Abstract: Objective:To investigate the measuring method of residual gastric volume and its correlation with the effect of weight loss after laparoscopic sleeve gastrectomy (LSG).
Methods:The clinical data of 25 patients with obesity who received LSG at the Ruijin Hospital of Shanghai Jiaotong University between June 2012 and October 2013 were retrospectively analyzed. All the patients received the management during the perioperative period based on the “International Sleeve Gastrectomy Expert Panel Consensus Statement (2013)”, and the intra and postoperative conditions were recorded. All the patients were followed up by outpatient examination and admission to hospital at postoperative month 1, 6, 12 and 18, and the body mass index (BMI), excess of body weight and excess weight loss (EWL) rate were recorded. The postoperative residual gastric volumes of patients were estimated by simulating geometry after Xray radiography using oral iodine. A correlation between the residual gastric volume at postoperative month 12 and increment of residual gastric volume from postoperative week 1 to month 12 and EWL at postoperative month 18 was studied. All the patients were divided into the large fundus group (residual gastric fundus volume>20 mL) and the small fundus group (residual gastric fundus volume≤20 mL). EWL of the 2 groups at postoperative month 18 was analyzed. Measurement data with normal distribution were presented as ±s and analyzed by the t test, and repeated measurement data were analyzed by the repealed measures ANOVA. Correlation analysis among the multivariate data was done by the multiple linear regression.
Results:All the 25 patients received successful LSG and regular followup with operation time of (180±60)minutes and volume of blood loss of (30±20)mL. All the patients were not complicated with intraoperative hemorrhea and splenic rupture and postoperative anastomotic leakage, stenosis and hemorrhea with the good recovery and satisfaction of incision. BMI at postoperative year 1 was (29±7)kg/m2，which was significantly different from (39±5)kg/m2 before operation (F=6.773, P<0.05). The residual gastric volume, volume of gastricum (including gastric fundus) and volume of gastric antrum in 25 patients were (88±14)mL, (48±10)mL and (41±9)mL at post operative week 1, (137±23)mL, (70±18)mL and (67±14)mL at postoperative month 12, respectively, with significant differences (F=7.122, 6.912, 7.836, P<0.05).The increment of residual gastric volume from postoperative week 1 to month 12 and EWL at postoperative month 18 in 25 patients were (49±26)mL and 24%±3%. The results of multiple linear regression showed that there was a negative correlation between residual gastric volume at postoperative month 12, increment of residual gastric volume from postoperative week 1 to month 12 and EWL at postoperative month 18, with significant differences (r=-0.485,-0.837, P<0.05). Nine patients were detected in the large fundus group with EWL of 66%±13% and 16 patients in the small fundus group with EWL of 73%±23%, showing no significant difference (t=0.932, P>0.05).
Conclusion:The residual gastric volume of patients is increased gradually within postoperative year 1. There is a negative correlation between the effect of postoperative weight loss and the postoperative residual gastric volume and increment of residual gastric volume, and no obvious correlation between the postoperative volume of residual gastric fundus and shortterm effect of weight loss.