a32e-4e1d-4041-9d3e-edf573987bd1","order_by":6,"name":"Ali AlKhayat","email":"","orcid":"","institution":"Al Amiri Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"AlKhayat","suffix":""},{"id":368491156,"identity":"a8f38b80-09b7-4d1e-bec6-946201e55705","order_by":7,"name":"Ammar F. Saleem","email":"","orcid":"","institution":"Mubarak AlKabeer Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ammar","middleName":"F.","lastName":"Saleem","suffix":""},{"id":368491157,"identity":"682be80d-78b5-400b-8f16-ce459d9e4b32","order_by":8,"name":"Mousa Behbehani","email":"","orcid":"","institution":"Al Amiri Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mousa","middleName":"","lastName":"Behbehani","suffix":""}],"badges":[],"createdAt":"2024-10-20 16:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5299255/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5299255/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00423-025-03680-1","type":"published","date":"2025-03-31T15:57:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":68539771,"identity":"8dcd063e-8fdd-4000-ac66-8845effb6f97","added_by":"auto","created_at":"2024-11-08 10:39:05","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":157610,"visible":true,"origin":"","legend":"\u003cp\u003eLoss to Follow-Up (F/U) Diagram over time\u003c/p\u003e","description":"","filename":"Fig1Losstofollowup.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5299255/v1/60169b8bb78a05a28b56d18c.jpg"},{"id":68539772,"identity":"2a74a10a-1602-48df-b94b-5d39a7828e0d","added_by":"auto","created_at":"2024-11-08 10:39:05","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":74098,"visible":true,"origin":"","legend":"\u003cp\u003eWeight loss, Change in BMI, % Excess Weight loss and % Total Weight loss over 13 years\u003c/p\u003e","description":"","filename":"Fig2WeightlossEWLTWLBMI.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5299255/v1/7ea5c8634de07ad75468c0b9.jpg"},{"id":80082129,"identity":"a9f8bf23-5ffa-457a-8130-081f5adf4fce","added_by":"auto","created_at":"2025-04-07 16:07:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1399991,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5299255/v1/aa610eb3-2b48-45a6-a53c-535d2dfcdae1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Beyond the Decade: Unveiling Long-Term Weight and Co- Morbidity Outcomes up to 10 Years Post Laparoscopic Sleeve Gastrectomy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe long-term management of the obesity crisis has become one of the most important items on the health budgets of countries around the world [1\u0026ndash;3] given the chronic nature of the disease and the comorbidities associated with it. Bariatric surgery is the most effective treatment for managing morbid obesity, leading to satisfactory long-term weight loss and a significant reduction in related comorbidities. [4].\u003c/p\u003e \u003cp\u003eLaparoscopic sleeve gastrectomy (LSG) was initially described either as a first step procedure for the biliopancreatic diversion duodenal switch (BPD/DS) [5] or as a primary intervention for high-risk bariatric patients scheduled to undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) [6]. Over time, LSG has become the most frequently performed bariatric/metabolic procedure worldwide, largely due to its straightforward operative technique, absence of gastrointestinal anastomoses and foreign material, minimal alteration of patient anatomy, successful short- and mid-term weight loss outcomes, low morbidity rates, and its ability to be easily converted to another bariatric procedure. [7\u0026ndash;10]. However, despite its increasing popularity, a paucity of studies looking at long-term outcomes exist, restricting the assessment of the LSGs\u0026rsquo; sustained effectiveness and safety [11], while the ones that do exist exhibit high incidences of weight regain [12, 13] and de-novo reflux or worsening of pre-existing gastroesophageal reflux disease [14, 15].\u003c/p\u003e \u003cp\u003eWe herein present our long-term primary LSG results in terms of weight loss, remission of comorbidities, and complication and reoperations rates at a single institution with a maximum follow-up time of 13 years.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient Follow-Up\u003c/h2\u003e \u003cp\u003eWe conducted follow-up assessments using phone interviews to gather information on long-term outcomes of LSG, which were further corroborated with data from hospital records. The study included patients who had their initial LSG procedure at our facility. All participants met the standard criteria for bariatric surgery, which include having a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher accompanied by obesity-related health conditions [16].\u003c/p\u003e \u003cp\u003eWe conducted telephone interviews that included comprehensive questions about weight changes, obesity-related health issues such as hypertension, type 2 diabetes mellitus (T2DM), and obstructive sleep apnea, as well as post-surgical complications like bleeding, leaks, and gastroesophageal reflux disease (GERD). The interviews also addressed whether patients required abdominoplasty after LSG or any subsequent bariatric surgery.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePre-Operative Evaluation\u003c/h3\u003e\n\u003cp\u003eComprehensive pre-operative evaluation was performed on all patients as indicated by our previously performed studies (Long term adolescents).\u003c/p\u003e\n\u003ch3\u003eLSG Procedure Technique\u003c/h3\u003e\n\u003cp\u003eThe LSG procedure involved the use of five laparoscopic ports while the patient was in the standard split-leg French position. The greater curvature of the stomach was devascularized starting 4 to 6 cm from the pylorus and extending to the angle of His. A 36-Fr calibrating bougie was then inserted from the stomach to the duodenum to guide the sleeve creation. Using a linear laparoscopic stapler, the stomach was divided along the bougie, ensuring the staple lines were placed 0.5 to 2 cm lateral to the esophagus. The bougie was subsequently removed, and a leak test was performed by injecting 100 ml of methylene blue. No intra-abdominal drains were used. If a hiatal hernia was detected during the operation, it was repaired concurrently with the sleeve gastrectomy.\u003c/p\u003e \u003cp\u003eTo prevent venous thromboembolism, prophylactic measures were started within 12 hours post-surgery and continued for two weeks [17]. A bariatric dietitian provided detailed dietary instructions for recovery [18] and patients were advised to attend regular follow-up appointments with their multidisciplinary bariatric team.\u003c/p\u003e\n\u003ch3\u003eDefinition of Co-morbidities – Diabetes\u003c/h3\u003e\n\u003cp\u003eDiabetes was defined as either the Impaired glycaemia or impaired glucose tolerance and/or the need for insulin treatment and/or the need for oral antidiabetics (OAD) \u0026amp; insulin treatment and/or the need for oral hypoglycemics.\u003c/p\u003e\n\u003ch3\u003eDefinition of Co-morbidities – GERD\u003c/h3\u003e\n\u003cp\u003eGastro-esophageal reflux disease (GERD) was defined for patients based on their use of medication or symptoms: 1) Daily use of H2 receptor antagonists (H2RA) or proton pump inhibitors (PPI); 2) Intermittent use of medication; or 3) Intermittent symptoms without the need for medication. All patients scheduled for sleeve gastrectomy at our institution were pre-operatively evaluated for reflux. For patients with Grade A or lower reflux, the sleeve gastrectomy proceeded, as obesity was considered the primary cause. For those with Grade B reflux, further evaluation was conducted, and patients were placed on a PPI regimen as described previously [19]. If the reflux resolved, the sleeve gastrectomy was performed. Persistent reflux led to the recommendation of a Roux-en-Y gastric bypass instead.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDefinition of Co-morbidities \u0026ndash; Hypertension (HTN)\u003c/h2\u003e \u003cp\u003eHypertension was categorized as either: 1) Treated hypertension; or 2) Untreated hypertension.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDefinition of Co-morbidities – Obstructive Sleep Apnea (OSA)\u003c/h3\u003e\n\u003cp\u003eIf the reflux resolved, the sleeve gastrectomy was performed. Persistent reflux led to the recommendation of a Roux-en-Y gastric bypass instead. [20]. Apneas were identified by a\u0026thinsp;\u0026ge;\u0026thinsp;90% reduction in airflow for at least two breaths. Obstructive apneas were characterized by the presence of respiratory effort throughout the apnea event.