CLINICAL RESEARCH Sleeve Gastrectomy as Sole and Definitive Bariatric Procedure: 5-Year Results for Weight Loss and Ghrelin Arthur Bohdjalian & Felix B. Langer & Soheila Shakeri-Leidenmühler & Lisa Gfrerer & Bernhard Ludvik & Johannes Zacherl & Gerhard Prager Received: 10 October 2009 / Accepted: 17 December 2009 / Published online: 22 January 2010 # Springer Science+Business Media, LLC 2010 Abstract Background Due to excellent efficacy for weight loss in the short-term follow-up, sleeve gastrectomy (SG) has gained enormous popularity as bariatric procedure, not only as first step in high-risk or super-obese patients but mainly as a sole and definitive operation in morbidly obese. In contrast to a large number of short and intermediate-term results, no series of SG with a follow-up of 5 years or more has been published so far. Methods We report on the weight loss results of our first consecutive 26 patients with a complete follow-up of 5 years. Furthermore in a subgroup of 12 patients, plasma ghrelin levels were measured preoperatively, and up to 5 years following SG. Results Weight loss defined as mean percent excess weight loss (%EWL) was found as 57.5±4.5, 60.3±5.0, 60.0±5.7, 58.4±5.4, and 55.0±6.8 (not converted, n =21) for the first 5 years. Weight regain of more than 10 kg from nadir was observed in five (19.2%) of the 26 patients. Four of the patients (15.4%) were converted to gastric bypass due to severe reflux (n =1, 3.8%) and weight loss failure (n =3, 11.5%). A total of eight patients (30.8%) were at chronic need for proton pump inhibitor medication due to severe reflux. Plasma ghrelin levels were reduced from 593±52 to 219±23 pg/ml 12 months postoperatively, with a slightly, non-significant increase toward the 5-years values of mean 257±23 pg/ml. Conclusions At 5-year follow-up, a mean EWL of 55.0± 6.8% was achieved, indicating that SG leads to stable weight loss. Beside significant weight regain, severe reflux might necessitate conversion to gastric bypass or duodenal switch. After an immediate reduction postoperatively, plasma ghrelin levels remained low for the first 5 years postoperatively. Keywords Sleeve gastrectomy . Gastric bypass . Weight loss . Weight regain . Reflux . Ghrelin Introduction A widening field of indications for sleeve gastrectomy (SG) is available today, from a procedure introduced as first step for high-risk or super-obese patients intended for a second intervention, such as the Roux-en-Y gastric bypass (RYGB) [1, 2] or bilio-pancreatic diversion with duodenal switch (BPDDS) [3, 4]. In these settings, a significant weight regain in the longer follow-up was of no consequence, as the second intervention was scheduled within a short period of time to benefit from the initial weight loss. With short-time results [5–8] comparable to more invasive procedures like gastric bypass, SG has gained enormous popularity in the bariatric world and is performed as sole and definitive bariatric procedure in the majority of patients today [9, 10]. Recently, we addressed plasma levels of ghrelin as short- time result of SG. As an appetite-inducing peptide hormone mainly deriving from the gastric fundus resected in SG, A. Bohdjalian : F. B. Langer : S. Shakeri-Leidenmühler : J. Zacherl : G. Prager (*) Department of Surgery, Division of General Surgery, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria e-mail: gerhard.prager@meduniwien.ac.at L. Gfrerer : B. Ludvik Department of Internal Medicine III, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria OBES SURG (2010) 20:535–540 DOI 10.1007/s11695-009-0066-6