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

Autor: Marius Nedelcu, Audrey Jaussent, Ion Donici, Sandrine Akouete, Marie-Christine Picot, Olivier Emungania, Alexandrine Robert, Anamaria Nedelcu, David Nocca
Přispěvatelé: 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)
Rok vydání: 2020
Předmět:
Weight loss
medicine.medical_specialty
Complications
[SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery
Nausea
MESH: Laparoscopy
030209 endocrinology & metabolism
[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery
Sleeve
Group B
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Antrum conservation
Gastrectomy
MESH: Postoperative Complications
medicine
Humans
Prospective Studies
Antrum
MESH: Treatment Outcome
Retrospective Studies
Gastrin
2. Zero hunger
MESH: Humans
business.industry
Reflux
MESH: Retrospective Studies
GERD
MESH: Obesity
Morbid
medicine.disease
MESH: Prospective Studies
Obesity
Morbid
3. Good health
Surgery
MESH: France
MESH: Gastrectomy
Treatment Outcome
Laparoscopy
030211 gastroenterology & hepatology
France
medicine.symptom
business
Body mass index
Zdroj: 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⟩
ISSN: 1550-7289
1878-7533
DOI: 10.1016/j.soard.2020.06.041
Popis: 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).
Databáze: OpenAIRE
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