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Alghazawi L, Fadel MG, Chen JY, Das B, Robb H, Rodriguez-Luna MR, Fakih-Gomez N, Perretta S, Ashrafian H, Fehervari M. Development and Evaluation of a Quality Assessment Tool for Laparoscopic Sleeve Gastrectomy Videos: A Review and Comparison of Academic and Online Video Resources. Obes Surg 2024; 34:1909-1916. [PMID: 38581627 PMCID: PMC11031436 DOI: 10.1007/s11695-024-07199-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Video recording of surgical procedures is increasing in popularity. They are presented in various platforms, many of which are not peer-reviewed. Laparoscopic sleeve gastrectomy (LSG) videos are widely available; however, there is limited evidence supporting the use of reporting guidelines when uploading LSG videos to create a valuable educational video. We aimed to determine the variations and establish the quality of published LSG videos, in both peer-reviewed literature and on YouTube, using a newly designed checklist to improve the quality and enhance the transparency of video reporting. METHODS A quality assessment tool was designed by using existing research and society guidelines, such as the Bariatric Metabolic Surgery Standardization (BMSS). A systematic review using PRISMA guidelines was performed on MEDLINE and EMBASE databases to identify video case reports (academic videos) and a similar search was performed on the commercial YouTube platform (commercial videos) simultaneously. All videos displaying LSG were reviewed and scored using the quality assessment tool. Academic and commercial videos were subsequently compared and an evidence-based checklist was created. RESULTS A total of 93 LSG recordings including 26 academic and 67 commercial videos were reviewed. Mean score of the checklist was 5/11 and 4/11 for videos published in articles and YouTube, respectively. Academic videos had higher rates of describing instruments used, such as orogastric tube (P < 0.001) and stapler information (P = 0.04). Fifty-four percent of academic videos described short-term patient outcomes, while not reported in commercial videos (P < 0.001). Sleeve resection status was not universally reported. CONCLUSIONS Videos published in the academic literature are describing steps in greater detail with more emphasis on specific technical elements and patient outcomes and thus have a higher educational value. A new quality assessment tool has been proposed for video reporting guidelines to improve the reliability and value of published video research.
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Affiliation(s)
- Laith Alghazawi
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Michael G Fadel
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
| | - Jun Yu Chen
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Henry Robb
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Maria Rita Rodriguez-Luna
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Naim Fakih-Gomez
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
| | - Silvana Perretta
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- Department of Digestive and Endocrine Surgery, University of Strasbourg, Strasbourg, France
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matyas Fehervari
- Department of Surgery and Cancer, Imperial College London, London, UK
- Gastrointestinal Surgery, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
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Chen HY, Yang PJ, Lee PC, Chuang PH, Yang YH, Chiu WT, Wu CH. Computed tomography-based gastric volumetry for morbid obesity to assess weight loss and fatty liver change. J Formos Med Assoc 2024:S0929-6646(24)00144-X. [PMID: 38433034 DOI: 10.1016/j.jfma.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/02/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND/PURPOSE Laparoscopic sleeve gastrectomy (LSG) is an effective treatment for patients with morbid obesity, but the optimal gastric volume (GV) for resection remains unclear. Accordingly, we aimed to determine the optimal percentage of excised stomach that could engender significant weight loss and improve fatty liver. METHODS This prospective study included 63 patients. Computed tomography (CT) scans were performed before and 1 year after LSG to evaluate the gastric lumen (GL) and GV. Specifically, the stomach was distended with effervescent powder, following water-contrast mixture (20:1) and assessed by three-dimensional reconstruction. The correlations of reduced gastric lumen/volume (RGL/RGV) with total body weight (BW) loss and liver-spleen density ratio (LSDR) changes were analyzed, and optimal RGL/RGV associated with significant BW and fatty liver changes were determined. RESULTS We noted a positive correlation between the percentage of RGV/RGL (%RGV/%RGL) and percentage of total weight loss (%TWL; r = 0.359, p = 0.004 and r = 0.271, p = 0.032). Furthermore, a %RGL value of >78.2% and %RGV value of >75.3% were associated with more significant BW loss than did limited excision (both p < 0.01). On the other hand, LSDR values increased significantly after LSG, corresponding to the improvement of fatty liver disease at %RGL and %RGV values of >59.1% and >56.4% (both p < 0.01), respectively. CONCLUSION %RGV and %RGL were determined to be factors affecting LSG outcomes. LSG engendered significantly more BW loss when %RGV was >75.3% and resulted in fatty liver disease improvement when %RGV was >56.4%.
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Affiliation(s)
- Hsin-Yu Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Po-Jen Yang
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Center for Obesity, Life Style and Metabolic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chu Lee
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Center for Obesity, Life Style and Metabolic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Han Chuang
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Yung-Hsuan Yang
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Wan-Ting Chiu
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chih-Horng Wu
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
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Sobutay E, Bilgiç Ç, Kabaoğlu B, Yavuz Y. Can Weight of The Resected Stomach Predict Weight Loss Results After Laparoscopic Sleeve Gastrectomy? Surg Laparosc Endosc Percutan Tech 2024; 34:29-34. [PMID: 38306493 DOI: 10.1097/sle.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/11/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. Many factors have been investigated in the literature to predict weight loss outcomes after LSG. However, insufficient data regarding the resected stomach weight (RGW) exists. This retrospective study aimed to investigate the association between RGW and weight loss outcomes 1 year after LSG. MATERIALS AND METHODS Fifty-four patients who underwent LSG in a tertiary care center were evaluated retrospectively. The statistical analyses were performed to investigate the correlation between preoperative demographics, RGW, and the excess weight loss percentage (%EWL) and percent total weight loss (%TWL). RESULTS The mean RGW was 169.7±40.1, ranging from 101 to 295 grams. The RGW was significantly correlated with preoperative weight (r=0.486; P<0.001), body mass index (r=0.420; P=0.002), and age (r=0.327; P=0.01). However, RGW did not predict postoperative weight loss, as measured by percent total weight loss (%TWL) and percent excess weight loss (%EWL), respectively (r=0.044; P=0.75 and r=-0.216; P=0.11). Multiple linear regression analysis identified age as a negative predictor for both %TWL (β=-0.351, P=0.005) and %EWL (β=-0.265, P=0.03), while preoperative body mass index was a negative predictor for %EWL (β=-0.469, P<0.001). CONCLUSION The RGW, although correlated with patient characteristics, does not serve as a reliable predictor of postoperative weight loss in the first year after LSG. Further research is needed to improve predictive models and patient care in bariatric surgery.
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Affiliation(s)
- Erman Sobutay
- Department of General Surgery, Koç Foundation American Hospital
| | - Çağri Bilgiç
- Department of General Surgery, Koç Foundation American Hospital
| | - Burçak Kabaoğlu
- Department of General Surgery, Koç Foundation American Hospital
| | - Yunus Yavuz
- Department of General Surgery, Koç Foundation American Hospital
- Department of General Surgery, Obesity and Metabolic Surgery Center, Koç University, School of Medicine, Istanbul, Turkey
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Does Gastric Expansibility Affect Weight Loss Success After Laparoscopic Sleeve Gastrectomy? SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:476-480. [PMID: 35881990 DOI: 10.1097/sle.0000000000001066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
Reduced excess weight loss (EWL) or regain is a worrying problem after metabolic surgery. Factors attainable from the resected specimen that can predict this outcome are investigated. We retrospectively analyzed 64 patients who had undergone laparoscopic sleeve gastrectomy. We collected demographic data, preoperative gastric emptying measurements, volume, expansion capacity, and 6-dimensional measurements of sleeve gastrectomy specimens. Correlations between EWL, body mass index levels, and gastric specimen measurements related to gastric remnant dimensions were also scrutinized. We found a significant correlation between the gastric specimen and remnant gastric volume, the resection line length in the gastric specimen, and 12th-month EWL%. Antrum expansibility was significantly increased in patients with weight regain. There was also a negative correlation between weight loss and age at postoperative first and third years. Sleeve resection line measurement and resected antrum diameter measurements can be used to predict weight loss, especially in the first year postoperatively.
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Salman MA, Elshazli M, Shaaban M, Esmat MM, Salman A, Ibrahim HMM, Tourky M, Helal A, Mahmoud AA, Aljarad F, Saadawy AMI, Shaaban HED, Mansour D. Correlation Between Preoperative Gastric Volume and Weight Loss After Laparoscopic Sleeve Gastrectomy. Int J Gen Med 2021; 14:8135-8140. [PMID: 34795518 PMCID: PMC8594781 DOI: 10.2147/ijgm.s335368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Long-term studies reported inadequate weight loss or weight regain after laparoscopic sleeve gastrectomy (LSG). This study investigated a possible relationship between preoperative gastric volume (GV) measured by CT volumetry and weight loss one year after LSG. Methods This prospective study included 120 patients scheduled for LSG. 3D CT gastric volumetry was done before surgery. The weight loss in the first year was serially recorded. The primary outcome measure was the correlation between preoperative GV and postoperative weight loss after one year. The secondary outcomes were the correlation between preoperative GV and other patients’ characteristics as age and body mass index (BMI). Results Weight and BMI decreased significantly up to 12 months. The percentage of excess weight loss (%EWL) at 6 and 12 months was significantly higher than at three months. Preoperative GV was 1021 ± 253, ranging from 397 to 1543 mL. GV was not related to sex, age, weight, height, postoperative weight, and BMI. Conclusion Preoperative gastric volume cannot predict weight loss one year after LSG. It is not correlated with age, sex, or preoperative weight, and BMI.