\u003c/p\u003e\n\u003ch3\u003ePostoperative Evaluation\u003c/h3\u003e\n\u003cp\u003eFollow-up assessments were scheduled at 1, 3, 6, and 12 months post-surgery, and annually thereafter for up to 13 years post-LSG. Weight loss was measured in terms of BMI changes, percentage of excess weight loss (%EWL), and percentage of total weight loss (%TWL). The patient follow-up attrition is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eSPSS software version 22 was used to carry out statistical analysis of the data. A two-tailed unpaired Student\u0026rsquo;s t-test was used to evaluate the significance of the difference between two values. For all data comparisons, statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. %EWL was calculated using an ideal body weight equivalent to a BMI of 25 kg/m2.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics\u003c/h2\u003e \u003cp\u003eOur study analyzed data from 2982 patients who had laparoscopic sleeve gastrectomy as a initial procedure, with 2147 (72%) being female. At the time of surgery, the average age was 34.69 years old (\u0026plusmn;\u0026thinsp;11.25), the average pre-operative weight was 122.66 Kg (\u0026plusmn;\u0026thinsp;24.60), resulting in an average BMI of 45.50 Kg/m\u003csup\u003e2\u003c/sup\u003e (\u0026plusmn;\u0026thinsp;7.73) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Of those patients, 93 (3.1%) were classified in the Class 1 obesity group (BMI\u0026thinsp;=\u0026thinsp;30\u0026ndash;35 Kg/m\u003csup\u003e2\u003c/sup\u003e), 573 patients (19.2%) in the Class 2 group (BMI\u0026thinsp;=\u0026thinsp;35\u0026ndash;40 Kg/m\u003csup\u003e2\u003c/sup\u003e), and 2264 patients (75.9%) in the Class 3 group (BMI\u0026thinsp;\u0026gt;\u0026thinsp;40 Kg/m\u003csup\u003e2\u003c/sup\u003e). There were no significant differences in baseline characteristics across the different obesity classes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Demographics Pre-Operatively\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObesity Class I\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eObesity Class II\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eObesity Class III\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNumber of Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e93 (3.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e573 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e2264 (75.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge at Surgery (Years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.69 (11.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e37.62 (11.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e36.09 (10.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e34.20 (11.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e835 (28%)\u003c/p\u003e \u003cp\u003e2147 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWeight (Kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122.66 (24.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e94.57 (10.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e103.30 (11.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e128.99 (23.84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI (Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.50 (7.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e33.53 (1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e37.94 (1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e48.00 (7.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe most prevalent pre-operative weight-related medical illness observed was diabetes (n\u0026thinsp;=\u0026thinsp;309), followed by hypertension (n\u0026thinsp;=\u0026thinsp;298) and obstructive sleep apnea (n\u0026thinsp;=\u0026thinsp;127). The mean follow-up period was 8.60 (\u0026plusmn;\u0026thinsp;3.05) years.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eWeight Outcomes\u003c/h2\u003e \u003cp\u003eMean weight at 13 years was 84.57 Kg (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), corresponding to a mean BMI of 31.83 Kg/m\u003csup\u003e2\u003c/sup\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), an EWL% of 69.6% (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) and TWL% of 31.43% (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The highest excess weight loss was achieved at 4 years post-op (EWL\u0026thinsp;=\u0026thinsp;74.35%), while the highest total weight loss percentage was achieved at 18 months post-op (TWL\u0026thinsp;=\u0026thinsp;32.96%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This corresponded to a %EWL of 101.72% in patients that were classified in the Class I obesity group pre-operatively, 78.34% in Class 2, and 71.73% in Class 3, respectively; and a %TWL of 34.12% in Class 1, 30.87% in Class 2, and 33.54% in Class 3, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWeight Change with time post-operatively; divided between the three obesity classes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight Post-LSG (Kg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll Patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObesity Class I\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eObesity Class II\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eObesity Class III\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 weeks (n\u0026thinsp;=\u0026thinsp;1490)\u003c/p\u003e \u003cp\u003e3 months (n\u0026thinsp;=\u0026thinsp;1084)\u003c/p\u003e \u003cp\u003e6 months (n\u0026thinsp;=\u0026thinsp;708)\u003c/p\u003e \u003cp\u003e1 year (n\u0026thinsp;=\u0026thinsp;929)\u003c/p\u003e \u003cp\u003e18 months (n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e \u003cp\u003e2 years (n\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e \u003cp\u003e3 years (n\u0026thinsp;=\u0026thinsp;143)\u003c/p\u003e \u003cp\u003e4 years (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003cp\u003e5 years (n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003cp\u003e6 years (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003cp\u003e7 years (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003cp\u003e8 years (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003cp\u003e9 years (n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e \u003cp\u003e10 years (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003cp\u003e11 years (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003cp\u003e12 years (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003cp\u003e13 years (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113.92 (24.00)\u003c/p\u003e \u003cp\u003e104 (22.13)\u003c/p\u003e \u003cp\u003e95.51 (21.08)\u003c/p\u003e \u003cp\u003e91.08 (39.34)\u003c/p\u003e \u003cp\u003e84.37 (18.42)\u003c/p\u003e \u003cp\u003e82.13 (18.52)\u003c/p\u003e \u003cp\u003e81.60 (18.02)\u003c/p\u003e \u003cp\u003e81.57 (17.00)\u003c/p\u003e \u003cp\u003e88.81 (16.00)\u003c/p\u003e \u003cp\u003e82.81 (18.42)\u003c/p\u003e \u003cp\u003e89.49 (18.54)\u003c/p\u003e \u003cp\u003e88.48 (19.66)\u003c/p\u003e \u003cp\u003e89.90 (10.72)\u003c/p\u003e \u003cp\u003e92.20 (24.86)\u003c/p\u003e \u003cp\u003e92.17 (21.66)\u003c/p\u003e \u003cp\u003e94.47 (20.26)\u003c/p\u003e \u003cp\u003e84.57 (16.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.040\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e0.855\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.64 (10.00)\u003c/p\u003e \u003cp\u003e79.63 (6.96)\u003c/p\u003e \u003cp\u003e73.08 (6.76)\u003c/p\u003e \u003cp\u003e72.00 (10.08)\u003c/p\u003e \u003cp\u003e56.00\u003c/p\u003e \u003cp\u003e65.75 (14.38)\u003c/p\u003e \u003cp\u003e62.00 (2.64)\u003c/p\u003e \u003cp\u003e69.00 (6.32)\u003c/p\u003e \u003cp\u003e87.00 (4.24)\u003c/p\u003e \u003cp\u003e81.00\u003c/p\u003e \u003cp\u003e83.00\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e79.33 (16.77)\u003c/p\u003e \u003cp\u003e75.00\u003c/p\u003e \u003cp\u003e81.00\u003c/p\u003e \u003cp\u003e72.00\u003c/p\u003e \u003cp\u003e95.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.75 (11.92)\u003c/p\u003e \u003cp\u003e86.79 (10.79)\u003c/p\u003e \u003cp\u003e78.43 (10.04)\u003c/p\u003e \u003cp\u003e76.69 (11.24)\u003c/p\u003e \u003cp\u003e73.90 (13.58)\u003c/p\u003e \u003cp\u003e72.40 (13.48)\u003c/p\u003e \u003cp\u003e81.29 (12.41)\u003c/p\u003e \u003cp\u003e76.83 (12.47)\u003c/p\u003e \u003cp\u003e78.67 (13.62)\u003c/p\u003e \u003cp\u003e80.38 (20.97)\u003c/p\u003e \u003cp\u003e83.86 (14.29)\u003c/p\u003e \u003cp\u003e77.44 (10.64)\u003c/p\u003e \u003cp\u003e83.43 (14.78)\u003c/p\u003e \u003cp\u003e72.67 (8.74)\u003c/p\u003e \u003cp\u003e88.71 (20.83)\u003c/p\u003e \u003cp\u003e84.25 (6.55)\u003c/p\u003e \u003cp\u003e70.40 (10.