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Effect of Resection Distance from Pylorus on Weight Loss Outcomes in Laparoscopic Sleeve Gastrectomy.

Abstract：

BACKGROUND:Despite the established efficacy and safety of laparoscopic sleeve gastrectomy (LSG), controversy still exists on optimal operative technique, the resection distance from pylorus (DP) being among the most controversial issues. This study aimed to examine the effect of resection distance from pylorus on % excess weight loss (EWL) during postoperative period, in patients who underwent LSG for morbid obesity. METHODS:A total of 390 patients who underwent laparoscopic sleeve gastrectomy for morbid obesity were included in this retrospective study. Patients were allocated into one of the two groups based on the distance between antrum resection margin and pylorus: group A, ≤ 3 cm and group B, > 3 cm. Follow-up data for %EWS and nausea/vomiting as well as demographical and perioperative data were retrospectively reviewed and logistic regression analysis was done. RESULTS:Follow-up data up to 12 months were available for all patients, whereas 199 patients had follow-up data at 24 months. Shorter distance from pylorus was associated with higher %EWL throughout the treatment period (p < 0.001), evident from the first postoperative month (p = 0.013 for the first month, p < 0.001 for all other time points). The benefit extended up to 24 months in ≤ 3 cm group. However, nausea/vomiting was more frequent in the ≤ 3 cm group only at 1-month visit (15% vs. 4%, p < 0.001). In multivariate evaluations, while %EWL variable was taken as a dependent variable, time variable with DP × time interaction was statistically significant in the model. CONCLUSIONS:Our findings indicate that a short distance between resection margin and pylorus is associated with better and sustained %EWL in LSG. However, these patients seem to be more prone to nausea and vomiting in the early postoperative period. Further prospective large studies would help to define an optimal resection distance.

journal_name

Obes Surg

journal_title

Obesity surgery

authors

Avlanmis O,Isil RG,Burcu B

doi

10.1007/s11695-019-03923-3

subject

Has Abstract

pub_date

2019-09-01 00:00:00

pages

2731-2738

issue

eissn

0960-8923

issn

1708-0428

pii

10.1007/s11695-019-03923-3

journal_volume

pub_type

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Effect of Resection Distance from Pylorus on Weight Loss Outcomes in Laparoscopic Sleeve Gastrectomy.