Clinical Effectiveness of Different Variants of Laparoscopic Sleeve Gastrectomy in Patients with Obesity

Relevance: Laparoscopic sleeve gastrectomy (LSG) remains one of the most commonly used surgical methods for the treatment of morbid obesity.However, variations in the technical approaches to the procedure result in significant differences in complication profiles, metabolic safety, and sustainability of weight loss.Objective: To compare the clinical effectiveness, safety, and long-term outcomes of three LSG techniques: standard (Classic), reinforced (Hard), and modified with a preventive program (Soft). Materials and Methods:The study included 1,194 patients who underwent LSG between 2019 and 2022.Early and late surgical and metabolic complications, changes in body weight, BMI, and indicators such as %TWL(total body weight loss), %EWL,(>50% excess weight loss) and %EBL(endoscopic band ligation)were assessed up to 36 months postoperatively.Weight regain was defined as an increase in BMI category after 12 months.Statistical analysis included , t-test, and Mann-Whitney test with a significance level of p<0.05. Results:The Soft group showed the lowest complication rate (26.85%) compared to the Hard (49.39%) and Classic (35.22%) groups (p<0.001).The incidence of metabolic disorders was 15.76% in the Soft group versus 64.34% in the Hard group.The rate of late GERD was minimal in the Soft group (1.48%).Despite a less aggressive restriction, the Soft group achieved a high level of weight reduction: %EWL -106.9 21.1%, %TWL -49.5 8.9%, %EBL -114.2 22.1% at 12 months.Weight regain was observed in 30.3% of patients in the Soft group, significantly lower than in the Classic group (62.4%) and comparable to the Hard group (24.7%). Conclusion:The modified LSG technique with an anatomically sparing approach and an integrated complication prevention program provides an optimal balance between weight loss effectiveness and safety.It demonstrated a lower complication rate and greater weight stability in the long term, making it a preferable option for most patients with obesity.This comparative study was conducted from