The effect of residual gastric antrum size on the outcome of laparoscopic sleeve gastrectomy: a prospective randomized trial.

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity worldwide as a definitive bariatric procedure. However, there are still some controversial issues associated with the technique, one of which is the size of the residual antrum.

OBJECTIVES

The aim of this prospective randomized trial is to study the effect of the size of the residual gastric antrum on the outcome of LSG.

SETTINGS: University-affiliated hospital.

METHODS

Between November 2009 and August 2013, 113 morbidly obese patients submitted for LSG were randomized into 2 groups, namely antral preserving-LSG (AP-LSG) and antral resecting-LSG (AR-LSG), depending on the distance from the pylorus at which gastric division begins. In the AP-LSG group, the distance was 6 cm from the pylorus and included 58 patients, whereas the distance was 2 cm in the AR-LSG group and included 55 patients. The follow-up period was at least 12 months. Baseline and 6 and 12 month outcomes were analyzed including assessments of the percent excess weight lost (%EWL), reduction in BMI, morbidity, mortality, reoperations, quality of life, and co-morbidities.

RESULTS

Both groups were comparable regarding age, gender, body mass index (BMI), and co-morbidities. There was one 30-day mortality, and there was no significant difference in the complication rate or early reoperations between the 2 groups. Weight loss was significant in both groups at 6 and 12 months. At 12 months, weight loss was greater in the AR-LSG than in the AP-LSG group, but with was no significant difference between the 2 groups at 12 months (%EWL was 64.2% in the AP-LSG group and 67.6% in the AR-LSG group; p>.05). The resolution/improvement of co-morbidities, quality of life outcome and the overall prevalence of co-morbidities were similar.

CONCLUSIONS

LSG with or without antral preservation produces significant weight loss after surgery. The 2 procedures are equally effective regarding %EWL, morbidity, quality of life, and amelioration of co-morbidities.