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e119.69 (23.40)\u003c/p\u003e \u003cp\u003e108.73 (21.78)\u003c/p\u003e \u003cp\u003e99.74 (20.84)\u003c/p\u003e \u003cp\u003e93.47 (19.54)\u003c/p\u003e \u003cp\u003e85.98 (18.53)\u003c/p\u003e \u003cp\u003e85.38 (18.79)\u003c/p\u003e \u003cp\u003e82.32 (19.07)\u003c/p\u003e \u003cp\u003e85.48 (18.70)\u003c/p\u003e \u003cp\u003e93.46 (15.67)\u003c/p\u003e \u003cp\u003e83.15 (14.77)\u003c/p\u003e \u003cp\u003e91.44 (19.29)\u003c/p\u003e \u003cp\u003e90.51 (20.32)\u003c/p\u003e \u003cp\u003e91.78 (21.75)\u003c/p\u003e \u003cp\u003e104.83 (24.54)\u003c/p\u003e \u003cp\u003e93.86 (22.65)\u003c/p\u003e \u003cp\u003e99.00 (21.57)\u003c/p\u003e \u003cp\u003e87.32 (16.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.693\u003c/p\u003e \u003cp\u003e0.458\u003c/p\u003e \u003cp\u003e0.857\u003c/p\u003e \u003cp\u003e0.775\u003c/p\u003e \u003cp\u003e0.131\u003c/p\u003e \u003cp\u003e0.885\u003c/p\u003e \u003cp\u003e0.127\u003c/p\u003e \u003cp\u003e0.141\u003c/p\u003e \u003cp\u003e0.699\u003c/p\u003e \u003cp\u003e0.178\u003c/p\u003e \u003cp\u003e0.171\u003c/p\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBMI Change with time post-operatively; divided between the three obesity classes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI Post-LSG (Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll Patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObesity Class I\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eObesity Class II\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eObesity Class III\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 weeks (n\u0026thinsp;=\u0026thinsp;1490)\u003c/p\u003e \u003cp\u003e3 months (n\u0026thinsp;=\u0026thinsp;1084)\u003c/p\u003e \u003cp\u003e6 months (n\u0026thinsp;=\u0026thinsp;708)\u003c/p\u003e \u003cp\u003e1 year (n\u0026thinsp;=\u0026thinsp;929)\u003c/p\u003e \u003cp\u003e18 months (n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e \u003cp\u003e2 years (n\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e \u003cp\u003e3 years (n\u0026thinsp;=\u0026thinsp;143)\u003c/p\u003e \u003cp\u003e4 years (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003cp\u003e5 years (n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003cp\u003e6 years (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003cp\u003e7 years (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003cp\u003e8 years (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003cp\u003e9 years (n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e \u003cp\u003e10 years (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003cp\u003e11 years (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003cp\u003e12 years (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003cp\u003e13 years (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.58 (7.96)\u003c/p\u003e \u003cp\u003e38.94 (7.55)\u003c/p\u003e \u003cp\u003e35.74 (7.21)\u003c/p\u003e \u003cp\u003e33.97 (13.33)\u003c/p\u003e \u003cp\u003e31.78 (6.63)\u003c/p\u003e \u003cp\u003e30.39 (6.05)\u003c/p\u003e \u003cp\u003e30.43 (6.73)\u003c/p\u003e \u003cp\u003e29.84 (5.44)\u003c/p\u003e \u003cp\u003e32.09 (7.51)\u003c/p\u003e \u003cp\u003e31.47 (6.12)\u003c/p\u003e \u003cp\u003e33.09 (6.64)\u003c/p\u003e \u003cp\u003e32.91 (6.78)\u003c/p\u003e \u003cp\u003e32.73 (6.96)\u003c/p\u003e \u003cp\u003e33.12 (6.33)\u003c/p\u003e \u003cp\u003e33.74 (6.66)\u003c/p\u003e \u003cp\u003e35.95 (7.85)\u003c/p\u003e \u003cp\u003e31.83 (6.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.050\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e0.675\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.87 (1.67)\u003c/p\u003e \u003cp\u003e28.52 (1.93)\u003c/p\u003e \u003cp\u003e26.78 (2.71)\u003c/p\u003e \u003cp\u003e25.52 (3.00)\u003c/p\u003e \u003cp\u003e22.15\u003c/p\u003e \u003cp\u003e26.02 (6.21)\u003c/p\u003e \u003cp\u003e24.84 (1.32)\u003c/p\u003e \u003cp\u003e25.32 (3.19)\u003c/p\u003e \u003cp\u003e28.96 (4.69)\u003c/p\u003e \u003cp\u003e29.04\u003c/p\u003e \u003cp\u003e31.24\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e30.79 (5.46)\u003c/p\u003e \u003cp\u003e28.93\u003c/p\u003e \u003cp\u003e24.45\u003c/p\u003e \u003cp\u003e25.82\u003c/p\u003e \u003cp\u003e29.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.05 (2.24)\u003c/p\u003e \u003cp\u003e32.01 (2.49)\u003c/p\u003e \u003cp\u003e29.07 (2.81)\u003c/p\u003e \u003cp\u003e28.15 (3.65)\u003c/p\u003e \u003cp\u003e25.96 (4.80)\u003c/p\u003e \u003cp\u003e26.42 (4.02)\u003c/p\u003e \u003cp\u003e29.66 (5.01)\u003c/p\u003e \u003cp\u003e27.80 (3.69)\u003c/p\u003e \u003cp\u003e28.58 (3.96)\u003c/p\u003e \u003cp\u003e29.00 (3.31)\u003c/p\u003e \u003cp\u003e31.82 (4.38)\u003c/p\u003e \u003cp\u003e28.74 (2.93)\u003c/p\u003e \u003cp\u003e30.61 (4.13)\u003c/p\u003e \u003cp\u003e28.20 (3.96)\u003c/p\u003e \u003cp\u003e30.54 (5.29)\u003c/p\u003e \u003cp\u003e30.47 (3.92)\u003c/p\u003e \u003cp\u003e26.35 (3.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44.83 (7.46)\u003c/p\u003e \u003cp\u003e40.73 (7.27)\u003c/p\u003e \u003cp\u003e37.39 (6.92)\u003c/p\u003e \u003cp\u003e35.07 (6.67)\u003c/p\u003e \u003cp\u003e32.66 (6.44)\u003c/p\u003e \u003cp\u003e31.70 (5.99)\u003c/p\u003e \u003cp\u003e30.74 (7.07)\u003c/p\u003e \u003cp\u003e31.53 (5.78)\u003c/p\u003e \u003cp\u003e33.77 (8.28)\u003c/p\u003e \u003cp\u003e33.49 (7.24)\u003c/p\u003e \u003cp\u003e33.65 (7.04)\u003c/p\u003e \u003cp\u003e33.67 (7.02)\u003c/p\u003e \u003cp\u003e33.30 (7.45)\u003c/p\u003e \u003cp\u003e36.28 (5.98)\u003c/p\u003e \u003cp\u003e35.25 (6.58)\u003c/p\u003e \u003cp\u003e38.24 (7.68)\u003c/p\u003e \u003cp\u003e33.18 (6.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.693\u003c/p\u003e \u003cp\u003e0.458\u003c/p\u003e \u003cp\u003e0.857\u003c/p\u003e \u003cp\u003e0.775\u003c/p\u003e \u003cp\u003e0.131\u003c/p\u003e \u003cp\u003e0.885\u003c/p\u003e \u003cp\u003e0.127\u003c/p\u003e \u003cp\u003e0.141\u003c/p\u003e \u003cp\u003e0.699\u003c/p\u003e \u003cp\u003e0.178\u003c/p\u003e \u003cp\u003e0.171\u003c/p\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercent EWL with time post-operatively; divided between the three obesity classes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEWL %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll Patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObesity Class I\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eObesity Class II\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eObesity Class III\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 weeks (n\u0026thinsp;=\u0026thinsp;1490)\u003c/p\u003e \u003cp\u003e3 months (n\u0026thinsp;=\u0026thinsp;1084)\u003c/p\u003e \u003cp\u003e6 months (n\u0026thinsp;=\u0026thinsp;708)\u003c/p\u003e \u003cp\u003e1 year (n\u0026thinsp;=\u0026thinsp;929)\u003c/p\u003e \u003cp\u003e18 months (n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e \u003cp\u003e2 years (n\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e \u003cp\u003e3 years (n\u0026thinsp;=\u0026thinsp;143)\u003c/p\u003e \u003cp\u003e4 years (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003cp\u003e5 years (n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003cp\u003e6 years (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003cp\u003e7 years (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003cp\u003e8 years (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003cp\u003e9 years (n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e \u003cp\u003e10 years (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003cp\u003e11 years (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003cp\u003e12 years (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003cp\u003e13 years (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.01(11.08)\u003c/p\u003e \u003cp\u003e37.71 (15.53)\u003c/p\u003e \u003cp\u003e54.58 (19.42)\u003c/p\u003e \u003cp\u003e61.94 (45.87)\u003c/p\u003e \u003cp\u003e71.89 (30.08)\u003c/p\u003e \u003cp\u003e74.99 (28.00)\u003c/p\u003e \u003cp\u003e72.94 (33.67)\u003c/p\u003e \u003cp\u003e74.35 (29.22)\u003c/p\u003e \u003cp\u003e65.12 (30.28)\u003c/p\u003e \u003cp\u003e61.26 (30.63)\u003c/p\u003e \u003cp\u003e59.55 (30.66)\u003c/p\u003e \u003cp\u003e63.26 (26.58)\u003c/p\u003e \u003cp\u003e59.96 (31.55)\u003c/p\u003e \u003cp\u003e60.47 (21.04)\u003c/p\u003e \u003cp\u003e56.60 (33.38)\u003c/p\u003e \u003cp\u003e50.76 (24.27)\u003c/p\u003e \u003cp\u003e69.60 (27.