Laparoscopic sleeve gastrectomy: Correlation of gastric emptying and weight loss

Abstract

Aim: Laparoscopic Sleeve Gastrectomy (LSG) has become a popular technique as a definitive procedure in obesity treatment. It has been linked to an alteration in gastric motility and gastric emptying. The purpose of the study is to analyze the changes in gastric emptying (GE) after LSG produces and its correlation with weight loss after surgery. Methods: The preoperative and postoperative GE was estimated by gastric emptying scintigraphy at 1 month and 18 months in 52 successive patients who underwent LSG surgery. The gastric emptying scintigraphy was conducted after the ingestion of TC99m sulfur colloid labeled solid food. Images were obtained using a gamma camera at 0, 30, 60, 120, 180 and 240 minutes. Calculations were made to find out the half time gastric emptying (T½) and the retention percentage at 2 and 4 hours. Results: The T½ preoperatively, at 1 month and at 18 months were 101.1 (44) minutes, 88.6 (51.5) minutes and 80.7 (53) minutes, respectively (P<0.05). Before the operation, and at the 1st and 18th months postoperatively, the percentage of retention at 2 hours were 33.4% (17.4), 26.1% (18.5), and 28.6% (15.2), respectively (P<0.05), and that at 4 hours were 5.8% (18.3), 4.5% (16.2), and 2.8% (12.6), respectively (P>0.05). The volume of the gastric reservoir increased from 239.5 (88.7) ml to 280.8 (100.8) ml (P<0.05) at 1 and 18 months after the operation. There was an inverse correlation between GE and the weight loss data at the first postoperative month, which did not remain at the 18th postoperative month. Conclusion: According to our series, LSG with an initial transection at 4 cm from the pylorus affects gastric emptying but is not significantly correlated with weight loss.

Keywords

• Gastric emptying scintigraphy
• gastric volume
• weight loss
• sleeve gastrectomy
• morbid obesity

Laparoskopik sleeve gastrektomi: Mide boşalması ve kilo kaybı arasındaki ilişki

Abstract

Amaç: Laparoskopik Sleeve Gastrektomi (LSG), obezite tedavisinde kesin çözüm olarak popüler bir teknik haline gelmiştir. LSG, mide motilitesi ve mide boşalmasında değişiklikle ilişkilendirilmiştir. Bu çalışmanın amacı, LSG sonrası mide boşalmasındaki (MB) değişiklikleri ve ameliyat sonrası kilo kaybı ile ilişkisini analiz etmektir. Yöntemler: LSG ameliyatı geçiren 52 ardışık hastada mide boşalması, ameliyat öncesi ve ameliyattan sonraki 1 ve 18. aylarda, TC99m sülfür kolloid etiketli katı gıda alımından sonra, mide boşalma sintigrafisi ile değerlendirildi. Görüntüler 0, 30, 60, 120, 180 ve 240. dakikalarda bir gama kamera kullanılarak elde edildi. İkinci ve 4. saatlerde mide boşalmasının (T½) yarısı ve retansiyon yüzdesini bulmak için hesaplamalar yapıldı. Bulgular: Ameliyat öncesi, ve postoperative 1 ve 18. Aylarda T1/2 sırasıyla 101.1 (44) dakika, 88.6 (51.5) dakika ve 80.7 (53) dakika idi (P <0.05). Ameliyat öncesi ve ameliyat sonrası 1. ve 18. aylarda 2. saatteki retansiyon yüzdesi sırasıyla % 33.4 (17.4), % 26.1 (18.5) ve % 28.6 (15.2) (P <0.05), aynı değerler 4. saatte sırasıyla % 5.8 (18.3), % 4.5 (16.2) ve % 2.8 (12.6) idi (P> 0.05). Mide rezervuar hacmi operasyondan sonraki 1. ve 18. aylarda 239.5 (88.7) ml'den 280.8 (100.8) ml'ye (P <0.05) yükseldi. GE ile postoperatif ilk ayda kilo verme verileri arasında ters bir korelasyon saptandı, ancak bu korelasyon postoperatif 18. ayda izlenmedi. Sonuç: Serimize göre pilorun 4 cm distalinden transeksiyonla yapılan LSG mide boşalmasını etkilemekte ancak kilo kaybı ile anlamlı bir korelasyon göstermemektedir.

