Impact of Extent of Antral Resection on Surgical Outcomes of Sleeve Gastrectomy for Morbid Obesity (A Prospective Randomized Study)

Abstract

LSG is a safe and effective procedure with good short-term outcome. Increasing the size of the resected antrum is associated with better weight loss without increasing the rate of complications significantly.

Long-Term Outcome of Laparoscopic Sleeve Gastrectomy in Morbidly Obese Japanese Patients

“…Regarding the antral resection, conservative surgeons may prefer to begin the resection at 6 cm from the pylorus with the aims of improving gastric emptying by preserving its contractile function and of decreasing intraluminal pressure, which allow early closure of any potential gastric leakage, whereas other surgeons perform the resection close to the pylorus and therefore achieve and maintain better weight loss results. Abdallah et al randomly allocated 159 morbidly obese patients undergoing LSG as a standalone procedure into group I (LSG in which the division begins 2 cm from the pylorus) and group II (LSG in which the division begins 6 cm from the pylorus), and they found the group I patients achieved significantly better weight loss up to 2 years without increasing complication rates [20]. On the other hand, according to a systematic review and meta-analysis (9991 cases in 112 studies) by Parikh M et al, distance from the pylorus did not affect %EWL or leakage when LSG is performed as a primary bariatric procedure [21].…”

The effect of residual gastric antrum size on the outcome of laparoscopic sleeve gastrectomy: a prospective randomized trial

“…Recently a prospectively randomized trial studied this issue and found that antral resection is associated with better weight loss without increasing the morbidity [40].…”

The Distance between the Pylorus and Left Vagus Nerve during Sleeve Gastrectomy

“…Antral preservation seems to be preferable in spite of the low level of evidence of the studies comparing these two techniques. In fact, the preservation of the antrum could reduce the risk of postoperative leak (Abdallah et al, ; ElGeidie et al, ), could accelerate gastric emptying allowing to reduce postoperative food discomfort (Melissas et al, ), and could reduce the frequency of postoperative gastro esophageal reflux diseases (Stenard and Ianelli, ). All these advantages are related to the preservation of distal branches of the left vagus nerve during antral preservation.…”