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Effect of Resection Distance from Pylorus on Weight Loss Outcomes in Laparoscopic Sleeve Gastrectomy

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Abstract

Background

Despite the established efficacy and safety of laparoscopic sleeve gastrectomy (LSG), controversy still exists on optimal operative technique, the resection distance from pylorus (DP) being among the most controversial issues. This study aimed to examine the effect of resection distance from pylorus on % excess weight loss (EWL) during postoperative period, in patients who underwent LSG for morbid obesity.

Methods

A total of 390 patients who underwent laparoscopic sleeve gastrectomy for morbid obesity were included in this retrospective study. Patients were allocated into one of the two groups based on the distance between antrum resection margin and pylorus: group A, ≤ 3 cm and group B, > 3 cm. Follow-up data for %EWS and nausea/vomiting as well as demographical and perioperative data were retrospectively reviewed and logistic regression analysis was done.

Results

Follow-up data up to 12 months were available for all patients, whereas 199 patients had follow-up data at 24 months. Shorter distance from pylorus was associated with higher %EWL throughout the treatment period (p < 0.001), evident from the first postoperative month (p = 0.013 for the first month, p < 0.001 for all other time points). The benefit extended up to 24 months in ≤ 3 cm group. However, nausea/vomiting was more frequent in the ≤ 3 cm group only at 1-month visit (15% vs. 4%, p < 0.001). In multivariate evaluations, while %EWL variable was taken as a dependent variable, time variable with DP × time interaction was statistically significant in the model.

Conclusions

Our findings indicate that a short distance between resection margin and pylorus is associated with better and sustained %EWL in LSG. However, these patients seem to be more prone to nausea and vomiting in the early postoperative period. Further prospective large studies would help to define an optimal resection distance.

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Authors and Affiliations

  1. Department of General Surgery, Private Camlica Erdem Hospital, Alemdağ Yanyolu Cad. No:36 Üsküdar, Istanbul, Turkey

    Omer Avlanmis & Busra Burcu

  2. Department of General Surgery, Okmeydani Research and Education Hospital, Istanbul, Turkey

    Riza Gurhan Isil

Authors
  1. Omer Avlanmis
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  2. Riza Gurhan Isil
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  3. Busra Burcu
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Correspondence to Omer Avlanmis.

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The authors declare that they have no competing interests.

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All procedures performed in this study were in accordance with the ethical standards of the local ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee.

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Formal consent is not required for this retrospective study.

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Avlanmis, O., Isil, R.G. & Burcu, B. Effect of Resection Distance from Pylorus on Weight Loss Outcomes in Laparoscopic Sleeve Gastrectomy. OBES SURG 29, 2731–2738 (2019). https://doi.org/10.1007/s11695-019-03923-3

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  • DOI: https://doi.org/10.1007/s11695-019-03923-3

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