Intrathoracic Migration of Gastric Sleeve Affects Weight Loss as well as GERD-an Analysis of Remnant Gastric Morphology for 100 Patients at One Year After Laparoscopic Sleeve Gastrectomy

Abstract

Purpose: Laparoscopic sleeve gastrectomy (SG) is now frequently performed as a definitive bariatric procedure. The aim of the study was to evaluate the detailed morphology of remnant stomachs after SG with respect to volume and sleeve migration.

Materials and methods: We performed a review of prospectively collected data on patients that completed a 12-month postop examination, which included CT volumetry of the sleeve, and a questionnaire that addressed postop food tolerance. CT volumetry study included total sleeve volume (TSV), tube volume (TV), antral volume (AV), tube/antral volume ratio (TAVR), and the presence of intrathoracic sleeve migration (ITSM).

Results: One hundred patients were included in this study. Mean %TWL (total weight loss) at 12 months postop was 31.1% (14.3~55.5), and mean TSV, TV, AV, and TAVR were 188.3 ± 67.3 ml, 81.3 ± 38.5 ml. 107.0 ± 45.1 ml, and 0.846 ± 0.514 respectively. TSV was not correlated significantly with %TWL at 12 months postop (r=-0.140, p=0.164). Thirty patients (30/100, 30%) showed ITSM. Patients with ITSM had a significantly lower mean GER score (5.9 ± 2.3 vs. 7.5±1.9, p=0.001), and a higher proportion showed suboptimal weight loss (43.3% vs. 15.7%, p=0.003).

Conclusions: Mean TSV was not found to be significantly correlated with %TWL at 12 months postop. The presence of ITSM indicated more frequent GER symptoms and a higher probability of suboptimal weight loss.

Keywords: Gastroesophageal reflux; Laparoscopy; Sleeve gastrectomy; volumetry.