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.003\u003c/p\u003e \u003cp\u003e0.066\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e0.639\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.85 (15.67)\u003c/p\u003e \u003cp\u003e60.08 (19.05)\u003c/p\u003e \u003cp\u003e82.59 (30.15)\u003c/p\u003e \u003cp\u003e98.16 (38.52)\u003c/p\u003e \u003cp\u003e133.04\u003c/p\u003e \u003cp\u003e91.50 (65.44)\u003c/p\u003e \u003cp\u003e101.82 (14.09)\u003c/p\u003e \u003cp\u003e101.72 (45.64)\u003c/p\u003e \u003cp\u003e59.35 (47.63)\u003c/p\u003e \u003cp\u003e44.38\u003c/p\u003e \u003cp\u003e29.69\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e39.54 (53.39)\u003c/p\u003e \u003cp\u003e59.53\u003c/p\u003e \u003cp\u003e108.54\u003c/p\u003e \u003cp\u003e88.77\u003c/p\u003e \u003cp\u003e48.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.86 (13.25)\u003c/p\u003e \u003cp\u003e45.94 (17.46)\u003c/p\u003e \u003cp\u003e69.44 (21.28)\u003c/p\u003e \u003cp\u003e76.60 (27.66)\u003c/p\u003e \u003cp\u003e94.32 (38.40)\u003c/p\u003e \u003cp\u003e89.64 (30.80)\u003c/p\u003e \u003cp\u003e63.59 (38.77)\u003c/p\u003e \u003cp\u003e78.34 (27.86)\u003c/p\u003e \u003cp\u003e70.92 (35.53)\u003c/p\u003e \u003cp\u003e67.43 (28.26)\u003c/p\u003e \u003cp\u003e47.33 (33.87)\u003c/p\u003e \u003cp\u003e72.81 (21.84)\u003c/p\u003e \u003cp\u003e54.79 (35.81)\u003c/p\u003e \u003cp\u003e72.38 (32.93)\u003c/p\u003e \u003cp\u003e55.07 (45.26)\u003c/p\u003e \u003cp\u003e59.82 (26.81)\u003c/p\u003e \u003cp\u003e91.85 (28.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.39 (9.51)\u003c/p\u003e \u003cp\u003e35.36 (13.78)\u003c/p\u003e \u003cp\u003e50.73 (15.98)\u003c/p\u003e \u003cp\u003e59.29 (20.33)\u003c/p\u003e \u003cp\u003e69.69 (21.85)\u003c/p\u003e \u003cp\u003e71.13 (22.17)\u003c/p\u003e \u003cp\u003e74.72 (32.42)\u003c/p\u003e \u003cp\u003e71.73 (22.83)\u003c/p\u003e \u003cp\u003e63.94 (27.63)\u003c/p\u003e \u003cp\u003e61.59 (32.72)\u003c/p\u003e \u003cp\u003e61.44 (29.23)\u003c/p\u003e \u003cp\u003e61.51 (27.19)\u003c/p\u003e \u003cp\u003e61.84 (29.79)\u003c/p\u003e \u003cp\u003e54.67 (15.40)\u003c/p\u003e \u003cp\u003e54.63 (28.39)\u003c/p\u003e \u003cp\u003e45.46 (21.97)\u003c/p\u003e \u003cp\u003e65.51 (25.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.693\u003c/p\u003e \u003cp\u003e0.458\u003c/p\u003e \u003cp\u003e0.857\u003c/p\u003e \u003cp\u003e0.775\u003c/p\u003e \u003cp\u003e0.131\u003c/p\u003e \u003cp\u003e0.885\u003c/p\u003e \u003cp\u003e0.127\u003c/p\u003e \u003cp\u003e0.141\u003c/p\u003e \u003cp\u003e0.699\u003c/p\u003e \u003cp\u003e0.178\u003c/p\u003e \u003cp\u003e0.171\u003c/p\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercent TWL with time post-operatively; divided between the three obesity classes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTWL %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll Patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObesity Class I\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eObesity Class II\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eObesity Class III\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 weeks (n\u0026thinsp;=\u0026thinsp;1490)\u003c/p\u003e \u003cp\u003e3 months (n\u0026thinsp;=\u0026thinsp;1084)\u003c/p\u003e \u003cp\u003e6 months (n\u0026thinsp;=\u0026thinsp;708)\u003c/p\u003e \u003cp\u003e1 year (n\u0026thinsp;=\u0026thinsp;929)\u003c/p\u003e \u003cp\u003e18 months (n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e \u003cp\u003e2 years (n\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e \u003cp\u003e3 years (n\u0026thinsp;=\u0026thinsp;143)\u003c/p\u003e \u003cp\u003e4 years (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003cp\u003e5 years (n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003cp\u003e6 years (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003cp\u003e7 years (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003cp\u003e8 years (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003cp\u003e9 years (n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e \u003cp\u003e10 years (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003cp\u003e11 years (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003cp\u003e12 years (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003cp\u003e13 years (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.63 (4.26)\u003c/p\u003e \u003cp\u003e16.25 (5.81)\u003c/p\u003e \u003cp\u003e23.82 (6.96)\u003c/p\u003e \u003cp\u003e27.49 (9.28)\u003c/p\u003e \u003cp\u003e32.96 (11.61)\u003c/p\u003e \u003cp\u003e31.79 (10.83)\u003c/p\u003e \u003cp\u003e32.02 (15.01)\u003c/p\u003e \u003cp\u003e30.14 (10.65)\u003c/p\u003e \u003cp\u003e27.38 (12.80)\u003c/p\u003e \u003cp\u003e25.46 (13.04)\u003c/p\u003e \u003cp\u003e25.62 (14.07)\u003c/p\u003e \u003cp\u003e27.94 (12.15)\u003c/p\u003e \u003cp\u003e26.31 (14.79)\u003c/p\u003e \u003cp\u003e24.42 (8.06)\u003c/p\u003e \u003cp\u003e23.55 (13.26)\u003c/p\u003e \u003cp\u003e20.85 (9.16)\u003c/p\u003e \u003cp\u003e31.43 (13.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.054\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e0.954\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.07 (4.04)\u003c/p\u003e \u003cp\u003e14.80 (4.07)\u003c/p\u003e \u003cp\u003e20.68 (6.40)\u003c/p\u003e \u003cp\u003e23.89 (7.26)\u003c/p\u003e \u003cp\u003e34.12\u003c/p\u003e \u003cp\u003e25.13 (17.16)\u003c/p\u003e \u003cp\u003e27.60 (3.79)\u003c/p\u003e \u003cp\u003e24.49 (6.85)\u003c/p\u003e \u003cp\u003e16.11 (12.57)\u003c/p\u003e \u003cp\u003e10.00\u003c/p\u003e \u003cp\u003e7.78\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e10.18 (14.20)\u003c/p\u003e \u003cp\u003e16.67\u003c/p\u003e \u003cp\u003e22.11\u003c/p\u003e \u003cp\u003e20.00\u003c/p\u003e \u003cp\u003e12.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.70 (4.39)\u003c/p\u003e \u003cp\u003e15.50 (5.81)\u003c/p\u003e \u003cp\u003e23.62 (6.88)\u003c/p\u003e \u003cp\u003e25.97 (9.02)\u003c/p\u003e \u003cp\u003e30.87 (11.65)\u003c/p\u003e \u003cp\u003e30.72 (10.45)\u003c/p\u003e \u003cp\u003e21.43 (13.21)\u003c/p\u003e \u003cp\u003e26.32 (9.62)\u003c/p\u003e \u003cp\u003e24.02 (11.82)\u003c/p\u003e \u003cp\u003e22.73 (9.80)\u003c/p\u003e \u003cp\u003e15.82 (10.94)\u003c/p\u003e \u003cp\u003e25.14 (6.73)\u003c/p\u003e \u003cp\u003e19.17 (12.58)\u003c/p\u003e \u003cp\u003e23.97 (12.14)\u003c/p\u003e \u003cp\u003e17.43 (13.43)\u003c/p\u003e \u003cp\u003e19.94 (7.65)\u003c/p\u003e \u003cp\u003e31.35 (8.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.58 (4.25)\u003c/p\u003e \u003cp\u003e16.46 (5.85)\u003c/p\u003e \u003cp\u003e23.98 (6.99)\u003c/p\u003e \u003cp\u003e27.94 (9.33)\u003c/p\u003e \u003cp\u003e33.54 (11.08)\u003c/p\u003e \u003cp\u003e32.59 (10.43)\u003c/p\u003e \u003cp\u003e34.22 (14.69)\u003c/p\u003e \u003cp\u003e33.05 (11.00)\u003c/p\u003e \u003cp\u003e29.37 (13.11)\u003c/p\u003e \u003cp\u003e28.30 (15.14)\u003c/p\u003e \u003cp\u003e28.36 (13.78)\u003c/p\u003e \u003cp\u003e28.46 (12.88)\u003c/p\u003e \u003cp\u003e28.52 (14.56)\u003c/p\u003e \u003cp\u003e25.93 (6.55)\u003c/p\u003e \u003cp\u003e25.66 (13.20)\u003c/p\u003e \u003cp\u003e21.16 (10.11)\u003c/p\u003e \u003cp\u003e32.29 (13.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003cp\u003e0.972\u003c/p\u003e \u003cp\u003e0.140\u003c/p\u003e \u003cp\u003e0.000\u003c/p\u003e \u003cp\u003e0.192\u003c/p\u003e \u003cp\u003e0.155\u003c/p\u003e \u003cp\u003e0.648\u003c/p\u003e \u003cp\u003e0.363\u003c/p\u003e \u003cp\u003e0.405\u003c/p\u003e \u003cp\u003e0.419\u003c/p\u003e \u003cp\u003e0.296\u003c/p\u003e \u003cp\u003e0.281\u003c/p\u003e \u003cp\u003e0.333\u003c/p\u003e \u003cp\u003e0.401\u003c/p\u003e \u003cp\u003e0.378\u003c/p\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMean nadir weight achieved, measured 10 months onwards post-LSG, was 86.86 Kg (\u0026plusmn;\u0026thinsp;19.53), corresponding to a nadir BMI of 32.35 Kg/m\u003csup\u003e2\u003c/sup\u003e (\u0026plusmn;\u0026thinsp;6.91). This weight loss equated to a mean nadir excess weight loss (EWL) of 67.03% (\u0026plusmn;\u0026thinsp;27.65). Overall, 31 patients (17.8% of patients with data at 18 months; 1.04% of total patient population) attained insufficient weight loss, defined as an excess weight loss percentage of \u0026lt;\u0026thinsp;50% 18 months post-LSG [21], while a total of 40 patients (1.3% of total patient population) experienced weight regain, defined as progressive weight regain that occurred after achieving an initial successful weight loss (defined as an EWL\u0026thinsp;\u0026gt;\u0026thinsp;50%) [21] (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMorbidity and Co-morbidity Resolution\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-op (% of total patient population)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResolved (% from pre-op)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOSA\u003c/p\u003e \u003cp\u003eObesity Class I\u003c/p\u003e \u003cp\u003eObesity Class II\u003c/p\u003e \u003cp\u003eObesity Class III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127 (4.7%)\u003c/p\u003e \u003cp\u003e2 (2.2%)\u003c/p\u003e \u003cp\u003e26 (4.5%)\u003c/p\u003e \u003cp\u003e91 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (73.2%)\u003c/p\u003e \u003cp\u003e2 (100%)\u003c/p\u003e \u003cp\u003e21 (80.8%)\u003c/p\u003e \u003cp\u003e63 (69.