Determinants of 10-Year Follow-Up Adherence After Sleeve Gastrectomy

Overview

This retrospective study of 150 patients undergoing sleeve gastrectomy identified older age as the sole independent predictor of 10-year follow-up adherence. Among patients completing follow-up, significant remission of type 2 diabetes and hypertension was observed, alongside sustained weight loss and notable rates of de novo gastroesophageal reflux disease (GERD).

Background

Sleeve gastrectomy (SG) is the most commonly performed bariatric surgery worldwide due to its technical simplicity, cost-effectiveness, and favorable risk profile. Long-term postoperative follow-up is essential to monitor weight loss durability, manage complications, and detect recurrence of obesity or GERD. However, maintaining patient adherence to follow-up over extended periods remains challenging, with rates declining substantially after 5 to 7 years.

Data Highlights

Key Findings

• Older age was the only independent predictor of completing 10-year follow-up (OR 1.03; 95% CI 1.00–1.07; p=0.048).
• 67.3% of patients completed the 10-year follow-up, with no other baseline characteristics significantly differing between adherent and non-adherent groups.
• Among patients followed, 55.6% achieved remission of type 2 diabetes and 36.8% remission of hypertension.
• Median total weight loss at 10 years was 21.5%, indicating sustained weight reduction post-SG.
• GERD symptoms persisted in 50% of patients with preoperative GERD, while 42.7% developed de novo GERD postoperatively.
• Six patients required conversion surgery due to complications or GERD.

Clinical Implications

Clinicians should recognize that younger patients may be at higher risk of loss to long-term follow-up after sleeve gastrectomy and may benefit from targeted interventions to improve adherence. Sustained weight loss and remission of metabolic comorbidities are achievable at 10 years, but the high incidence of de novo GERD underscores the need for ongoing surveillance and management. Providing accessible follow-up options and patient education may enhance long-term engagement.

Conclusion

Long-term follow-up adherence after sleeve gastrectomy is primarily influenced by patient age, with older individuals more likely to remain engaged. Sustained metabolic benefits are evident at 10 years, but attention to GERD development and strategies to improve follow-up adherence are critical for optimizing outcomes.

References

1. ASMBS/IFSO 2025 -- Standardized Reporting Guidelines for Bariatric Surgery Outcomes
2. University of Warmia and Mazury Bioethics Committee 2024 -- Ethical Approval for Bariatric Surgery Follow-Up Study