Residual Gastric Volume Relationship and Weight Loss After Laparoscopic Sleeve Gastrectomy

The Effect of Gluing Versus Suturing of the Stapler Line in Sleeve Gastrectomy on Weight Loss

BACKGROUND

Stapler line reinforcement during sleeve gastrectomy (LSG) was assessed thoroughly in the context of postoperative complications focusing on leakage and bleeding. However, the effect of stapler line reinforcement techniques on the short- and long-term weight loss is still unclear and lacking. We hypothesize that inverting of the stapler line by Lembert suturing could lead to further additional reduction of the remnant gastric volume and accordingly a more significant weight reduction.

METHODS

Retrospective analysis of patients that underwent LSG (2012-2018) from the two university hospitals. The first hospital routinely performed oversewing with inversion of the stapler line (first group, Lembert suture), while the second university hospital performed LSG without stapler line oversewing and inversion, but routinely used VeraSeal glue (second group, non-Lembert); both groups were compared in terms of weight loss and complications.

RESULTS

Four hundred eighty and 550 patients underwent LSG in the first and second hospital, consequently. The mean BMI change and EBWL at 1, 3, and 5 years were better in the first group than in second group. The mean last follow-up BMI was significantly lower in Lembert group (29.8 ± 5.2kg/m2) than in non-Lembert group (32.9 ± 6.7 kg/m2), P = 0.001. The mean EBWL at last follow-up point was significantly better for the Lembert group as compared to non-Lembert group (73.7 ± 26.59 versus 57.12 ± 27.71, P = 0.001).

CONCLUSIONS

Lembert suture line oversewing and inversion in LSG is associated with noticeable improvement in weight loss outcomes at 1, 3, and 5 years and last follow-up compared to LSG with VeraSeal gluing.

Posterior fixation of gastric tube with fibrin sealant in laparoscopic sleeve gastrectomy: a promising method to prevent revision surgeries

BACKGROUND

We aim to assess the effects of gastric posterior fixation with fibrin sealant in laparoscopic sleeve gastrectomy in aspects of 12th-month body mass index and gastric volume.

METHODS

The patients who underwent laparoscopic sleeve gastrectomy between January 2019 and February 2021 were divided into two groups preoperatively. The first 75 patients were appointed to the posterior fixation group, and the second 75 were to the control group. Changes in gastric volume and body mass index were assessed in the postoperative 12th month.

RESULTS

There were 110 patients in the final analysis. Fifty-four patients had posterior fixation, and 56 had only laparoscopic sleeve gastrectomy. The posterior fixation group was superior in terms of total weight loss rate (39.1% vs. 34.5%, p<0.001) and less gastric volume increase rate (39.8% vs. 164.7%, p<0.001) in the postoperative 12th month.

CONCLUSION

Our study suggests that posterior fixation with fibrin sealant in laparoscopic sleeve gastrectomy is a promising method for preventing weight regain and creating a need for revision surgery.

Volumetric Pouch Study After Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is considerably utilized as a bariatric method for treating morbid obesity through the reduction of stomach volume. The present study attempted to assess the volumetric changes of the gastric reservoir 1 year after LSG using multi-slice spiral computed tomography (MSCT) as well as to verify their association with weight loss. The current study is a prospective study of 40 consecutive morbid obese patients managed with laparoscopic sleeve gastrectomy. All patients were referred to abdominal MSCT besides volumetric measurement of the gastric pouch 1 month and 12 months postoperatively after the LSG. There were statistically substantial differences throughout the whole period of follow-up (p value ≤ 0.05) regarding the ratio of excess weight loss, weight loss, and decreased BMI, in addition to the ratio of excess body mass index loss (% EBMIL) after LSG. Substantial elevation of the overall volume of the gastric reservoir (82.9 SD11 and 171.6 SD23.6 ml at 1 and 12 months, respectively) was observed. However, the current findings did not demonstrate any significant association (r = 0.131, p = 0.491) between excess weight loss percentage and the increase in gastric reservoir volume 1 year postoperatively. Sleeve dilatation is a common finding following sleeve gastrectomy (SG) even after conducting a narrow gastric pouch, yet dilatation was not correlated with insufficient weight loss after 1 year postoperatively. Trial registration number: NCT04880902.