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHTN\u003c/p\u003e \u003cp\u003eObesity Class I\u003c/p\u003e \u003cp\u003eObesity Class II\u003c/p\u003e \u003cp\u003eObesity Class III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e298 (10.0%)\u003c/p\u003e \u003cp\u003e9 (9.7%)\u003c/p\u003e \u003cp\u003e58 (10.1%)\u003c/p\u003e \u003cp\u003e220 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (26.8%)\u003c/p\u003e \u003cp\u003e3 (33.3%)\u003c/p\u003e \u003cp\u003e14 (24.1%)\u003c/p\u003e \u003cp\u003e59 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003cp\u003eType 1\u003c/p\u003e \u003cp\u003eObesity Class I\u003c/p\u003e \u003cp\u003eObesity Class II\u003c/p\u003e \u003cp\u003eObesity Class III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e309 (10.4%)\u003c/p\u003e \u003cp\u003e31 (1.0%)\u003c/p\u003e \u003cp\u003e15 (16.1%)\u003c/p\u003e \u003cp\u003e66 (11.5%)\u003c/p\u003e \u003cp\u003e221 (9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (38.5%)\u003c/p\u003e \u003cp\u003e4 (12.9%)\u003c/p\u003e \u003cp\u003e7 (46.7%)\u003c/p\u003e \u003cp\u003e28 (42.4%)\u003c/p\u003e \u003cp\u003e83 (37.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBaseline characteristics of patients that did not experience weight regain (WR) vs patients that experienced weight regain (WR) did not show statistical differences (p\u0026thinsp;\u0026gt;\u0026thinsp;0.005): age at LSG 36.78 years old (\u0026plusmn;\u0026thinsp;11.34) vs 26.00 years old (\u0026plusmn;\u0026thinsp;1.41), respectively; pre-operative weight 125.67 Kg (\u0026plusmn;\u0026thinsp;23.67) vs 143.00 Kg (\u0026plusmn;\u0026thinsp;19.80), respectively; pre-operative BMI 45.33 Kg/m\u003csup\u003e2\u003c/sup\u003e (\u0026plusmn;\u0026thinsp;7.47) vs 42.70 Kg/m\u003csup\u003e2\u003c/sup\u003e (\u0026plusmn;\u0026thinsp;0.10), respectively.\u003c/p\u003e \u003cp\u003eThere was a significant difference between starting obesity class and TWL at 2w (p\u0026thinsp;=\u0026thinsp;0.001; obesity class 1 with the highest TWL) and 1y (p\u0026thinsp;=\u0026thinsp;0.000; obesity class 3 with the highest, followed by class 2, and class 1). There was also a significant difference between starting obesity class and weight regain at 13 years (p\u0026thinsp;=\u0026thinsp;0.011; obesity class 3 with the highest weight regain, followed by obesity class 1, then class 2).\u003c/p\u003e \u003cp\u003eInterestingly, we noted a significant difference between starting obesity class and weight (p\u0026thinsp;=\u0026thinsp;0.000) at 2w, 3m, 6m, 1y and 18m.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eComorbidity Outcomes and Complications\u003c/h2\u003e \u003cp\u003ePatients suffering from hypertension, obstructive sleep apnea and diabetes mellitus (DM) demonstrated significant reductions of these comorbidities from baseline (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for all parameters) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Of the patients that were diagnosed with type 1 DM pre-operatively, 4 patients experienced remission post-LSG (12.9%), defined as a decrease in insulin requirements.\u003c/p\u003e \u003cp\u003eComplications encountered post-LSG included bleed in 13 patients (0.4%), and leak in 16 patients (0.5%). Gastroesophageal reflux disease (GERD) was encountered in 237 (7.9%) of patients post-LSG, with the majority classified as Grade 1 GERD (235; 7.7%) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOccurrence of post-op complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBleed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeak\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eGERD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eRevisional Procedure Undertaken\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003eReason for Revision\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eGrade 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eGrade 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eGrade 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eResleeve\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eBypass\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eOAGB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e\u003cb\u003eTime until Revision (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003eInsufficient Weight Loss\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003eWeight Regain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e235 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 \u003c/p\u003e \u003cp\u003e(0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e5.27 (2.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e31 (1.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e40 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity Class I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e7.45 (4.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity Class II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e7.18 (4.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity Class III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e158 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13 (65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e7.47 (5.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e29 (93.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e29 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRevisional bariatric procedures were undertaken by 34 patients post-LSG (1.1%) after an average of 5.3 years, with the majority undergoing a revisional Roux-en-Y gastric bypass (n\u0026thinsp;=\u0026thinsp;20; 0.7%). The reasons behind the need for revisional surgery were weight regain (n\u0026thinsp;=\u0026thinsp;22; 64.7%), development of GERD (n\u0026thinsp;=\u0026thinsp;8; 23.5%), insufficient weight loss (n\u0026thinsp;=\u0026thinsp;2; 5.9%) and the development of hypoglycemic episodes (n\u0026thinsp;=\u0026thinsp;2; 5.9%).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWhen the use of sleeve gastrectomy\u0026rsquo;s began to rise in 2014, overtaking all other bariatric surgeries being performed at the time, no long-term data had existed on it\u0026rsquo;s weight loss outcomes, making quantification of success difficult to predict when recommending this procedure. Our study aimed to report the long-term weight loss and comorbidity outcomes of patients who underwent laparoscopic sleeve gastrectomy as a primary bariatric procedure. The main findings of our study were to provide an insight on the successful long-term weight loss achieved after LSG, as well as the control of comorbidities associated with untreated obesity.\u003c/p\u003e \u003cp\u003ePrimary LSG resulted in a sustained excess weight loss (EWL) of over 50% throughout the 13 year follow-up period, which is consistent with other studies examining long-term outcomes after LSG [22\u0026ndash;24]. However, until recently, finding studies reporting on \u0026gt;\u0026thinsp;7 year outcomes were rare, with the majority being published between the years of 2018\u0026ndash;2021 [24\u0026ndash;32]. A meta-analysis conducted by Clapp et al.[11] in 2018 was able to demonstrate successful weight loss achieved by patients at 7\u0026thinsp;+\u0026thinsp;years post LSG, with 72.2% achieving a %EWL of \u0026gt;\u0026thinsp;50%, while a systematic review conducted by Juodeikis et al. [33] was able to report a mean %EWL of 54.8% at 8 years post operatively. This has been emulated by our current study, with EWL standing in the range of 50.76\u0026ndash;69.60 at 7\u0026thinsp;+\u0026thinsp;years post-LSG.