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Affiliation(s)
- Mohamed AbdAlla Salman
- General Surgery Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Elshazli
- General Surgery Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Shaaban
- Damietta General Hospital, General Surgery Department, Damietta, Egypt
| | | | - Ahmed Salman
- Internal Medicine Department, Kasr Al AinyFaculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Tourky
- General Surgery Department, Great Western Hospital, NHS Foundation Trust, Swindon, UK
| | - Alaa Helal
- General Surgery Department, Great Western Hospital, NHS Foundation Trust, Swindon, UK
| | | | - Feras Aljarad
- General Surgery Department, Lewisham and Greenwich NHS Trust, London, UK
| | | | - Hossam El-Din Shaaban
- Gastroenterology and Hepatology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Doaa Mansour
- General Surgery Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
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Deręgowska-Cylke M, Palczewski P, Błaż M, Cylke R, Ziemiański P, Szeszkowski W, Lisik W, Gołębiowski M. Radiographic Measurement of Gastric Remnant Volume After Laparoscopic Sleeve Gastrectomy: Assessment of Reproducibility and Correlation with Weight Loss. Obes Surg 2021; 32:230-236. [PMID: 34799810 PMCID: PMC8794890 DOI: 10.1007/s11695-021-05812-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
| | - Piotr Palczewski
- 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Błaż
- 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Radosław Cylke
- Department of General and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Ziemiański
- Department of General and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Szeszkowski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Lisik
- Department of General and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Marek Gołębiowski
- 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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Singla V, Aggarwal S, Aggarwal S, Gupta M, Singh D. Correlation of weight loss with residual gastric volume on computerized tomography in patients undergoing sleeve gastrectomy: A systematic review. Clin Obes 2020; 10:e12394. [PMID: 32767720 DOI: 10.1111/cob.12394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/08/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022]
Abstract
Laparoscopic Sleeve gastrectomy (LSG) is the most commonly performed bariatric surgical procedure worldwide. There is wide variation however in post-operative weight loss on long term follow-up, and residual gastric volume (RGV) is believed to be an important variable. Multiple studies have correlated RGV as assessed by Computerized Tomography volumetry with excess weight loss (EWL%) following LSG, but definite consensus is lacking. This article systematically reviews the published studies in English literature to ascertain whether any correlation exists between the RGV and EWL% following LSG. Ten studies were included in this review, and significant differences were noted in the technique of RGV assessment, and timing of RGV and EWL% assessment. Five studies found a statistically significant correlation between the RGV and EWL%. One study found a correlation which did not reach statistical significance. Two additional studies reported that the resected volume rather than RGV correlated with the EWL%. Meta-analysis of studies reporting correlation between RGV and EWL% showed that up to 26.3% (95% CI: 5.1%-56.1%) of variability in EWL% can be explained by variations in RGV. A lower RGV is likely to result in a better post-operative weight loss following LSG. There is need for standardization of technique and timing of RGV assessment.
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Affiliation(s)
- Vitish Singla
- Department of Surgical disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Aggarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehul Gupta
- Department of Surgical disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Singh
- Department of Surgical disciplines, All India Institute of Medical Sciences, New Delhi, India
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Does antrum size matter in sleeve gastrectomy? A prospective randomized study. Surg Endosc 2020; 35:3524-3532. [PMID: 32691207 DOI: 10.1007/s00464-020-07811-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a safe and effective bariatric procedure in terms of excess weight loss. Nevertheless, controversies still exist on several technical and operative aspects of LSG. The aim of this study is to evaluate variations in anthropometric features in subjects with a LSG gastric resection starting from 2 cm or 6 cm from the pylorus. Secondary aim was the evaluation of differences in morbidity, food tolerance, and GERD incidence studied with upper endoscopy (UE) and GERD Health-Related Quality-of-Life score. METHODS Patients were prospectively randomized into 2 groups: Group A (at 2 cm proximally to the pylorus) and Group B (at 6 cm proximally to the pylorus). All patients were followed-up at 3, 6, 12, and 24 months. UE was performed in all patients at 12 or 24 months. RESULTS One hundred and fifty met the inclusion criteria and were enrolled in the study. The anthropometric features (BMI, %EWL, %TWL) resulted statistically different in the first 12 months (24.2 ± 3.4 vs 27.5 ± 4.3, 63.7 ± 14.1 vs 59.6 ± 12.5 and 42.9 ± 7.4 vs 38.2 ± 6.2), in favor of group A. At 24 months the differences disappeared (25.2 ± 4.4 vs 26.2 ± 3.3, 62.8 ± 13.1 vs 61.6 ± 10.5 and 41.9 ± 7.4 vs 40.2 ± 6.2). An increased GERD was found in both groups postoperatively with a higher incidence in group A at 6-month follow-up. CONCLUSION Performing the LSG with a radical antrectomy could improve weight loss at 12-month follow-up but expose to lower food tolerance and higher transitory GERD. The differences seem to be reduced to a 24-month.
