Skip to main content
Erschienen in: Obesity Surgery 7/2016

24.11.2015 | Original Contributions

Influence of the Resected Gastric Volume on the Weight Loss After Laparoscopic Sleeve Gastrectomy

verfasst von: Mohamed Bekheit, Tamer Nabil Abdel-Baki, Mostafa Gamal, Wael Abdel-salam, Mohamed Samir, ElSaied ElKayal, Khaled Katri

Erschienen in: Obesity Surgery | Ausgabe 7/2016

Einloggen, um Zugang zu erhalten

Abstract

Background

The relation between the resected gastric volume and the weight loss after laparoscopic sleeve gastrectomy appears conflicting in the literature. Both the residual and the resected volumes represent the total gastric volume, and if the weight loss is related to one of the two volumes, it should be related to the other. While some reports indicate that the weight loss is related to the resected gastric volume, others state that the weight loss is not related to the residual volume. The aim is to investigate the influence of the resected gastric volume on the weight loss after surgery.

Methods

The study included 287 consecutive patients. Gastrectomy was performed encroaching over a 38-Fr calibrating tube all the way to the angle of His. Filling volume of the resected stomach, with tap water, was measured. