Antral resection versus antral preservation during laparoscopic sleeve gastrectomy for severe obesity: Systematic review and meta-analysis

McGlone, Emma Rose; Gupta, Ajay; Reddy, Marcus; Khan, Omar

doi:10.1016/j.soard.2018.02.021

Cited by 41 publications

(17 citation statements)

References 39 publications

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“…were able to show that the preservation of the antrum accelerates gastric emptying, which might also reduce intragastric pressure and, consequently, GERD 58 . While clinical data did not show any differences in this regard, 62 we would suggest placing the first firing of the staple line at least 5 cm from the pylorus to preserve the antrum, in keeping with Garay et al .…”

Section: What Is the “Perfect” Sg To Prevent Gerd?supporting

confidence: 81%

Do we understand the pathophysiology of GERD after sleeve gastrectomy?

Felińska

Billeter

Nickel

et al. 2020

Annals of the New York Academy of Sciences

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Gastroesophageal reflux disease (GERD), a prevalent problem among obese individuals, is strongly associated with obesity and weight loss. Hence, bariatric surgery effectively improves GERD for many patients. Depending on the type of bariatric procedure, however, surgery can also worsen or even cause a new onset of GERD. As a consequence, GERD remains a relevant problem for many bariatric patients, and especially those who have undergone sleeve gastrectomy (SG). Affected patients report not only a decrease in physical functioning but also suffer from mental and emotional problems, resulting in poorer social functioning. The pathomechanism of GERD after SG is most likely multifactorial and triggered by the interaction of anatomical, physiological, and physical factors. Contributing factors include the shape of the sleeve, the extent of injury to the lower esophageal sphincter, and the presence of hiatal hernia. In order to successfully treat post-sleeve gastrectomy GERD, the cause of the problem must first be identified. Therapeutic approaches include lifestyle changes, medication, interventional treatment, and/or revisional surgery.

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Section: What Is the “Perfect” Sg To Prevent Gerd?supporting

confidence: 81%

Do we understand the pathophysiology of GERD after sleeve gastrectomy?

Felińska

Billeter

Nickel

et al. 2020

Annals of the New York Academy of Sciences

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“…A meta-analysis of 6 randomized and 2 observational studies addressed this topic [98]. Weight loss was more pronounced with antral resection (SMD 0.95, 95% CI 0.32 to 1.58), with no differences in staple line leak (RR 1.87, 95% CI 0.46 to 7.61), bleeding (RR 1.27, 95% CI 0.40 to 4.01) or gastroesophageal reflux (0.69, 95% CI 0.26 to 1.82).…”

Section: Justificationmentioning

confidence: 99%

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

et al. 2020

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Background Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery. Methods A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards. Results Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-todecision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure. and Other Interventional Techniques Disclaimer This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g. surgeons, anesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g. surgical nurses, dietitians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by healthcare authorities (e.g. regional and national authorities, healthcare institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point Electronic supplementary material The online version of this article (

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“…In a randomized trial, the antrum‐resecting group had fewer suboptimal results with regard to excess BMI loss, despite there being no difference in RGV in both the groups at 12 months 22 . Similarly, a meta‐analysis showed that antrum resecting sleeve had a trend towards better weight loss at 12 months and significantly higher EWL% at 24 months of follow‐up when compared to the antrum preserving sleeve 23 with similar rates of leak, bleed, and reflux.…”

Section: Discussionmentioning

confidence: 95%

Correlation of weight loss with residual gastric volume on computerized tomography in patients undergoing sleeve gastrectomy: A systematic review

et al. 2020

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Summary 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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Antral resection versus antral preservation during laparoscopic sleeve gastrectomy for severe obesity: Systematic review and meta-analysis

Cited by 41 publications

References 39 publications

Do we understand the pathophysiology of GERD after sleeve gastrectomy?

Do we understand the pathophysiology of GERD after sleeve gastrectomy?

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

Correlation of weight loss with residual gastric volume on computerized tomography in patients undergoing sleeve gastrectomy: A systematic review

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