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

Elgeidie, Ahmed; El-Hemaly, Mohamed; Hamdy, Emad; Sorogy, Mohamed El; Abdelgawad, Mohamed; Hak, Nabil GadEl

doi:10.1016/j.soard.2014.12.025

Cited by 50 publications

(27 citation statements)

References 43 publications

(44 reference statements)

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“…During the early postoperative period, caloric intake is usually one-tenth or less of the preoperative intake. The ability to digest/absorb also decreases as a result of the increased rate of upper intestinal passage 43 , which temporarily enhances the catabolism of cholesterol to BA in the liver 34 . Similarly, when BA levels in the intestinal tract decrease, the bactericidal activity of BA is attenuated 37 .…”

Section: Discussionmentioning

confidence: 99%

Alteration in faecal bile acids, gut microbial composition and diversity after laparoscopic sleeve gastrectomy

Ikeda

Aida

Yoshida

et al. 2020

British Journal of Surgery

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Background: Laparoscopic sleeve gastrectomy (LSG) is a well established treatment for severe obesity and type 2 diabetes. Although the gut microbiota is linked to the efficacy of LSG, the underlying mechanisms remain elusive. The effect of LSG for morbid obesity on the gut microbiota and bile acids was assessed here. Methods: Severely obese subjects who were candidates for LSG were included and followed until 6 months after surgery. The composition and abundance of the microbiota and bile acids in faeces were assessed by 16S ribosomal RNA sequencing, quantitative PCR and liquid chromatography-mass spectrometry. Results: In total, 28 patients with a mean(s.d.) BMI of 44⋅2(6⋅6) kg/m 2 were enrolled. These patients had achieved excess weight loss of 53⋅2(19⋅0) per cent and showed improvement in metabolic diseases by 6 months after LSG, accompanied by an alteration in the faecal microbial community. The increase in-diversity and abundance of specific taxa, such as Rikenellaceae and Christensenellaceae, was strongly associated with reduced faecal bile acid levels. These changes had a significant positive association with excess weight loss and metabolic alterations. However, the total number of faecal bacteria was lower in patients before (mean(s.d.) 10⋅26(0⋅36) log 10 cells per g faeces) and after (10⋅39(0⋅29) log 10 cells per g faeces) operation than in healthy subjects (10⋅83(0⋅27) log 10 cells per g faeces). Conclusion: LSG is associated with a reduction in faecal bile acids and greater abundance of specific bacterial taxa and-diversity that may contribute to the metabolic changes.

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Section: Discussionmentioning

confidence: 99%

Alteration in faecal bile acids, gut microbial composition and diversity after laparoscopic sleeve gastrectomy

Ikeda

Aida

Yoshida

et al. 2020

British Journal of Surgery

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“…A recent prospective randomized study by Elgeidie et al comparing 2 groups depending on the distance at which the gastric division started from the pylorus (Group A with antral preservation and gastric resection starting 6 cm from the pylorus and Group B with antral resection 2 cm from the pylorus), reported higher incidence of leakage with group B (EL:2) [23]. Another retrospective study by Obeidat et al reported similar results although the group with antral resection was operated after the group of antral preservation (better experience and technique) (EL:3) [24].…”

Section: Distance From the Pylorusmentioning

confidence: 99%

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Iossa

Abdelgawad

Watkins

et al. 2016

Langenbecks Arch Surg

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This review reports factors promoting leak and gives technical recommendations to avoid leak after LSG based on the available evidence and expert consensus which encompasses: (1) use a bougie size ≥40 Fr, EL:1, (2) begin the gastric transection 5-6 cm from the pylorus, EL:2-3, (3) use appropriate cartridge colors from antrum to fundus, EL:1, (4) reinforce the staple line with buttress material, EL:1, (5) follow a proper staple line, (6) remove the crotch staples, EL:4, (7) maintain proper traction on the stomach before firing, (8) stay away from the angle of His at least 1 cm, EL:1, (9) check the bleeding from the staple line, (10) perform an intraoperative methylene blue test, EL:4.

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“…Antral conservation advocates consider that preservation of the antrum may minimize distal gastric obstruction and the chance of proximal leakage at the angle of His [13]; on the other hand, antral resection supporters say that stapling within 2 cm of the pylorus is more restrictive and may lead to greater weight loss [17].…”

Section: Resultsmentioning

confidence: 99%

“…To date, multiple studies have investigated the impact of the pylorus resection distance on clinical outcomes; however, they have reported inconsistent ndings [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

The Effect of the Resection Distance from the Pylorus on the Short-Term Outcome of Laparoscopic Sleeve Gastrectomy

Hussein¹,

Khaled²,

Faisal³

2020

Preprint

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Background: Laparoscopic sleeve gastrectomy (LSG) was recently described as an effective approach for the operative treatment of obesity, but the ideal procedure remains controversial. One of the most debated issues is the resection distance from the pylorus (DP). We conducted this study to elucidate any potential difference in the short-term outcome between 2 cm and 6 cm DP in LSG.Methods: This was an interventional, prospective, randomized study aimed at assessing the effect of the resection DP on the weight loss outcome as expressed by the excess weight loss percentage (%EWL) after LSG carried out from January 2018 to March 2020 in 96 patients with morbid obesity who had LSG performed at the Surgical Department, Suez Canal University. The patients were randomly separated into two equal groups; Group 1 (48 patients) underwent LSG with a 2 cm DP resection distance and Group 2 (48 patients) underwent LSG with a 6 cm DP resection distance. Body weight, body mass index, bariatric quality of life, lipid profile, and comorbidities were evaluated pre- and postoperatively for a duration of 12 months.Results: Statistically, there was no significant difference between the two study groups regarding the %EWL, comorbidity resolution throughout the postoperative follow-up, enhancement of the quality of life score throughout the postoperative follow-up, or incidence of complications (25% in Group 1 vs. 25% in Group 2, p > 0.05).Conclusion: LSG was an effective and safe management for morbid obesity and obesity-related comorbidities with significant short-term weight loss; it also improved weight-related quality of life and had an acceptable complication rate. The DP resection distance did not affect the short-term effects of LSG with regard to %EWL, resolution of comorbidities, change in quality of life, and occurrence of complications.

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

Cited by 50 publications

References 43 publications

Alteration in faecal bile acids, gut microbial composition and diversity after laparoscopic sleeve gastrectomy

Alteration in faecal bile acids, gut microbial composition and diversity after laparoscopic sleeve gastrectomy

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

The Effect of the Resection Distance from the Pylorus on the Short-Term Outcome of Laparoscopic Sleeve Gastrectomy

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