The Impact of residual gastric size on the outcome of laparoscopic sleeve gastrectomy

BackgroundLaparoscopic sleeve gastrectomy (LSG) has become a primary surgical treatment for obesity and associated diseases; this procedure works by several mechanisms. The new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect of surgery on gut hormones that affect a number of factors including hunger, satiety, and blood sugar control. ObjectivesTo compare the outcomes of two different starting distance of stapling 2 and 6 cm from the pylorus in LSG on postoperative vomiting, reflux symptoms and other complications, time of gastric emptying after meals, changes of blood sugar for diabetics, effect on other comorbidities, and degree of weight loss.Patients and methodsThis study (randomized clinical control trial) included a total number of 40 obese patients. All patients were subjected to LSG at Menoufia University Hospital and subdivided into two groups: group 1 included 20 patients subjected to LSG with start of stapling 2 cm distance from the pylorus. Group 2 included 20 patients subjected to LSG with start of stapling 6 cm distance from the pylorus during the period between December 2018 and December 2019 with follow up of outcomes for 6-12 months postoperatively. All cases were calibrated intraoperatively on (36 Fr bougies) and using a gastrointestinal stapler device (Johnson Company).ResultsBoth groups were comparable regarding age, sex, BMI, and comorbidities. There was nonsignificant difference in early and late complication rates between the two groups but vomiting, gastroesophageal reflux disease, and nutritional deficiency were more with group 1. Patients in group 2 (more residual gastric volume) had less gastric emptying time than group 1. There were nonsignificant difference in both groups on improvement/resolution of comorbidities (control of blood sugar and hypertension). Excess weight loss was significant in both groups at 6 and 12 months postoperatively but was (statistically nonsignificant) more with group 1. There was no leakage or mortality.ConclusionsThe two different starting distances in LSG are almost equally effective regarding operative time, improvement/resolution of comorbidities, and percentage of weight loss. Less residual gastric size comes with more weight loss but may be associated with postoperative complications such as vomiting, gastroesophageal reflux disease symptoms, and nutritional deficiency. So the choice of the starting distance from the pylorus will mostly be decided by the bariatric surgeon regarding patient age, BMI, comorbidities, and life standards.