Abstract
Background
Laparoscopic sleeve gastrectomy (LSG) is a surgical technique that treats morbid obesity.
Methods
Consecutive patients with morbid obesity treated by LSG at our department were evaluated. Patients enrolled in the study were randomized into group I (LSG begins the division 2 cm from the pylorus) and group II (LSG begins the division 6 cm from the pylorus). The primary outcome measure was the percent of excess weight loss (% EWL); secondary outcomes included postoperative morbidity and mortality and improvement of comorbidity.
Results
One hundred five patients (79 (75.2 %) were females) were randomized into two groups of (GI) 52 patients and (GII) 53 patients. In group I, the mean % EWL was 51.8 ± 13.9, 63.8 ± 16.1 and 71.8 ± 12; however, in group II, the mean % EWL was 38.3 ± 10.9, 51.9 ± 13.6 and 61 ± 11.1 at 6, 12, and 24 months, respectively (P = 0.0001, 0.0001, 0.003). There was weight regain after 2 years in five patients in group II and only one patient in group I (P = 0.09). There was no significant difference between both group as regards gastric leakage, vomiting or GER. There was significant improvement in comorbidity after LSG in both groups, but no significant difference between them. Hospital mortality occurred in group II in one case as a result of gastric leakage.
Conclusions
LSG is a safe and effective procedure with good short-term outcome. Increasing the size of the resected antrum is associated with better weight loss without increasing the rate of complications significantly.
Similar content being viewed by others
References
Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10years after bariatric surgery. NEJM. 2004;351:2683–93.
Brunault P, Jacobi D, Léger J, Bourbao-Tournois C, Huten N, Camus V, et al. Observations regarding ‘quality of life’ and ‘comfort with food’ after bariatric surgery: comparison between laparoscopic adjustable gastric banding and sleeve gastrectomy. Obes Surg. 2011;21(8):1225–31.
Moy J, Pomp A, Dakin G, Parikh M, Gagner M. Laparoscopic sleeve gastrectomy for morbid obesity. Am J Surg. 2008;196(5):e56–9.
Pomerri F, Foletto M, Allegro G, Bernante P, Prevedello L, Muzzio PC. Laparoscopic sleeve gastrectomy—radiological assessment of fundus size and sleeve voiding. Obes Surg. 2011;21(7):858–63.
Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.
Frezza EE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg Today. 2007;37(4):275–81.
Márquez MF, Ayza MF, Lozano RB, Morales Mdel M, Díez JM, Poujoulet RB. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010;20(9):1306–11.
Albanopoulos K, Alevizos L, Flessas J, Menenakos E, Stamou KM, Papailiou J, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing two different techniques. Preliminary results. Obes Surg. 2012;22(1):42–6.
Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5.
Iannelli A, Dainese R, Piche T, Facchiano E, Gugenheim J. Laparoscopic sleeve gastrectomy for morbid obesity. World J Gastroenterol. 2008;14(6):821–7.
Ferrer-Márquez M, Belda-Lozano R, Ferrer-Ayza M. Technical controversies in laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(1):182–7.
Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg. 2005;15(7):1030–3.
Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20(6):859–63.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108(5):768–75.
Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, Gfrerer L, Ludvik B, Zacherl J, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20(5):535–40.
Prasad P, Tantia O, Patle N, Khanna S, Sen B. An analysis of 1-3-year follow-up results of laparoscopic sleeve gastrectomy: an Indian perspective. Obes Surg. 2012;22(3):507–14.
Shi X, Karmali S, Sharma AM, Birch DW. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(8):1171–7.
Baltasar A, Serra C, Pérez N, Bou R, Bengochea M, Ferri L. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15(8):1124–8.
Givon-Madhala O, Spector R, Wasserberg N, Beglaibter N, Lustigman H, Stein M, et al. Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients. Obes Surg. 2007;17(6):722–7.
Silecchia G, Boru C, Pecchia A, Rizzello M, Casella G, Leonetti F, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16(9):1138–44.
Sánchez-Santos R, Masdevall C, Baltasar A, Martínez-Blázquez C, de Gordejuela AGR, Ponsi E, et al. Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry. Obes Surg. 2009;19(9):1203–10.
Fischer L, Hildebrandt C, Bruckner T, Kenngott H, Linke GR, Gehrig T, et al. Excessive weight loss after sleeve gastrectomy: a systematic review. Obes Surg. 2012;22(5):721–31.
Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg. 2011;21(2):146–50.
Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.
Schneider JH, Küper M, Königsrainer A, Brücher B. Transient lower esophageal sphincter relaxation in morbid obesity. Obes Surg. 2009;19(5):595–600.
Tai CM, Huang CK. Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1year after laparoscopic sleeve gastrectomy among obese adults. Surg Endosc. 2013;27(10):3937.
Daes J, Jimenez ME, Said N, Daza JC, Dennis R. Laparoscopic sleeve gastrectomy: symptoms of gastroesophageal reflux can be reduced by changes in surgical technique. Obes Surg. 2012;22(12):1874–9.
Carabotti M, Silecchia G, Greco F, Leonetti F, Piretta L, Rengo M, et al. Severi C Impact of laparoscopic sleeve gastrectomy on upper gastrointestinal symptoms. Obes Surg. 2013;23(10):1551–7.
Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrectomy in the high-risk patient. Obes Surg. 2006;16(11):1445–9.
Nocca D, Krawczykowsky D, Bomans B, Noël P, Picot MC, Blanc PM. de Seguin de Hons C, Millat B, Gagner M, Monnier L, Fabre JM. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2years. Obes Surg. 2008;18(5):560–5.
Braghetto I, Lanzarini E, Korn O, Valladares H, Molina JC, Henriquez A. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg. 2010;20(3):357–62.
Melissas J, Koukouraki S, Askoxylakis J, Stathaki M, Daskalakis M, Perisinakis K, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17(1):57–62.
Eid GM, Brethauer S, Mattar SG, Titchner RL, Gourash W, Schauer PR. Laparoscopic sleeve gastrectomy for super obese patients: forty-eight percent excess weight loss after 6 to 8years with 93% follow-up. Ann Surg. 2012;256(2):262–5.
Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469–75.
Lakdawala MA, Bhasker A, Mulchandani D, Goel S, Jain S. Comparison between the result of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in the Indian population: a retrospective 1year study. Obes Surg. 2010;20:1–6.
Conflict of Interest
There was no financial support received. The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
Manuscript has been seen and approved by all authors.
This manuscript has not been submitted for publication in any other journal and will not subsequently be submitted for potential publication in another journal until a decision has been made, nor has it been published previously in any media.
Rights and permissions
About this article
Cite this article
Abdallah, E., El Nakeeb, A., Yousef, T. et al. Impact of Extent of Antral Resection on Surgical Outcomes of Sleeve Gastrectomy for Morbid Obesity (A Prospective Randomized Study). OBES SURG 24, 1587–1594 (2014). https://doi.org/10.1007/s11695-014-1242-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-014-1242-x