Early gastric dilation after laparoscopic sleeve gastrectomy: Insights from a three-dimensional computed tomography...

Laparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric surgery owing to its effective weight loss and low complication rates. Nonetheless, some patients experience weight regain or insufficient weight loss due to residual gastric dilation, the factors of which remain unclear.

To evaluate changes in residual gastric volume after LSG using three-dimensional computed tomography reconstruction and to investigate the factors contributing to gastric dilation.

This retrospective study included 50 patients who underwent LSG. Preoperative clinical and laboratory data were obtained. The residual gastric volume was measured using three-dimensional computed tomography reconstruction at 1 month and 3 months postoperatively. The total sleeve volume, tube volume, antral volume, and tube-to-antral volume ratio were also assessed. Resected gastric volume and staple line length were measured during surgery. Weight metrics and laboratory indices were recorded at 1 month, 3 months, 6 months, and 12 months postoperatively. The Eating Behavior After Bariatric Surgery Questionnaire and Gastroesophageal Reflux Disease Questionnaire (GERD-Q) were used to assess the dietary behavior of patients after LSG. Correlation between the degree of residual gastric dilation and percent total weight loss (%TWL) at 12 months postoperatively was analyzed. Univariate and multivariate correlation analyses were conducted to identify risk factors for residual gastric dilation after LSG.

The 50 included patients had a mean preoperative body mass index of 42.27 ± 7.19 kg/m² and average %TWL of 34% ± 7% at 1 year after LSG. At 1 month after LSG, the mean tube volume, antral volume, and total sleeve volume were 45.93 ± 16.75 mL, 115.85 ± 44.92 mL, and 161.77 ± 55.37 mL, respectively. At 3 months after LSG, the residual gastric volume showed statistically significant dilation (average dilation degree: 13.50% ± 17.35%). %TWL at 1 year significantly correlated with residual gastric dilation (P < 0.05). Univariate and multivariate linear regression analyses revealed that preoperative type 2 diabetes, residual gastric volume at 1 month after LSG, and GERD-Q scores were independent risk factors influencing the degree of residual gastric dilation.

In conclusion, residual gastric dilation after LSG significantly affected the efficacy of weight loss. Preoperative type 2 diabetes, residual gastric volume at 1 month after LSG, and GERD-Q scores were independent risk factors affecting the degree of residual gastric dilation.