Laparoscopic Sleeve Gastrectomy: Efficacy and Safety of Classic vs. Hard Techniques in Long-Term Weight Loss: A Retrospective Cohort Study

This study aimed to compare the efficacy and safety of Classic and Hard laparoscopic sleeve gastrectomy (LSG) techniques, with a focus on long-term weight loss outcomes and complication rates over a 3-year follow-up period. A retrospective cohort study was conducted on 785 patients who underwent LSG between January 2019 and December 2022, with follow-up completed by 2023. Patients were divided into 2 groups according to surgical technique: Classic LSG (n=372), involving standard resection along the lesser curvature using a 36-French bougie; and Hard LSG (n=413), characterized by more extensive fundal mobilization and creation of a narrower gastric tube using a 32-French bougie. Both techniques resulted in significant body mass index (BMI) reductions; however, Hard LSG demonstrated superior weight loss. At 12 months, 70.7% of Hard LSG patients achieved a normal BMI (<25 kg/m2), compared to 42.2% in the Classic group. At 3 years, 59.3% and 20.4% maintained normal BMI, respectively (P<0.001). However, Hard LSG was associated with higher complication rates: early metabolic complications occurred in 64.3% vs. 25.7% (P<0.001), and late surgical complications in 10.4% vs. 2.4% (P<0.001). While Hard LSG provides greater and more durable weight loss, it is associated with increased risks of complications. These findings support the need for individualized surgical decision-making to balance efficacy and safety in the management of obesity.