Keywords

• Mide boşalma sintigrafisi
• Mide hacmi
• Kilo kaybı
• Tüp mide ameliyatı
• Morbid obezite

References

1. 1. Braghetto I, Davanzo C, Korn O, Csendes A, Valladares H, Herrera E, et al. Scintigraphic Evaluation of Gastric Emptying in Obese Patients Submitted to Sleeve Gastrectomy Compared to Normal Subjects. Obes Surg. 2009;19(11):1515-21. doi: 10.1007/s11695-009-9954-z
2. 2. Yehoshua RT, Eidelman LA, Stein M, Fichman S, Mazor A, Chen J, et al. Laparoscopic Sleeve Gastrectomy—Volume and Pressure Assessment. Obes Surg. 2008;18(9):1083-8. doi 10.1007/s11695-008-9576-x
3. 3. Popescu A-L, Ioniţa-Radu F, Jinga M, Gavrilă A-I, Săvulescu F-A, Fierbinţeanu-Braticevici C. Laparoscopic sleeve gastrectomy and gastroesophageal reflux. Rom J Intern Med. 2018;56(4):227-32. doi 10.1007/s11695-007-9006-5
4. 4. Melissas J, Koukouraki S, Askoxylakis J, Stathaki M, Daskalakis M, Perisinakis K, et al. Sleeve Gastrectomy — A Restrictive Procedure? Obes Surg. 2007;17(1):57-62.
5. 5. Melissas J, Leventi A, Klinaki I, Perisinakis K, Koukouraki S, de Bree E, et al. Alterations of Global Gastrointestinal Motility After Sleeve Gastrectomy: A Prospective Study. Ann Surg. 2013;258(6):976-82. doi 10.1007/s11695-008-9791-5
6. 6. Bernstine H, Tzioni-Yehoshua R, Groshar D, Beglaibter N, Shikora S, Rosenthal RJ, et al. Gastric Emptying is not Affected by Sleeve Gastrectomy—Scintigraphic Evaluation of Gastric Emptying after Sleeve Gastrectomy without Removal of the Gastric Antrum. Obes Surg. 2009;19(3):293-8.
7. 7. Hubbard VS, Hall WH. Gastrointestinal Surgery for Severe Obesity. Obes Surg. 1991 Sep;1(3):257-265. doi: 10.1381/096089291765560962.
8. 8. Sabench Pereferrer F, Domínguez-Adame Lanuza E, Ibarzabal A, Socas Macias M, Valentí Azcárate V, García Ruiz de Gordejuela A, et al. Criterios de calidad en cirugía bariátrica: revisión de conjunto y recomendaciones de la Asociación Española de Cirujanos y de la Sociedad Española de Cirugía de la Obesidad. Cir Esp. 2017;95(1):4-16. doi10.1016/j.ciresp.2016.09.007

9. 9. Dindo D, Demartines N, Clavien P-A. Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg. 2004;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae.
10. 10. Grifo I, Bruna M, Puche J, Jareño S, Navarro C, Gómez R, et al. Gastrectomia vertical: importancia del volumen gástrico resecado. BMI-journal .2017;7(1):1304-8
11. 11. Gumbs AA, Gagner M, Dakin G, Pomp A. Sleeve Gastrectomy for Morbid Obesity. Obes Surg. 2007;17(7):962-9. doi:10.1007/s11695-007-9151-x
12. 12. Gagner M. Faster Gastric Emptying after Laparoscopic Sleeve Gastrectomy. Obes Surg. 2010;20(7):964-5. doi:10.1007/s11695-010-0086-2
13. 13. Pilone V, Tramontano S, Micco RD, Monda A, Hasani A, Izzo G, et al. Gastric emptying after sleeve gastrectomy: statistical evidence of a controlled prospective study with gastric scintigraphy. Minerva Chir. 2013;68(4):9. PMID: 24019046.
14. 14. Cardoso-Júnior A, Gonzaga Vaz Coelho L, Savassi-Rocha PR, Vignolo MC, Abrantes MM, Miranda de Almeida A, et al. Gastric Emptying of Solids and Semi-solids in Morbidly Obese and Non-obese Subjects: An Assessment Using the 13C-Octanoic Acid and 13C-Acetic Acid Breath Tests. Obes Surg. 2007;17(2):236-41. doi:10.1007/s11695-007-9031-4
15. 15. Verdich C, Lysgård Madsen J, Toubro S, Buemann B, Holst J, Astrup A. Effect of obesity and major weight reduction on gastric emptying. Int J Obes. 2000;24(7):899-905. doi: 10.1038/sj.ijo.0801250