\u003c/p\u003e \u003cp\u003eWeight regain was defined as progressive weight regain occurring after an initial successful weight loss (EWL\u0026thinsp;\u0026gt;\u0026thinsp;50%), while insufficient weight loss was defined as an excess weight loss percentage of \u0026lt;\u0026thinsp;50% at 18 months post-LSG [21], however, it is important to note that there is yet to be a standardized definition for these factors [34\u0026ndash;37], making reporting outcome comparison complicated. Nonetheless, by the definition we use at our institute, the rates of weight regain and insufficient weight loss was 1.3% and 1.04%, respectively. These numbers were significantly lower than those encountered by previous studies such as that of Clapp et al., with a pooled weighted mean proportion of weight regain demonstrated to be 27.8% (range\u0026thinsp;=\u0026thinsp;14\u0026ndash;37%) [11]. However, it should be taken into consideration that our follow up percentage declined with time, with results obtained from 50% of patients at 2 weeks post-op, 31% of patients at 1 year post-op, and from 4% of patients at 9 years post-LSG, which could have affected follow-up results collected. A study conducted by Capoccia et al. [26] defined weight regain of \u0026ge;\u0026thinsp;15 - \u0026lt;30% of maximum weight lost as mild, while a weight regain of \u0026gt;\u0026thinsp;30% was defined as severe. According to this definition, 61 of our patients (2%) experienced mild weight regain and 79 patients (2.6%) experienced severe weight regain post operatively. When using the definition created by Sakran et al. [38], patients that regained\u0026thinsp;\u0026lt;\u0026thinsp;25% of maximum weight lost were classified as having experienced mild weight regain, while those that regained\u0026thinsp;\u0026ge;\u0026thinsp;25% were classified as having experienced significant weight regain. According to this definition, 650 of our patients (22%) experienced mild weight regain, while 98 patients (3.3%) experienced significant weight regain. Further, our current study\u0026rsquo;s cohort had a mean percentage weight regain of maximum weight loss of 32.89%, slightly lower than that reported by Sakran et al. (33.4%), while being slightly higher than that reported by Capoccia et al. (31.5%) [26].\u003c/p\u003e \u003cp\u003eAlthough the success of laparoscopic sleeve gastrectomy is no longer disputed, complications and failures following this procedures still exist, with weight regain and the recurrence of obesity being one of the major worries for patients and surgeons alike. This is where revisional/secondary bariatric procedures come into play. Revisional bariatric surgery post primary LSG have increased as of recent years, making it a focal research topic [39, 40]. However, the results of our long-term analysis was able to demonstrate a need for a revisional procedure in only 1.1% of our cohort, with the majority needing to be converted to a Roux-en-Y gastric bypass. This is quite small a number when compared to previous studies looking at long-term outcomes. For example, the study conducted by Felsenreich et al. [27] followed their patients for greater than 15 years, demonstrating a %EWL of 61% at the end of the study period, however, this was encountered with a high revision rate of 49.1%. Arman et al reported a reoperation rate of 31.7% [41] and Kowalewski et al. demonstrated a revision rate of 16% after an 8 year follow-up period [42].\u003c/p\u003e \u003cp\u003eWhen it came to looking at resolution of comorbidities associated with obesity, we were able to demonstrate positive results, with a 73.2% resolution rate of patients with obstructive sleep apnea, a 26.8% resolution rate of hypertension, and a 38.5% resolution rate of type 2 diabetes mellitus. These numbers are lower than those seen by the study conducted by Kraljevic et al., with 60.5% resolution rates of hypertension and 61% resolution rates of DM [43]; as well as those encountered by Sakran et al. [38], with 51.7% resolution of hypertension, and a 72.2% resolution rate of DM encountered. On the other hand, complications encountered following the sleeve procedure were small in number with bleed encountered in 0.4% of patients post-op and a leak diagnosed in 0.5% of the patient population. This is comparable to other studies with post-operative leak rate for LSG varying between 1 and 3% for a primary procedure [44, 45], while incidence of bleeding following LSG\u0026rsquo;s has been reported to range between 1.16\u0026ndash;4.94% [33].\u003c/p\u003e \u003cp\u003eGastroesophageal reflux disease has recently become a major concern following the performance of sleeve gastrectomy due to the association that has linked the two together. There have been multiple mechanisms proposed to explain this phenomena, and those include the large compliant stomach being transformed into a long and narrow tube. This implies a lack of gastric compliance, with an increased intraluminal pressure that correlates inversely with the diameter of the gastric tube and is increased when the pylorus is closed. Other factors are related to dismantling of the anatomical anti-reflux mechanisms, including disruption to the Hiss angle and resection of the sling fibers in the distal part of the lower sphincter, which results in low esophageal-sphincter pressure. The final shape of the sleeve also plays a role as it may favor GERD and regurgitation when it is funnel-shaped. The role of the gastric antrum has not been fully clarified but it is thought that extensive resection of the antrum may impair gastric emptying and favor GERD [46]. However, previous studies have been inconsistent with the effect that sleeves have on GERD. A national analysis conducted by DuPree et al. was able to show that 84.1% of patients that had pre-existing GERD continued to have GERD symptoms post LSG, while 8.6% developed GERD postoperatively [47]. The mechanisms in which GERD may improve after undergoing LSG include the decrease in intra-abdominal pressure due to weight loss, reduced acid production related to resection of the acid-producing gastric fundus, accelerated gastric emptying, and reduced gastric volume [14, 48]. Our study was able to demonstrate low de novo GERD rates, with only 7.9% of patients developing GERD, 99% of which classified as Grade 1. This is significantly lower than the number demonstrated by Kowalewski et al. (44% de novo GERD), Kraljevic et al. (32.4%) and Hauters et al. (43%) [30, 43], but closer to the percentage seen in Juodeikis et al.\u0026rsquo;s study (10%) [33], as well as Garg et al. [49] and Melissas et al. [50].\u003c/p\u003e \u003cp\u003eEven though this study looked at a large cohort of patients that underwent LSG over a long-term follow-up period of 13 years, it is not without it\u0026rsquo;s limitations. Firstly, the data was collected via phone calls, entailing a potential for information, recall, and response bias. We attempted to increase the validity of our data by collecting the majority of the information we could by utilizing hospital charts, and when needed, data were verified by a telephone interview. Secondly, due to the long follow-up period of the study, we have lost a significant number of patients to follow-up, making it difficult to quantify the full potential of our results. Further, the data was collected retrospectively without the presence of a control group, possibly contributing to selection bias. However, it is one of the fewest published in this region with a long follow-up period in a geographic location which is heavily burdened by obesity. Finally, the study lacked objective measurements such as a medication list, blood test results, and imaging test results, and we could only base our results on presented symptoms and declared pharmacotherapy.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur results indicate that LSG is an effective bariatric procedure for weight loss, with a sustained %EWL up to 13 years post-operatively. Further, insufficient weight loss and weight regain were minimal within our cohort. Resolution of comorbidities was also seen to be satisfactory, and low complication rates were encountered within our cohort. Starting obesity class only significantly affected weight loss in the first 18 months post-operatively. However, increased patient engagement in follow-up routines is crucial for collecting long-term data following bariatric procedures.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003e \u003cem\u003eEthical Approval and consent to Participate\u003c/em\u003e:\u003c/strong\u003e \u003cp\u003e Ethical approval to conduct the study was obtained from the Ministry of Health and Kuwait Institute for Medical Specialization Ethical Approval Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent for study participation was obtained from all subjects (if subjects are under 16, from a parent and/or legal guardian).