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Does antrum size matter in sleeve gastrectomy? A prospective randomized study.

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Laparoscopic sleeve gastrectomy (LSG) at 2 cm from the pylorus improved weight loss initially but led to temporary GERD. Differences in weight loss and GERD resolved by 24 months.

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Area of Science:

  • Bariatric Surgery
  • Gastroenterology
  • Surgical Techniques

Background:

  • Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure.
  • Technical variations in LSG, specifically resection length, are debated.
  • The impact of pyloric distance on outcomes requires further investigation.

Purpose of the Study:

  • To compare anthropometric outcomes, morbidity, food tolerance, and GERD incidence after LSG with resections at 2 cm versus 6 cm from the pylorus.
  • To evaluate the long-term effects of these surgical variations.

Main Methods:

  • Prospective randomized study of 150 patients undergoing LSG.
  • Group A: resection at 2 cm from pylorus; Group B: resection at 6 cm from pylorus.
  • Follow-up at 3, 6, 12, and 24 months, including upper endoscopy and GERD-specific quality of life assessment.

Main Results:

  • Group A showed statistically significant better weight loss (%EWL, %TWL) at 12 months compared to Group B.
  • Differences in anthropometric features diminished by 24 months.
  • Increased GERD incidence was observed in both groups postoperatively, with a higher incidence in Group A at 6 months.

Conclusions:

  • LSG with resection at 2 cm from the pylorus may enhance early weight loss but is associated with transiently reduced food tolerance and increased GERD.
  • These differences appear to normalize by 24 months post-surgery.