Laparoscopic sleeve gastrectomy achieves normalization of C-reactive protein at 18 months after surgery  

Obesity leads to a chronic state of inflammation and elevated C-reactive protein (CRP). Bariatric surgery achieves both long-term weight loss and reduction in inflammatory markers. We aim to examine the effect of laparoscopic sleeve gastrectomy (LSG) on CRP levels.  
This is a retrospective review of patients who underwent LSG at our center between May 2011 and February 2014. Data was collected on patient demographics and obesity-associated comorbidities. CRP levels were measured pre-operatively and at 3, 6, 12, and 24 months post-operative. Secondary outcomes were post-operative weight loss, 30-day complications, and mortality. 
209 patients underwent LSG with average pre-operative BMI 49.2 kg/m2 (min 35.0 kg/m2, max 67.4 kg/m2), average age 43.4 years (min 22 years, max 70 years), and with 82% female. The most common comorbidities were hypertension (55.0%), obstructive sleep apnea (46.4%), dyslipidemia (42.1%) and diabetes (37.8%). The mean pre-operative CRP level was 11.53mg/L (min 0.6, max 49.3). The mean pre-operative weight was 134.3kg versus 97.7kg after 24 months (p<0.01). The total average %BMIL was 59.8%kg/m2 after 12 months and 58.5%kg/m2 after 24 months. No mortality occurred. Pre-operatively, 89 patients (Group N) had normal (≤8mg/L) and 114 patients (Group E) had elevated (>8mg/L) CRP levels. While pre-operatively, the mean CRP levels were significantly different between these groups (4.66 mg/L vs 16.90mg/L, p<0.001), this difference became non-significant after 18 months (2.85±5.72 versus 5.33±6.79, p= 0.076). Group E had significantly more females and higher mean BMI. Overall 30-day complication rate was 15.3% (13.4% minor and 1.9% major). While overall complications were higher in Group N (19.1%) compared to Group E (12.3%), this was not statistically significant (p=0.238).
LSG leads to significant decrease in mean CRP levels, which normalize at 18 months post-operative. Female gender and BMI>50kg/m2 were associated with elevated CRP levels. Elevated CRP levels did not correlate with post-operative complication rate.