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e \u003cem\u003eConsent for Publication\u003c/em\u003e:\u003c/strong\u003e \u003cp\u003eNot Applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interests:\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe authors declare no source of funding for the completion of this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceived Project: S.AS.Designed research: S.AS., E.AH.Collected data: I.Q., M.AM., A.AA., A.AQ., A.AK., A.S., M.B.Performed research: S.AS., E.AH.Analyzed data: E.AH.Wrote paper: E.AH.Edited paper: S.AS., E.AH.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank Kuwait University Research Sector for their support in producing this data.\u003c/p\u003e\u003ch2\u003eAvailability of Data and Materials:\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStevens GA, Singh GM, Lu Y, Danaei G, Lin JK, Finucane MM, et al. National, regional, and global trends in adult overweight and obesity prevalences. Popul Health Metr. 2012;10(1):22. Epub 20121120. doi: 10.1186/1478-7954-10-22. PubMed PMID: 23167948; PubMed Central PMCID: PMCPMC3543235.\u003c/li\u003e\n\u003cli\u003eBult MJ, van Dalen T, Muller AF. Surgical treatment of obesity. Eur J Endocrinol. 2008;158(2):135\u0026thinsp;\u0026minus;\u0026thinsp;45. doi: 10.1530/eje-07-0145. PubMed PMID: 18230819.\u003c/li\u003e\n\u003cli\u003eAngrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, et al. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg. 2018;28(12):3783-94. doi: 10.1007/s11695-018-3450-2. PubMed PMID: 30121858.\u003c/li\u003e\n\u003cli\u003eSchauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes \u0026mdash; 5-Year Outcomes. New England Journal of Medicine. 2017;376(7):641\u0026thinsp;\u0026minus;\u0026thinsp;51. doi: 10.1056/NEJMoa1600869. PubMed PMID: 28199805.\u003c/li\u003e\n\u003cli\u003eGagner M IW, Pomp A. Laparoscopic sleeve gastrectomy with second stage biliopancreatic diversion and duodenal switch in the superobese.. In: Inabnet W DE, Ikramuddin S, editor. Laparoscopic bariatric surgery: Philadelphia: Lippincott Williams \u0026amp; Wilkins; 2005. p. 143\u0026thinsp;\u0026minus;\u0026thinsp;50.\u003c/li\u003e\n\u003cli\u003eFelberbauer FX, Langer F, Shakeri-Manesch S, Schmaldienst E, Kees M, Kriwanek S, et al. Laparoscopic Sleeve Gastrectomy as an Isolated Bariatric Procedure: Intermediate-Term Results from a Large Series in Three Austrian Centers. Obesity Surgery. 2008;18(7):814-8. doi: 10.1007/s11695-008-9483-1.\u003c/li\u003e\n\u003cli\u003eAngrisani L, Santonicola A, Iovino P, Ramos A, Shikora S, Kow L. Bariatric surgery survey 2018: similarities and disparities among the 5 IFSO chapters. Obesity surgery. 2021;31:1937-48.\u003c/li\u003e\n\u003cli\u003eAngrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obesity surgery. 2018;28:3783-94.\u003c/li\u003e\n\u003cli\u003eEnglish WJ, DeMaria EJ, Brethauer SA, Mattar SG, Rosenthal RJ, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surgery for obesity and related diseases. 2018;14(3):259\u0026thinsp;\u0026minus;\u0026thinsp;63.\u003c/li\u003e\n\u003cli\u003eLo Menzo E, Szomstein S, Rosenthal R. Changing trends in bariatric surgery. Scandinavian Journal of Surgery. 2015;104(1):18\u0026ndash;23.\u003c/li\u003e\n\u003cli\u003eClapp B, Wynn M, Martyn C, Foster C, O\u0026rsquo;Dell M, Tyroch A. Long term (7 or more years) outcomes of the sleeve gastrectomy: a meta-analysis. 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PubMed PMID: 26420961; PubMed Central PMCID: PMCPMC4579881.\u003c/li\u003e\n\u003cli\u003eFelsenreich DM, Kefurt R, Schermann M, Beckerhinn P, Kristo I, Krebs M, et al. Reflux, Sleeve Dilation, and Barrett's Esophagus after Laparoscopic Sleeve Gastrectomy: Long-Term Follow-Up. Obes Surg. 2017;27(12):3092\u0026thinsp;\u0026minus;\u0026thinsp;101. doi: 10.1007/s11695-017-2748-9. PubMed PMID: 28593484.\u003c/li\u003e\n\u003cli\u003ePanel CDC. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115(12):956\u0026thinsp;\u0026minus;\u0026thinsp;61.\u003c/li\u003e\n\u003cli\u003eTelem DA, Gould J, Pesta C, Powers K, Majid S, Greenberg JA, et al. American Society for Metabolic and Bariatric Surgery: care pathway for laparoscopic sleeve gastrectomy. Surgery for Obesity and Related Diseases. 2017;13(5):742-9.\u003c/li\u003e\n\u003cli\u003eSherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Advances in nutrition. 2017;8(2):382\u0026thinsp;\u0026minus;\u0026thinsp;94.\u003c/li\u003e\n\u003cli\u003eHanson MN, Dennis S, Altieri MS, Andalib A. Reflux and bariatric surgery: a review of pre-operative assessment and post-operative approach. Mini-invasive Surgery. 2022;6:9. doi: 10.20517/2574-1225.2021.144.\u003c/li\u003e\n\u003cli\u003eRichard B. Berry MRB, MEd, RST, RPSGT; Charlene E. Gamaldo, MD; Susan M. Harding, MD; Robin M. Lloyd, MD; Carole L. Marcus, MBBCh; and Bradley V. Vaughn, MD The AASM Manual for the Scoring of Sleep and Associated Events RULES, TERMINOLOGY AND TECHNICAL SPECIFICATIONS. In: Medicine AAoS, editor. 2015.\u003c/li\u003e\n\u003cli\u003eRogula TG. Weight regain after bariatric surgery\u0026mdash;how should it be defined? population. 2015;25(10):1901-8.\u003c/li\u003e\n\u003cli\u003eFelsenreich DM, Langer FB, Prager G. Weight Loss and Resolution of Comorbidities After Sleeve Gastrectomy: A Review of Long-Term Results. Scand J Surg. 2019;108(1):3\u0026ndash;9. Epub 20180906. doi: 10.1177/1457496918798192. PubMed PMID: 30187823.\u003c/li\u003e\n\u003cli\u003eArman GA, Himpens J, Dhaenens J, Ballet T, Vilallonga R, Leman G. Long-term (11\u0026thinsp;+\u0026thinsp;years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(10):1778-86. Epub 20160119. doi: 10.1016/j.soard.2016.01.013. PubMed PMID: 27178613.\u003c/li\u003e\n\u003cli\u003eKraljević M, Cordasco V, Schneider R, Peters T, Slawik M, W\u0026ouml;lnerhanssen B, et al. Long-term effects of laparoscopic sleeve gastrectomy: what are the results beyond 10 years? Obesity Surgery. 2021;31:3427-33.\u003c/li\u003e\n\u003cli\u003eBen-Porat T, Mashin L, Kaluti D, Goldenshluger A, Shufanieh J, Khalaileh A, et al. Weight loss outcomes and lifestyle patterns following sleeve gastrectomy: an 8-year retrospective study of 212 patients. Obesity Surgery. 2021;31(11):4836-45.\u003c/li\u003e\n\u003cli\u003eCapoccia D, Coccia F, Guarisco G, Testa M, Rendina R, Abbatini F, et al. Long-term metabolic effects of laparoscopic sleeve gastrectomy. Obesity surgery. 2018;28:2289-96.\u003c/li\u003e\n\u003cli\u003eFelsenreich DM, Artemiou E, Steinlechner K, Vock N, Jedamzik J, Eichelter J, et al. Fifteen years after sleeve gastrectomy: weight loss, remission of associated medical problems, quality of life, and conversions to Roux-en-Y gastric bypass\u0026mdash;long-term follow-up in a multicenter study. Obesity surgery. 2021;31(8):3453-61.\u003c/li\u003e\n\u003cli\u003eFiorani C, Coles SR, Kulendran M, McGlone ER, Reddy M, Khan OA. Long-term quality of life outcomes after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass\u0026mdash;a comparative study. Obesity Surgery. 2021;31:1376-80.\u003c/li\u003e\n\u003cli\u003eGr\u0026ouml;nroos S, Helmi\u0026ouml; M, Juuti A, Tiusanen R, Hurme S, L\u0026ouml;yttyniemi E, et al. Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss and quality of life at 7 years in patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA surgery. 2021;156(2):137\u0026thinsp;\u0026minus;\u0026thinsp;46.\u003c/li\u003e\n\u003cli\u003eHauters P, Dubart J-W, Desmet J, Degolla R, Roumain M, Malvaux P. Ten-year outcomes after primary vertical sleeve gastrectomy for morbid obesity: a monocentric cohort study. Surgical Endoscopy. 2021;35:6466-71.\u003c/li\u003e\n\u003cli\u003eIsmail M, Nagaraj D, Rajagopal M, Ansari H, Nair M, Hegde A, et al. Seven-year outcomes of laproscopic sleeve gastectomy in Indian patients with different classes of obesity. Obesity Surgery. 2019;29:191-6.\u003c/li\u003e\n\u003cli\u003eMajor P, Stefura T, Dziurowicz B, Radwan J, Wysocki M, Małczak P, et al. Quality of life 10 years after bariatric surgery. Obesity Surgery. 2020;30:3675-84.\u003c/li\u003e\n\u003cli\u003eJuodeikis Ž, Brimas G. Long-term results after sleeve gastrectomy: a systematic review. Surgery for Obesity and Related Diseases. 2017;13(4):693-9.\u003c/li\u003e\n\u003cli\u003eBaig SJ, Priya P, Mahawar KK, Shah S, Group IBSOR. Weight regain after bariatric surgery\u0026mdash;a multicentre study of 9617 patients from Indian Bariatric Surgery Outcome Reporting Group. Obesity surgery. 2019;29:1583-92.\u003c/li\u003e\n\u003cli\u003eBrethauer SA, Kim J, El Chaar M, Papasavas P, Eisenberg D, Rogers A, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Obesity surgery. 