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Della Penna A, Lange J, Archid R, Hönes F, Königsrainer A, Quante M. Impact of Resection Volume/Stapler Firings-Ratio on Perioperative Complications and Weight Loss After Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 31:207-214. [PMID: 32728840 PMCID: PMC7808967 DOI: 10.1007/s11695-020-04870-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/22/2022]
Abstract
Background Major postoperative morbidity after laparoscopic sleeve gastrectomy (LSG) is often related to staple line leaks (SLL). Of note, a recent study suggested a central role of the absolute numbers of stapler firings as a predictive factor for postoperative morbidity due to SLL. In addition, a larger gastric remnant volume could be responsible for lower weight loss after LSG, and nevertheless, the gastric resection volume (GRV) is strictly related to the residual volume. Methods Prospectively, collected data of 384 consecutive patients with complete follow-up at 12 months after LSG at our institution were retrospectively analyzed. Patients were stratified according to three different variables (i.e., number of stapler firings, GRV, and GRV/stapler firings-ratio), and respective impact on postoperative complications and weight loss was analyzed. Results High absolute number of stapler firings was linked to increased intraoperative and postoperative bleeding and prolonged hospitalization, but was not associated with SLL, transfusion rate or revisional procedures. Absolute GRV showed no impact on both complications and outcome after LSG. Interestingly, higher ratio of GRV/stapler firings was not only linked to decreased intraoperative bleeding and shorter hospital stay but also to higher Excess Body Mass Index Loss (EBMIL) at 12 months after LSG. Conclusions Here, we introduce GRV/stapler firings-ratio as a simple predictive factor for identifying patients at risk for postoperative complications and impaired weight loss that is superior compared with absolute number of stapler firings or GRV alone.
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Affiliation(s)
- Andrea Della Penna
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jessica Lange
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
| | - Rami Archid
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Felix Hönes
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Markus Quante
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
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Effects of Laparoscopic Sleeve Gastrectomy on Gastric Structure and Function Documented by Magnetic Resonance Imaging Are Strongly Associated with Post-operative Weight Loss and Quality of Life: a Prospective Study. Obes Surg 2020; 30:4741-4750. [PMID: 32642883 DOI: 10.1007/s11695-020-04831-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND This prospective study applied magnetic resonance imaging (MRI) to assess the effect of laparoscopic sleeve gastrectomy (LSG) on gastric structure and function. The impact of these changes on patient outcomes was analyzed. METHOD Obese patients without gastrointestinal symptoms referred for bariatric surgery were recruited prospectively. Pre-operative assessment included (i) high-resolution manometry and pH-impedance monitoring and (ii) magnetic resonance imaging (MRI) measurement of gastric capacity, accommodation, and emptying with the 400 ml liquid Nottingham test meal (NTM). Studies were repeated 6-7 months after LSG. Weight loss and changes in the Gastrointestinal Quality of Life Index (GIQLI) assessed patient outcomes. RESULTS From 35 patients screened, 23 (66%) completed the study (17 females, age 36 ± 10 years, BMI 42 ± 5 kg/m2). Mean excess weight loss was 59 ± 18% at follow-up. Total gastric volume (capacity) after the meal was 467 mL (455-585 ml) before and 139 mL (121-185 ml) after LSG (normal reference 534 (419-675) mL), representing a mean 70% reduction (p < 0.0001). Similar findings were present for gastric content volume indicating rapid early-phase gastric emptying (GE) post-LSG. Conversely, late-phase GE was slower post-LSG (2.5 ± 1.0 vs. 1.4 ± 0.6 mL/min; p < 0.0001; (reference 1.5(1.4-4.9) mL/min)). Patients with ≥ 80% reduction in gastric capacity had greater weight loss (p = 0.008), but worse gastrointestinal outcomes (p = 0.023). CONCLUSIONS MRI studies quantified the marked reduction in gastric capacity after LSG. The reduction in capacity was associated with rapid early- but slow late-phase GE after surgery. These changes were associated with weight loss; however, reductions in gastric capacity ≥ 80% were linked to increased acid reflux and impacted on gastrointestinal quality of life.
