Long-Term Effects of Sleeve Gastrectomy on Super Obesity: A Retrospective Cohort Study of Weight Loss and Metabolic Recovery at Centro Médico Nacional 20 de Noviembre

Background: Patients with a body mass index (BMI) >50 kg/m² represent a major clinical challenge because of their high burden of metabolic comorbidities and increased mortality. Laparoscopic sleeve gastrectomy (LSG) is widely used as a primary bariatric procedure; however, evidence regarding its effectiveness in individuals with super obesity remains limited. This study aimed to evaluate weight loss and metabolic outcomes in patients with BMI >50 kg/m² who underwent LSG. Methods: We conducted an observational, retrospective, longitudinal study at the Centro Médico Nacional 20 de Noviembre, a tertiary care university hospital. Patients with BMI between 50 and 60 kg/m² who underwent primary LSG between January 2020 and December 2024 were included. The maximum institutional follow-up was 24 months. Anthropometric and metabolic variables were analyzed using paired Student’s t test or Wilcoxon test, whereas categorical variables were compared with the chi-square or Fisher’s exact test. Simple linear regression was performed, and statistical significance was set at p < 0.05. Results: Of 42 patients, 33 met the inclusion criteria. A female predominance was observed (69.7%), and the mean age was 43 ± X years. Mean baseline BMI was 57 ± 4.9 kg/m², decreasing to 35.5 kg/m² at 24 months. Mean weight declined from 150.7 ± 19.9 kg to 96.9 ± 18.7 kg, corresponding to 35.0% total weight loss and 59.6% excess weight loss. Remission rates were 66.7% for type 2 diabetes mellitus, 57.9% for hypertension, and 44.4% for dyslipidemia. HbA1c and HOMA-IR decreased significantly (p < 0.0001). Weight regain and insufficient weight loss occurred in 3.0% of cases each. Complications were infrequent, and no mortality was observed. Conclusions: LSG in patients with BMI >50 kg/m² achieved substantial and clinically meaningful weight reduction, with most individuals meeting established criteria for surgical success at two years. The procedure was associated with significant improvement and high remission rates of major metabolic comorbidities, while maintaining a favorable safety profile and very low rates of weight regain. These findings support LSG as an effective primary strategy for super-obese patients within a structured multidisciplinary follow-up program. Our results contribute regional evidence that may assist decision-making and counseling in similar high-risk populations.