Predictive Value of Preoperative Ultrasound for Gastric Wall Thickness in Bariatric Procedures

Staple line leakage is a major complication after bariatric surgery, often requiring prolonged and complex treatment. While ultrasonography has been used for gastric cancer screening, its role in evaluating gastric wall before bariatric surgery is not well studied. This study aimed to measure antral gastric wall thickness preoperatively using ultrasonography to provide objective data that may guide stapler selection and reduce complication rates.

Between December 2024 and May 2025, 42 bariatric surgery patients underwent preoperative ultrasonography to measure the total thickness of the gastric antrum's 5 layers. Immediately after surgery, a pressure of 8 g/mm² was applied to the fresh specimen for 15 seconds, and antral wall thickness was measured using the micrometer.

Mean antral, corpus, and fundus wall thicknesses measured by the micrometer under standardized pressure were 2.81 ± 0.36, 2.47 ± 0.27, and 1.71 ± 0.29 mm, respectively. A significant difference was found among these regions (P < .001). Mean antral wall thickness by ultrasonography was 3.97 ± 1.08 mm. No significant correlation was observed between ultrasonographic and micrometric antral measurements (P = .178).

Preoperative ultrasonography may be sufficient for measuring gastric wall thickness at rest; however, it is inadequate for estimating thickness under intraoperative conditions. Based on our findings and the limited existing literature, conventional ultrasonography does not reliably predict gastric wall thickness under compression. Therefore, noninvasive and cost-effective methods are still needed for accurate preoperative or intraoperative assessment of gastric wall thickness.