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The Unconventional Role for Gastric Volume in the Response to Bariatric Surgery for Both Weight Loss and Glucose Lowering. Ann Surg 2020; 271:1102-1109. [PMID: 30817350 DOI: 10.1097/sla.0000000000003240] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To study the relationship between the amount of surgery-induced gastric volume reduction and long-term weight loss and glucose tolerance. BACKGROUND DATA Vertical sleeve gastrectomy (VSG) has recently surpassed gastric bypass to become the most popular surgical intervention to induce sustained weight loss. Besides inducing significant weight loss, VSG also improves glucose tolerance. Although no clear correlation has been observed between the size of the residual stomach and sustained weight loss, this begs the question whether less aggressive gastric volume reduction may provide sufficient efficacy when weight loss is not the major goal of the surgical intervention. METHODS A series of strategies to reduce gastric volume were developed and tested in Long Evans male rats, namely: VSG, Fundal (F)-Resection, Gastric Sleeve Plication (GSP), Fundal-Plication, and Fundal-Constrained. RESULTS All surgical interventions resulted in a reduction of gastric volume relative to sham, but none of the interventions were as effective as the VSG. Gastric volume was linearly correlated to increased gastric emptying rate as well as increased GLP-1 response. Overall, cumulative food intake was the strongest correlate to weight loss and was logarithmically related to gastric volume. Regression modeling revealed a nonlinear inverse relation between body weight reduction and gastric volume, confirming that VSG is the only effective long-term weight loss strategy among the experimental operations tested. CONCLUSIONS The data suggest a minimum threshold volume of the residual stomach that is necessary to induce sustained weight loss. Although all gastric volume interventions increased the GLP-1 response, none of the interventions, except VSG, significantly improved glucose tolerance. In conclusion, if weight loss is the primary goal of surgical intervention, significant volume reduction is required, and this most likely requires excising gastric tissue.
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Impact of Resected Gastric Volume on Postoperative Weight Loss after Laparoscopic Sleeve Gastrectomy. Gastroenterol Res Pract 2019; 2019:3742075. [PMID: 31871448 PMCID: PMC6913301 DOI: 10.1155/2019/3742075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022] Open
Abstract
Among the bariatric surgery community, it has recently emerged the idea of a possible association between resected gastric volume (RGV) and weight loss after laparoscopic sleeve gastrectomy (LSG). If the size of the sleeve depends on the bougie caliber, the resected volume of the stomach remains something which is not possible to standardize. The aim of the study was to investigate a possible relationship between RGV and weight loss after LSG. We developed a mathematical method to calculate the RGV, based on the specimen size removed during LSG. Ninety-one patients (63 females and 28 males) affected by morbid obesity were included in the study. They underwent LSG between 2014 and 2016. Mean preoperative BMI was 45 ± 6.4. At 1 year after LSG, the mean BMI was 30 ± 5.3 and the EWL% was 65 ± 20.2. The statistical analysis of RGV, BMI, and EWL% at 1-year follow-up did not find any correlation between the volume of stomach removed and the weight loss after LSG. Further studies in the future should clarify the potential role of RGV during LSG. This trial is registered with ClinicalTrials.gov NCT03938025.
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Cottam S, Cottam D, Cottam A. Sleeve Gastrectomy Weight Loss and the Preoperative and Postoperative Predictors: a Systematic Review. Obes Surg 2019; 29:1388-1396. [DOI: 10.1007/s11695-018-03666-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Sista F, Abruzzese V, Guadagni S, Carandina S, Clementi M. High Resected Gastric Volume and poorly controlled DM2 in laparoscopic sleeve gastrectomy. Ann Med Surg (Lond) 2018; 36:142-147. [PMID: 30479760 PMCID: PMC6240704 DOI: 10.1016/j.amsu.2018.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/14/2018] [Indexed: 01/19/2023] Open
Abstract
Background Our aim is to evaluate the effects of High Resected Gastric Volume(HRGV) on poorly Type 2 Diabetes Mellitus(DM2) after Laparoscopic Sleeve Gastrectomy(LSG). Methods 256 patients were divided into two groups according to the RGV: < 1500 mL(Group A: 131 pts) and > 1500 mL(Group B: 147 pts). % excess body mass index loss (%EBMIL), Fasting Blood Glucose (FBG), HbA1c, C peptide were assessed before surgery and at the 3rd day, 6th,12th,24th,36th month after LSG. Results A significant difference in %EBMIL between the two groups at 24 and 36 months was found. RGV was not significantly associated with DM2 in the multivariate logistic regression. FBG levels showed no differences between the two groups. A significant decrease of Hb1Ac at 6 and 12 months was found in group B. The C-peptide level showed a significant reduction at 6 and 12 months in group B. Conclusion The HRGV may play a role in the regulation of the glucose metabolism in the first year after LSG without influence in poorly DM2 control. Further studies are needed to confirm these findings.
