Obesity Surgery

, 18:1083

Laparoscopic Sleeve Gastrectomy—Volume and Pressure Assessment

Authors

  • Ronit T. Yehoshua
    • Felsenstein Medical Research Center, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel Aviv University
  • Leonid A. Eidelman
    • Department of Anesthesiology, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel Aviv University
  • Michael Stein
    • Department of Surgery, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel Aviv University
  • Suzana Fichman
    • Department of Pathology, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel Aviv University
  • Amir Mazor
    • Department of Surgery, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel Aviv University
  • Jacopo Chen
    • Department of Surgery, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel Aviv University
  • Hanna Bernstine
    • Department of Nuclear Medicine, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel Aviv University
  • Pierre Singer
    • Intensive care unit, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel Aviv University
  • Ram Dickman
    • Gastroenterology unit, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel Aviv University
  • Scott A. Shikora
    • Tufts–New England Medical Center
  • Raul J. Rosenthal
    • Cleveland Clinic Florida
    • Felsenstein Medical Research Center, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel Aviv University
    • Department of Surgery, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel Aviv University
Research Article

DOI: 10.1007/s11695-008-9576-x

Cite this article as:
Yehoshua, R.T., Eidelman, L.A., Stein, M. et al. OBES SURG (2008) 18: 1083. doi:10.1007/s11695-008-9576-x

Abstract

Background

Aiming to clarify the mechanism of weight loss after the restrictive bariatric procedure of sleeve gastrectomy (LSG), the volumes and pressures of the stomach, of the removed part, and of the remaining sleeve were measured in 20 morbidly obese patients.

Methods

The technique used consisted of occlusion of the pylorus with a laparoscopic clamp and of the gastroesophageal junction with a special orogastric tube connected to a manometer. Instillation of methylene-blue-colored saline via the tube was continued until the intraluminal pressure increased sharply, or the inflated stomach reached 2,000 cc. After recording of measurements, LSG was performed.

Results

Mean volume of the entire stomach was 1,553 cc (600–2,000 cc) and that of the sleeve 129 cc (90–220 cc), i.e., 10% (4–17%) and that of the removed stomach was 795 cc (400–1,500 cc). The mean basal intragastric pressure of the whole stomach after insufflations of the abdominal cavity with CO2 to 15 mmHg was 19 mmHg (11–26 mmHg); after occlusion and filling with saline it was 34 mmHg (21–45 mmHg). In the sleeved stomach, mean basal pressure was similar 18 mmHg (6–28 mmHg); when filled with saline, pressure rose to 43 mmHg (32–58 mmHg). The removed stomach had a mean pressure of 26 mmHg (12–47 mmHg). There were no postoperative complications and no mortality.

Conclusions

The notably higher pressure in the sleeve, reflecting its markedly lesser distensibility compared to that of the whole stomach and of the removed fundus, indicates that this may be an important element in the mechanism of weight loss.

Keywords

Bariatric surgerySleeve gastrectomyDistensibilityVolumePressure

Copyright information

© Springer Science + Business Media, LLC 2008