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

Abstract

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. 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, ≤ 3cm and group B, > 3cm. Follow-up data for %EWS and nausea/vomiting as well as demographical and perioperative data were retrospectively reviewed and logistic regression analysis was done. Follow-up data up to 12months were available for all patients, whereas 199 patients had follow-up data at 24months. 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 24months in ≤ 3cm group. However, nausea/vomiting was more frequent in the ≤ 3cm 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. 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.