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Affiliation(s)
- Federico Sista
- Dipartimento DISCAB, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
| | - Valentina Abruzzese
- Dipartimento DISCAB, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
| | - Stefano Guadagni
- Dipartimento DISCAB, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
| | - Sergio Carandina
- ELSAN, Surgical Obesity Center (CCO), Clinique Saint Michel, Toulon, France
| | - Marco Clementi
- Dipartimento MESVA, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
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Du X, Luo R, Chen YY, Peng BQ, Hu JK, Cheng Z. Resected gastric volume has no influence on early weight loss after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2018; 14:129-135. [DOI: 10.1016/j.soard.2017.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/29/2017] [Accepted: 11/05/2017] [Indexed: 01/28/2023]
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Pakula AM, Martin MJ. Comment on: resected gastric volume has no influence on early weight loss after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2017; 14:135-137. [PMID: 29287735 DOI: 10.1016/j.soard.2017.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 11/25/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea M Pakula
- Bariatric Surgery Service Department of Surgery Kern Medical Center Bakersfield, California
| | - Matthew J Martin
- Bariatric Surgery Service Department of Surgery Madigan Army Medical Center Tacoma, Washington
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Changes in Gastric Volume and Their Implications for Weight Loss after Laparoscopic Sleeve Gastrectomy. Obes Surg 2017; 27:303-309. [PMID: 27484976 DOI: 10.1007/s11695-016-2274-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a relatively new surgical technique for the treatment of morbid obesity. It is unclear whether the volume of the gastric remnant can expand after surgery as a result of intraluminal pressure maintained over time. If this were the case, the increased volume could affect weight loss and the improvement in comorbidities. This study aims to assess the evolution of residual gastric volume (RGV) during the first year after LSG and its relationship with weight loss. MATERIAL AND METHODS We conducted a prospective study of 112 patients who underwent LSG from February 2009 to December 2013. In order to measure the RGV after surgery, all patients were evaluated radiologically by an esophagogastroduodenal (EGD) transit at 1 and 12 postoperative months. RESULTS All patients showed a significant reduction in BMI compared with the preoperative measurement (33.48 ± 5.78 vs. 50.54 ± 6.69 kg/m2; p < 0.001). Increased RGV was observed when comparing the results obtained by EGD transit at 1 (68.39 ± 25.89 cm3) and 12 postoperative months (122.58 ± 38.76 cm3; p < 0.001). There was no association between increase in gastric volume and weight loss at 1-year follow-up (r = 0.01; p = 0.910). CONCLUSIONS The volume of the gastric remnant increased significantly during the first year after LSG. However, this increase was not associated with weight loss. Further prospective research with longer follow-up periods is needed to confirm or contrast the present results.
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Bekheit M, Abdel-Baki TN, Gamal M, Abdel-Salam W, Samir M, ElKayal E, Katri K. Influence of the Resected Gastric Volume on the Weight Loss After Laparoscopic Sleeve Gastrectomy. Obes Surg 2017; 26:1505-10. [PMID: 26602213 DOI: 10.1007/s11695-015-1981-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The relation between the resected gastric volume and the weight loss after laparoscopic sleeve gastrectomy appears conflicting in the literature. Both the residual and the resected volumes represent the total gastric volume, and if the weight loss is related to one of the two volumes, it should be related to the other. While some reports indicate that the weight loss is related to the resected gastric volume, others state that the weight loss is not related to the residual volume. The aim is to investigate the influence of the resected gastric volume on the weight loss after surgery. METHODS The study included 287 consecutive patients. Gastrectomy was performed encroaching over a 38-Fr calibrating tube all the way to the angle of His. Filling volume of the resected stomach, with tap water, was measured. Patients were analyzed into group 1 with BMI ≤50 kg/m(2) and group 2 >50 kg/m(2). RESULTS Females represented 74 % of cases. Mean age was 32.9 ± 9.5 years; preoperative BMI = 48.7 ± 7.9 kg/m(2). The mean resected gastric volume was 1525 ± 408 ml, and it was significantly lower in females compared to that in males (1443 ± 311 vs 1824 ± 502 ml, p < 0.001). Data were analyzed in two groups: group 1 with BMI ≤5050 kg/m(2) and group 2 >50 kg/m(2). Both groups were similar in preoperative BMI (p = 0.399) and excess weight percent (EW%) (p = 0.33). Group 2 had a resected gastric volume (1663 ± 424.7 ml) greater than that of group 1 (1440 ± 347 ml; p < 0.001). The percentage of excess weight loss (EWL%) was 57.9 ± 14.5 % at 6 months (62.7 ± 13.5 % vs 48.34 ± 11.29 %, p < 0.001), 77 ± 19 % at 12 months (84 ± 19.6 % vs 68 ± 14.2 %, p = 0.001), 76.6 ± 7.4 % at 18 months (79.7 ± 4.8 vs 74.7 ± 8.2 %, p = 0.5), and 75.8 ± 11.5 % at 24 months (81.7 ± 11.17 vs 70 ± 11 %, p = 0.8) (group 1 vs group 2, respectively). At 12 months, 86 % patients achieved more than 50 % EWL% (100 % of group 1 vs 60 % of group 2). Preoperative BMI correlated with resected gastric volume (r = 0.239, p = 0.004). In multiple regression, the initial BMI was a predictor of EWL% at 6 and 12 months (r partial = -0.65, p < 0.0001) while the resected gastric volume was not. CONCLUSIONS The resected gastric volume is related to the total gastric volume when the technique is standardized and the residual volume is calibrated using a consistent technique. It is not in itself a predictor of weight loss, but it is related to the initial BMI which predicts the weight loss.
