Objective To investigate the application value of membrane anatomy theory-guided disassociation of fundus of stomach in laparoscopic sleeve gastrectomy (LSG).

Methods The retrospective and descriptive study was conducted. The clinical data of 101 obesity patients who underwent LSG in The Affiliated Hospital of Guizhou Medical University from June 2020 to September 2024 were collected. There were 29 males and 72 females, aged 32(25,39) years, with the body mass index as (36±8) kg/m². Observation indicators: (1) treatment conditions; (2) intraoperative conditions; (3) postoperative conditions; (4) follow‑up. Comparison of measurement data with normal distribu-tion between pre‑ and postoperation was conducted using the paired sample t test.

Results (1) Treatment conditions: of the 101 obesity patients, 99 patients underwent successful surgery, and 2 patients underwent remedial Roux‑en‑Y gastric bypass at 18 and 24 months after surgery due to unsatisfactory weight loss effect. (2) Intraoperative conditions: of the 101 obesity patients, the operation time was 90(80, 120) minutes, the volume of intraoperative blood loss was 20(10,50) mL, and no patient underwent conversion to open surgery. During intraoperative exploration, 15 patients were found to have occult esophageal hiatus hernia, and all underwent hernia repair surgery. (3) Postoperative conditions: of the 101 obesity patients, 29 cases experienced postoperative nausea and vomiting and all of them alleviated within 48 hours after surgery, 13 cases developed temporary dysphagia and were improved after 1 to 2 weeks of liquid diet adjustment. There was no severe complication such as postoperative gastric fistula, anastomotic stenosis, or intra‑abdominal bleeding, and no death of patient. The duration of postoperative hospital stay of the 101 patients was 5(4,6) days. (4) Follow‑up: of the 101 patients, 96 cases were followed up for 6 months, and 90 cases were followed up for 12 months. At the 6‑month follow‑up, the percentage of total weight loss (%TWL) for the 96 patients who were followed up was 23%±6%, and the percentage of excess weight loss (%EWL) was 64%±17%. At the 12‑month follow‑up, the %TWL for the 90 patients who were followed up was 28%±7%, and the %EWL was 74%±18%. The successful weight loss rate within 12 months was 92.2%(83/90). At the 12‑month follow‑up, the levels of albumin, vitamin B12, vitamin D, and ferritin were all within the normal range in the 90 patients who were followed up. Among 28 patients with type 2 diabetes, 22 cases experienced remission. Among 22 patients with hypertension, 15 cases experienced remission. Among 34 patients with dyslipidemia, 28 cases showed improvement. Among 19 patients with obstructive sleep apnea syndrome, 16 cases showed improvement. Among the 84 patients without gastroesophageal reflux disease (GERD) before surgery, 10 cases developed new reflux symptoms 12 months after surgery, with a gastroesophageal reflux disease questionnaire (GERD‑Q) score of 8.5±1.2. Among the 17 patients with preoperative GERD, the preoperative GERD‑Q score was 12.3±2.8, and the postoperative GERD‑Q score was 6.4±2.1 12 months after surgery, showing a significant difference between pre‑ and postoperative GERD‑Q score (t=8.36, P<0.05).

Conclusion Measures such as the membrane anatomy theory‑guided disassociation of fundus of stomach, segmental incision edge reinforcement, and management of occult hiatus hernia can help to improve surgical safety of LSG.