Comparative Analysis of the Effectiveness and Frequency of Complications of Different Techniques of Laparoscopic Sleeve Gastrectomy in Patients with Obesity.

Abstract

Relevance: Laparoscopic sleeve gastrectomy (LSG) is recognized as an effective method for treating severe obesity; however, technical variations in this procedure significantly impact the complication profile and long-term metabolic outcomes.

Objective: To compare the clinical effectiveness, frequency of postoperative complications, and body weight outcomes using three LSG strategies: standard (Standard), enhanced (Tight), and modified (Wide).

Materials and methods: The study included 1,194 patients with obesity who underwent LSG between 2019 and 2022. Patients were not randomized to a specific LSG technique; rather, the choice reflected both clinical profile and the chronological evolution of practice in our center. Initially, the Standard technique was applied, followed by the Tight technique in cases of suboptimal initial response, and finally the Wide technique was adopted to achieve a safer balance between efficacy and safety. Early and late surgical and metabolic complications, body mass index (BMI) reduction, and the frequency of weight recurrence over 36 months (per IFSO definition: ≥ 25% regain from nadir) were assessed. Data analysis was performed using Python (SciPy, StatsModels, Pandas). Normality of distribution was tested using the Shapiro-Wilk test. For between-group comparisons, Student's t-test or the Mann-Whitney U test were used for continuous variables depending on distribution, and the χ² test was used for categorical variables. In addition to p-values, 95% confidence intervals (95% CI) were calculated for all main outcomes. To address the issue of multiple comparisons, the Bonferroni correction was applied where appropriate. All results were reported with appropriate rounding (one or two decimals), and differences were considered statistically significant at p < 0.05.

Results: The lowest overall complication rate was observed in the Wide group (26.85%) compared to the Tight (49.39%) and Standard (35.22%) groups (p < 0.001). The incidence of early metabolic disorders was 15.76% in the Wide group versus 64.34% in the Wide group (p < 0.001). Late complications (GERD, nutritional deficiencies) were also significantly less frequent in the Wide group. Although the Tight technique resulted in the greatest BMI reduction (to 22.4 ± 3.8 kg/m² at 12 months), it was associated with a high complication rate. The modified technique (Soft) achieved a comparable BMI reduction (to 24.1 ± 4.1 kg/m²) with significantly better tolerance. Weight recurrence (defined as ≥ 25% regain of lost weight per IFSO consensus) at the 2-year follow-up was observed in 30.3% of patients in the Wide group, which was significantly lower than in the Standard group (62.4%).

Conclusions: The modified LSG technique provides the optimal balance between effectiveness and safety. It enables significant and sustained weight loss with minimal risks of metabolic, functional, and psychological complications.