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Affiliation(s)
- Mohamed Bekheit
- Department of Surgery, El Kabbary General Hospital, Alexandria, Egypt.
- U1193 INSERM, University of Paris-XI, Paris, France.
| | | | - Mostafa Gamal
- Department of Surgery, Louran Hospital, Alexandria, Egypt
| | - Wael Abdel-Salam
- HBP Surgery Unit, Department of Surgery, University of Alexandria, Alexandria, Egypt
| | - Mohamed Samir
- Department of Surgery, Medical Research Institute, University of Alexandria, Alexandria, Egypt
| | - ElSaied ElKayal
- HBP Surgery Unit, Department of Surgery, University of Alexandria, Alexandria, Egypt
| | - Khaled Katri
- HBP Surgery Unit, Department of Surgery, University of Alexandria, Alexandria, Egypt
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3D Volumetry and its Correlation Between Postoperative Gastric Volume and Excess Weight Loss After Sleeve Gastrectomy. Obes Surg 2017; 28:775-780. [DOI: 10.1007/s11695-017-2927-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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20
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Predictability of first-year weight loss in laparoscopic sleeve gastrectomy. Surg Endosc 2017; 31:4145-4149. [DOI: 10.1007/s00464-017-5467-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/15/2017] [Indexed: 12/19/2022]
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Effect of Resected Gastric Volume on Ghrelin and GLP-1 Plasma Levels: a Prospective Study. J Gastrointest Surg 2016; 20:1931-1941. [PMID: 27738878 DOI: 10.1007/s11605-016-3292-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The correlation between resected gastric volume (RGV) and neuro-humoral changes (ghrelin and GLP-1) after laparoscopic sleeve gastrectomy (LSG) and their effects on type 2 diabetes mellitus (T2DM) has been evaluated. MATERIALS Ninety-eight patients were divided in two groups: RGV <1200 mL (group A: 53 pts) and RGV >1200 mL (group B: 45 pts). Insulin secretion (insulin area under the curve (AUC)), insulinogenic index (IGI) and insulin-resistance (homeostasis model assessment, HOMAIR) were assessed before and after surgery (at the 3rd day and 6, 12 and 24 months after LSG) using the oral glucose tolerance test (OGTT). At the same time, ghrelin and GLP-1 levels were determined. RESULTS A significant difference in T2DM resolution rate was observed after 6, 12 and 24 months in favour of RGV >1200 mL. Group B performed better than group A at the 3rd day and at the 6th, 12th and 24th months with regard to AUC, IGI and HOMAIR. In both groups, OGTT resulted in decreased ghrelin values and a significant increase in GLP-1 values for group B at the 3rd day and at the 6th and 12th months with no difference at the 24th month. CONCLUSION Ghrelin and GLP-1 changes play a role in the regulation of glucose metabolism during the 1st year after LSG. RGV influences ghrelin and GLP-1 plasma levels after LSG, with a significant improvement in the T2DM control.
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Huh J, Lee IS, Kim KW, Park J, Kim AY, Lee JS, Yook JH, Kim BS. CT gastrography for volumetric measurement of remnant stomach after distal gastrectomy: a feasibility study. Abdom Radiol (NY) 2016; 41:1899-905. [PMID: 27251737 DOI: 10.1007/s00261-016-0792-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To evaluate the feasibility of post-operative CT gastrography for volumetry of the remnant stomach in gastric cancer patients treated with distal gastrectomy. METHODS CT gastrography was performed with oral administration of effervescent granules in 35 gastric cancer patients who underwent distal gastrectomy. Two readers independently rated the degree of gastric distension on a four-point scale, one (near-total collapse) to four (well distended) and measured the volume of remnant stomach using either 3D or 2D volumetry. The inter-volumetry agreements between the 2D and 3D methods and the interobserver agreements between readers 1 and 2 were assessed by intraclass correlation coefficients (ICCs) and Bland-Altman plots. RESULTS The mean score of gastric distension was 3.4 ± 0.6 points and 3.4 ± 0.7 points from readers 1 and 2, respectively. We regarded CT images scored with 3-4 points as a technical success for reliable CT volumetry, which achieved a rate of 91.4% (32/35). For the inter-volumetry agreements between 3D and 2D volumetry, the ICCs were 0.9778 and 0.9814 from readers 1 and 2, respectively. The interobserver agreement between readers 1 and 2 was also excellent, with ICCs of 0.9961 and 0.9876 for 2D and 3D volumetry, respectively. On Bland-Altman plots, the means of differences between any pairs of volumetry measurements ranged from -31.1 to 3.2 cm(3), which may be an acceptable range of measurement variability. CONCLUSIONS Post-operative CT gastrography is feasible in patients treated with distal gastrectomy. Both 2D and 3D volumetry methods are comparable in measuring the remnant stomach volume.
