Single-Center Metabolic Bariatric Surgery Experience Study: Outcomes from 21,205 Cases over 12 Years

Abstract

Abstract Introduction: Metabolic bariatric surgery (MBS) is the most effective treatment for obesity; nevertheless, long-term results from high-volume centers are scarce in the literature. Materials and Methods: We retrospectively analyzed prospectively collected records of our high-volume center from June 2010 to December 2022 on demographics, evolution of procedures, follow-up, effectiveness, and safety of MBS. Results: A total of 21,205 patients underwent MBS over the 12-year period. Laparoscopic sleeve gastrectomy (LSG) was performed in 6136 patients, Roux-en-Y gastric bypass (RYGB) in 5878, one-anastomosis gastric bypass (OAGB) in 7678, endoscopic sleeve gastroplasty (ESG) in 941, and swallow balloon in 572. At the end of the study period, the follow-up rates for different procedures were LSG group (68.7%, 2108/3068), RYGB group (63.2%, 1312/2075), OAGB group (68.9%, 1135/1647), and ESG group (67.8%, 319/470), resulting in an overall follow-up rate of 68.1%, respectively. At 10 years, the percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and percentage of weight regain (%WR) for LSG were 22.4%, 53.4%, and 31.8%, respectively. Similarly, the figures were 23.9%, 60.2%, and 25.2% for RYGB and 27.3%, 70.3%, and 20.9% for OAGB. These differences were significant among procedures according to the repeated-measures analysis of variance (%TWL: F = 25.13, P < 0.0001; %EWL: F = 21.36, P < 0.0001; %WR: F = 2.31, P = 0.004). Operative times and intraoperative blood loss were significantly higher for RYGB. Postoperative complications occurred in 2.0%, 1.2%, and 1.8% of patients in the LSG, RYGB, and OAGB groups, respectively (P < 0.001). There were no significant differences in serious complication rates among groups (P = 0.787). The mortality rate was 0.04%. Conclusion: The long-term results from a high-volume bariatric center provide real-world data on the effectiveness and safety of MBS. Most importantly, they reflect the incorporation of new techniques and facilitate the implementation of regional algorithms for optimizing patient selection and improving outcomes.