Radiographic Measurement of Gastric Remnant Volume After Laparoscopic Sleeve Gastrectomy: Assessment of Reproducibility and Correlation with Weight Loss

BACKGROUND

As a restrictive procedure, laparoscopic sleeve gastrectomy (LSG) relies primarily on the reduction of gastric volume. It has been suggested that an immediate postoperative gastric remnant volume (GRV) may influence long-term results of LSG; however, there are no consensus in this matter. The aim of this study was to assess the reproducibility of different radiographic methods of GRV calculation and evaluate their correlation with the weight loss (WL) after surgery.

METHODS

This retrospective study evaluated 174 patients who underwent LSG in the period from 2014 to 2017. Using UGI, GRV was measured with 3 different mathematical methods by 2 radiologists. Intraobserver and interobserver calculations were made. Correlation between GRV and WL were estimated with calculations percentage of total weight loss (%TWL) and percentage of excess weight loss (%EWL) after 1, 3, 6, 12, 18, and 24 months postoperatively.

RESULTS

During analysis of intraobserver similarities, the results of ICC calculation showed that reproducibility was good to excellent for all GRV calculation methods. The intraobserver reproducibility for Reader I was highest for cylinder and truncated cone formula and for Reader II for ellipsoid formula. The interobserver reproducibility was highest for ellipsoid formula. Regarding correlation between GRV and WL, significant negative correlation has been shown on the 12th month after LSG in %TWL and %EWL for every method of GRV calculation, most important for ellipsoid formula (%TWL - r(X,Y) = -0.335, p < 0.001 and %EWL - r(X,Y) = -0.373, p < 0.001).

CONCLUSION

Radiographic methods of GRV calculation are characterized by good reproducibility and correlate with the postoperative WL.

Sleeve Volume and Preoperative Gastric Volume Assessment Using Three-dimensional MDCT Gastrography and Their Correlation to Short-term Post-Sleeve Gastrectomy Weight Loss

PURPOSE

Several factors including preoperative stomach capacity and sleeve volume impact weight loss after laparoscopic sleeve gastrectomy (LSG). We aimed at measuring these volumes using multidetector computed tomography (MDCT) gastrography and correlating them with postoperative weight losses.

MATERIALS AND METHODS

Morbidly obese patients prepared for LSG during 2018 were included in the study. MDCT gastrography was performed 1 week before, 6 and 12 months after LSG. Preoperative gastric volume and postoperative sleeve volumes were measured. Correlation with preoperative BMI and postoperative %TWL was performed. The change in sleeve volume at 6 and 12 months was assessed.

RESULTS

A total of 98 patients (62 F) were included. Mean preoperative BMI was47 ± 7 kg/m². Follow-up was achieved in 89 patients (91%) and 82 patients (83%) at 6 and 12 months, respectively. Mean %TWL was 24 ± 3 and 32.8 ± 3 at 6 and 12 months, respectively (p < 0.05). Preoperative gastric volume ranged from 800 to 1800 ml (mean ± SD, 1310 ± 307) and dropped significantly to range from 140 to 170 ml (158 ± 9) and from 165 to 210 ml (181 ± 12) at 6 and 12 months postoperatively, respectively. Pouch was not significantly dilated at 12 vs. 6 months postoperatively. Preoperative gastric volume was significantly correlated with preoperative BMI (p = 0.006*) but not with postoperative weight losses. Correlation between postoperative pouch volumes and weight losses at 6 and 12 months postoperatively showed no significance.

CONCLUSION

Sleeve pouch is significantly smaller than preoperative stomach, but not significantly correlated to weight loss. Restriction is an important, but not the only factor controlling weight loss after LSG.