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Affiliation(s)
- Jimi Huh
- Department of Radiology, Bioimaging Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - In-Seob Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Won Kim
- Department of Radiology, Bioimaging Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Jisuk Park
- Department of Radiology, Bioimaging Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Ah Young Kim
- Department of Radiology, Bioimaging Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Jong Seok Lee
- Department of Radiology, Bioimaging Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Jeong-Hwan Yook
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung-Sik Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Observed Variability in Sleeve Gastrectomy Volume and Compliance Does Not Correlate to Postoperative Outcomes. Surg Laparosc Endosc Percutan Tech 2016. [PMID: 26197018 DOI: 10.1097/sle.0000000000000181] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Restrictive bariatric procedures reduce gastric capacity as a primary mechanism of action. Intraoperatively, surgeons observe variability in size and compliance of specimens. We hypothesized that higher gastric specimen volume or tissue compliance would respond better to restrictive procedures. MATERIALS AND METHODS Consecutive patients undergoing laparoscopic sleeve gastrectomy between September 2012 and September 2013 were enrolled. Specimens were insufflated at graduated pressure points creating pressure volume curves, and compliance was calculated. Postoperative weight loss and a hunger scores were recorded. Correlations were determined by Spearman correlation. RESULTS Eighty-four patients consented to enrollment. Mean age, weight, and body mass index (BMI) were 45 ± 12 years, 126 ± 23 kg, and 45.4 ± 6 m/kg2, respectively. The resected specimens varied in insufflated capacity from 0.3 to 1.8 (0.71 ± 0.32) L and compliance varied from 14.3 to 85.7 (36.1 ± 14.7) cc/mm Hg. Male patients had a larger greater curvature length (GCL) (P < 0.001), staple line length (SLL) (P = 0.03), gastric volume (GV) (P = 0.002), and gastric compliance (GC) (P < 0.001). Neither GV nor GC correlated to excess body weight loss (EBWL%) as hypothesized. There was an inverse correlation between hunger score and GV (P = 0.010). The mean 1-month, 3-month, 6-month, and 12-month EBWL was 17.4%, 33.2%, 43.7%, and 54.1%, respectively. Follow-up was 71.4% at 1 month, 39.3% at 3 months, 54.8% at 6 months, and 42.9% at 12 months. CONCLUSIONS Sleeve gastrectomy specimens exhibit nearly 6-fold variability in both volume and compliance. A large GC is anticipated in male and tall subjects. These observations do not appear to be correlated to %EBWL.
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Robert M, Pasquer A, Pelascini E, Valette PJ, Gouillat C, Disse E. Impact of sleeve gastrectomy volumes on weight loss results: a prospective study. Surg Obes Relat Dis 2016; 12:1286-1291. [PMID: 27134194 DOI: 10.1016/j.soard.2016.01.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/24/2015] [Accepted: 01/22/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Causes of weight loss failure after sleeve gastrectomy (SG) are still controversial. The impact of the size of the sleeve continues to be debated. OBJECTIVE The aim of our study was to determine the impact of sleeve volumes assessed at 3 months using gastric computed tomography (CT) on weight loss at 18 months. SETTING University Hospital, France. METHODS Sixty-seven obese patients eligible for SG were prospectively evaluated. Sleeve volumes were assessed postsurgery using 3-dimensional gastric CT with gas at 3 months and weight loss outcomes recorded up to 18 months. The population was divided into 2 groups: the first tertile (n = 22) with the smallest gastric volume was defined as the "small sleeve" group (SSG) and the rest of the population (n = 45) was defined as the "without small sleeve" group (WSSG). RESULTS No patients were lost to follow-up. In the SSG, overall gastric volume was 133±7 mL versus 264±11 mL for the WSSG (P<.0001). Percentage excess body mass index loss (%EBMIL) during the first postoperative 18 months was significantly greater in the SSG compared with the WSSG (P = .04). Although the volume of the gastric tube was not correlated with weight loss (r =-.04, P = .78), there was a negative linear correlation between the volume of the antrum and the %EBMIL at 18 months (r =-.39, P = .005). A narrow gastric tube was also associated with a high digestive intolerance and reflux. CONCLUSION Our data suggest that performing the sleeve with a not-too-small bougie size and a radical antrectomy could improve weight loss and digestive tolerance.
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Affiliation(s)
- Maud Robert
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France.
| | - Arnaud Pasquer
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Elise Pelascini
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Pierre-Jean Valette
- Claude Bernard Lyon 1 University, Lyon, France; Department of Radiology, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Christian Gouillat
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Emmanuel Disse
- Claude Bernard Lyon 1 University, Lyon, France; Department of Endocrinology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France
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