Influence of antrum size on gastric emptying and weight-loss outcomes after laparoscopic sleeve gastrectomy (preliminary analysis of a randomized trial)

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) has increased in popularity in recent years as a definitive bariatric procedure. Despite its growing popularity worldwide, the surgical technique is not well standardized. There is a lack of evidence on the matter of the antrum size and its relation to gastric emptying and weight-loss outcomes. The aim of the study is to evaluate the influence of antrum size over gastric emptying and weight-loss outcomes.

Methods

Twenty-five patients were prospectively randomized according to the distance between the first firing and the pylorus: AR group (antrum resection—2 cm from the pylorus) and AP group (antrum preservation—5 cm from the pylorus). Gastric emptying (%GE) was evaluated by a gastric emptying scintigraphy before surgery, 2 months and 1 year after LSG. Antrum volume was measured using a MultiSlice CT Scan performed 2 months and 1 year after surgery. The percent of excess weight loss (%EWL) was calculated after 1 year follow-up.

Results

At 2 months after LSG the mean %GE was 69.7 ± 18 in the AR group and 72.8 ± 20 in the AP group (p = 0.69). At 1 year it was 66.5 ± 21 and 74.2 ± 16 in the AR and AP groups, respectively (p = 0.30). A significant accelerated gastric emptying was observed at 2 months (p = 0.025) and at 1 year (p = 0.013) in the AP group. Meanwhile in the AR group this increase was not significant (p = 0.12 at 2 months and p = 0.21 at 1 year). Differences regarding the %EWL between groups were no statistically significant (p = 0.74).

Conclusions

After LSG there is a global tendency to an accelerated gastric emptying, although only significant in the antrum preservation group; however, no differences were observed regarding the %EWL between groups after 1 year follow-up.

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Acknowledgements

Authors appreciate research contributions by European Association for Endoscopic Surgery (EAES Research Grant Project 2011) and the Karl Storz EAES Award (Amsterdam, 2016).

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Correspondence to Meritxell Garay.

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Meritxell Garay, Carmen Balagué, Carlos Rodríguez-Otero, Berta Gonzalo, Anna Domenech, Juan Carlos Pernas, Ignasi J. Gich, Sonia Fernández-Ananín and Eduardo M. Targarona have no conflict of interest or financial ties to disclose.

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Garay, M., Balagué, C., Rodríguez-Otero, C. et al. Influence of antrum size on gastric emptying and weight-loss outcomes after laparoscopic sleeve gastrectomy (preliminary analysis of a randomized trial). Surg Endosc 32, 2739–2745 (2018). https://doi.org/10.1007/s00464-017-5972-4

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Keywords

  • Bariatric surgery
  • Sleeve gastrectomy
  • Gastric emptying scintigraphy
  • Pyloric antrum
  • Antrum size
  • Weight loss