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Evaluating the impact of the antrum size following laparoscopic sleeve gastrectomy: a randomized multicenter study

Authors :
Marius Nedelcu
Audrey Jaussent
Ion Donici
Sandrine Akouete
Marie-Christine Picot
Olivier Emungania
Alexandrine Robert
Anamaria Nedelcu
David Nocca
CCSD, Accord Elsevier
Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
CIC Montpellier
Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Saint Eloi (CHRU Montpellier)
Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)
Hôpital Nord [CHU - APHM]
Clinique Bouchard - ELSAN [Marseille]
Clinique Saint Michel - ELSAN [Toulon]
Institut de Génomique Fonctionnelle (IGF)
Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS)
Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi-Institut National de la Santé et de la Recherche Médicale (INSERM)
Neuropsychiatrie : recherche épidémiologique et clinique (PSNREC)
Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)
Université Montpellier 1 (UM1)-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Source :
Surgery for Obesity and Related Diseases, Surgery for Obesity and Related Diseases, Elsevier, 2020, 16 (11), pp.1731-1736. ⟨10.1016/j.soard.2020.06.041⟩
Publication Year :
2020
Publisher :
Elsevier BV, 2020.

Abstract

Background The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) remains discordant and highly related to the surgical technique. GERD and weight regain are probably understudied by prospective clinical studies depending on different technical factors. Objectives The purpose of this article is to evaluate the effect of extent to which the antrum is resected on GERD following LSG but also on early complications and short-term weight loss results. Setting University Hospital, France. Methods Patients were randomly assigned in group A (172 patients), LSG with antral resection, or group B (174 patients), LSG with antral preservation. The baseline characteristics collected were demographic characteristics and anthropometric data (age, sex, body mass index), presence of GERD clinical characteristics, ± pH-metry, postoperative complications, or gastrin level. Results A total of 279 patients underwent LSG and they were included in the final analysis. The GERD analyzed at 3 months postoperatively by pH-metry was observed for 57.8% in group A and for 52.4% of patients in group B (P = .4819). There was no statistically significant difference (P = .3755) between the 2 groups at 1 year after surgery (group A, 49.5% versus group B, 43.6%). The gastrin serum level was analyzed 1 year after surgery for a total of 107 patients. For group A, the mean gastrin level was 97.4 ± 85.9 pg/mL, which was inferior compared with group B (150.6 ± 152.4 pg/mL) with no statistical difference (P = .067). The recorded excess weight loss for group A was 79.67% (± 28.88) with no statistically significant difference with group B 74.46% (± 36.61) (P = .3678). The mortality rate was nil. We recorded 5 cases of staple line leakage (3 in group A and 2 in group B); 11 patients presented bleeding (3 in group A and 8 group B), and 4 patients presented with gastric stenosis (2 in group A and 2 in group B). Conclusions The antrum preservation has no significant difference in terms of reflux, weight loss, or complications at 3 or 12 months following LSG. The only significant difference was achieved for nausea and vomiting symptoms, which were more significant for the antrum resection group. Further clinical trials with newer procedures will indicate the factors that can diminish the reflux following LSG. Furthermore, the conservation of a large part of the antrum may be helpful to convert the sleeve to another bariatric procedure (transit bipartition).

Details

ISSN :
15507289 and 18787533
Volume :
16
Database :
OpenAIRE
Journal :
Surgery for Obesity and Related Diseases
Accession number :
edsair.doi.dedup.....946aed09d3f511c77d6ffbfa70caf613