Influence of antrum size on gastric emptying and weight-loss outcomes after laparoscopic sleeve gastrectomy (preliminary analysis of a randomized trial)
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.
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.
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).
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.
KeywordsBariatric surgery Sleeve gastrectomy Gastric emptying scintigraphy Pyloric antrum Antrum size Weight loss
Authors appreciate research contributions by European Association for Endoscopic Surgery (EAES Research Grant Project 2011) and the Karl Storz EAES Award (Amsterdam, 2016).
Compliance with ethical standards
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.
- 6.Bernstine H, Yehoshua RT, Groshar D, Beglaibter N, Shikora S, Rosenthal RJ, Rubin M (2009) Gastric emptying is nor affected by sleeve gastrectomy–scintigraphic evaluation of gastric emptying after sleeve gastrectomy without removal of the gastric antrum. Obes Surg 19:293–298CrossRefPubMedGoogle Scholar
- 12.Tougas G, Eaker EY, Abell TL, Abrahamsson H, Boivin M, Chen J, Hocking MP, Quigley EM, Koch KL, Tokayer AZ, Stanghellini V, Chen Y, Huizinga JD, Rydén J, Bourgeois I, McCallum RW (2000) Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol 95:1456–1462CrossRefPubMedGoogle Scholar
- 16.Abdallah E, El Nakeeb A, Yousef T, Abdallah H, Abd Ellatif M, Lofty A, Youssef M, Elganash A, Moatamed A, Morshed M, Farid M (2014) Impact of extent of antral resection on surgical outcomes of sleeve gastrectomy for morbid obesity (a prospective randomized study). Obes Surg 24:1587–1594CrossRefPubMedGoogle Scholar