2015;25:587\u0026ndash;606.\u003c/li\u003e\n\u003cli\u003eKing WC, Hinerman AS, Belle SH, Wahed AS, Courcoulas AP. Comparison of the performance of common measures of weight regain after bariatric surgery for association with clinical outcomes. Jama. 2018;320(15):1560-9.\u003c/li\u003e\n\u003cli\u003eVoorwinde V, Steenhuis IH, Janssen IM, Monpellier VM, van Stralen MM. Definitions of long-term weight regain and their associations with clinical outcomes. Obesity surgery. 2020;30:527\u0026thinsp;\u0026minus;\u0026thinsp;36.\u003c/li\u003e\n\u003cli\u003eSakran N, Soifer K, Hod K, Sherf-Dagan S, Soued S, Kessler Y, et al. Long-term Reported Outcomes Following Primary Laparoscopic Sleeve Gastrectomy. Obesity Surgery. 2023;33(1):117\u0026thinsp;\u0026minus;\u0026thinsp;28. doi: 10.1007/s11695-022-06365-6.\u003c/li\u003e\n\u003cli\u003eSilecchia G, De Angelis F, Rizzello M, Albanese A, Longo F, Foletto M. Residual fundus or neofundus after laparoscopic sleeve gastrectomy: is fundectomy safe and effective as revision surgery? Surg Endosc. 2015;29(10):2899\u0026thinsp;\u0026minus;\u0026thinsp;903. Epub 20141206. doi: 10.1007/s00464-014-4017-5. PubMed PMID: 25480629.\u003c/li\u003e\n\u003cli\u003eHoman J, Betzel B, Aarts EO, van Laarhoven KJ, Janssen IM, Berends FJ. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2015;11(4):771-7. Epub 20141014. doi: 10.1016/j.soard.2014.09.029. PubMed PMID: 25769402.\u003c/li\u003e\n\u003cli\u003eArman GA, Himpens J, Dhaenens J, Ballet T, Vilallonga R, Leman G. Long-term (11\u0026thinsp;+\u0026thinsp;years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surgery for Obesity and Related Diseases. 2016;12(10):1778-86.\u003c/li\u003e\n\u003cli\u003eKowalewski PK, Olszewski R, Walędziak MS, Janik MR, Kwiatkowski A, Gałązka-Świderek N, et al. Long-Term Outcomes of Laparoscopic Sleeve Gastrectomy\u0026mdash;a Single-Center, Retrospective Study. Obesity Surgery. 2018;28(1):130-4. doi: 10.1007/s11695-017-2795-2.\u003c/li\u003e\n\u003cli\u003eKraljevic M, Cordasco V, Schneider R, Peters T, Slawik M, Wolnerhanssen B, et al. Long-Term Effects of Laparoscopic Sleeve Gastrectomy: What Are the Results beyond 10 Years?(Apr, 10.1007/s11695-021-05437-3, 2021). OBESITY SURGERY. 2021;31(8):3434-5.\u003c/li\u003e\n\u003cli\u003eCommittee ACI. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surgery for obesity and related diseases: official Journal of the American Society for Bariatric Surgery. 2012;8(3):e21-e6.\u003c/li\u003e\n\u003cli\u003eAbou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World Journal of Gastroenterology: WJG. 2014;20(38):13904.\u003c/li\u003e\n\u003cli\u003eG\u0026aacute;lvez-Valdovinos R, Cruz-Vigo JL, Mar\u0026iacute;n-Santill\u0026aacute;n E, Funes-Rodr\u0026iacute;guez JF, L\u0026oacute;pez-Ambriz G, Dom\u0026iacute;nguez-Carrillo LG. Cardiopexy with Ligamentum Teres in Patients with Hiatal Hernia and Previous Sleeve Gastrectomy: An Alternative Treatment for Gastroesophageal Reflux Disease. Obes Surg. 2015;25(8):1539-43. doi: 10.1007/s11695-015-1740-5. PubMed PMID: 25990381.\u003c/li\u003e\n\u003cli\u003eDuPree CE, Blair K, Steele SR, Martin MJ. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease : a national analysis. JAMA Surg. 2014;149(4):328\u0026thinsp;\u0026minus;\u0026thinsp;34. doi: 10.1001/jamasurg.2013.4323. PubMed PMID: 24500799.\u003c/li\u003e\n\u003cli\u003eSharma A, Aggarwal S, Ahuja V, Bal C. Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy. Surg Obes Relat Dis. 2014;10(4):600-5. Epub 20140128. doi: 10.1016/j.soard.2014.01.017. PubMed PMID: 24837563.\u003c/li\u003e\n\u003cli\u003eGarg H, Aggarwal S, Misra MC, Priyadarshini P, Swami A, Kashyap L, et al. Mid to long term outcomes of Laparoscopic Sleeve Gastrectomy in Indian population: 3\u0026ndash;7 year results\u0026ndash;A retrospective cohort study. International Journal of Surgery. 2017;48:201-9.\u003c/li\u003e\n\u003cli\u003eMelissas J, Braghetto I, Molina JC, Silecchia G, Iossa A, Iannelli A, et al. Gastroesophageal reflux disease and sleeve gastrectomy. Obesity surgery. 2015;25:2430-5.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"langenbecks-archives-of-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"laos","sideBox":"Learn more about [Langenbeck's Archives of Surgery](http://link.springer.com/journal/423)","snPcode":"423","submissionUrl":"https://submission.nature.com/new-submission/423/3","title":"Langenbeck's Archives of Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5299255/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5299255/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eDespite its effectiveness, long-term data on the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) for morbid obesity are sparce.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe collected data through phone interviews and hospital records for patients who had LSG, assessing their weight outcomes, associated health conditions, and complications.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e2982 patients (72% female) were included in the study, with a maximum follow-up reached of 13 years. The mean pre-operative age and body mass index (BMI) were 34.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3 years and 45.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7 kg/m2, respectively. The prevalence of obesity classes were as follows: Class I, 3.1%; Class II, 19.2%; and Class III, 75.9%. BMI at nadir was 32.35 Kg/m2 equating to a mean nadir excess weight loss (EWL) of 67.03%. Weight outcomes at 13 years post-LSG showed a mean BMI of 31.83 kg/m\u003csup\u003e2\u003c/sup\u003e and total weight loss (TWL) percentage of 31.43%. Weight loss outcomes varied according to pre-operative obesity class, with class I achieving the highest percentage EWL and class III observing the highest TWL at the end of one year. Weight regain occurred in 1.3% of the patient population, with class III experiencing the highest weight regain at 13 years. Significant reductions in comorbidities were observed, while complication rates were low, with 0.4% bleed, 0.5% leak, and 7.9% GERD.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eLSG demonstrates sustained weight loss and resolution of comorbidities with low complication rates. The influence of initial obesity class on weight loss was significant only in the first 18 months post-LSG.\u003c/p\u003e","manuscriptTitle":"Beyond the Decade: Unveiling Long-Term Weight and Co- Morbidity Outcomes up to 10 Years Post Laparoscopic Sleeve Gastrectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-08 10:39:00","doi":"10.21203/rs.3.rs-5299255/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-17T14:08:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-15T13:44:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39411459117361442547502566898242820161","date":"2025-01-12T10:49:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314806496902613118504801607764158524693","date":"2025-01-06T06:08:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115503910526700098582663164561038324659","date":"2024-11-14T13:23:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-06T13:14:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-21T10:36:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-21T10:18:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Langenbeck's Archives of Surgery","date":"2024-10-20T16:00:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"langenbecks-archives-of-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"laos","sideBox":"Learn more about [Langenbeck's Archives of Surgery](http://link.springer.com/journal/423)","snPcode":"423","submissionUrl":"https://submission.nature.com/new-submission/423/3","title":"Langenbeck's Archives of Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e12c7c88-2d79-43b8-97d0-d871c518a90d","owner":[],"postedDate":"November 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-07T16:04:13+00:00","versionOfRecord":{"articleIdentity":"rs-5299255","link":"https://doi.org/10.1007/s00423-025-03680-1","journal":{"identity":"langenbecks-archives-of-surgery","isVorOnly":false,"title":"Langenbeck's Archives of Surgery"},"publishedOn":"2025-03-31 15:57:32","publishedOnDateReadable":"March 31st, 2025"},"versionCreatedAt":"2024-11-08 10:39:00","video":"","vorDoi":"10.1007/s00423-025-03680-1","vorDoiUrl":"https://doi.org/10.1007/s00423-025-03680-1","workflowStages":[]},"version":"v1","identity":"rs-5299255","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5299255","identity":"rs-5299255","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}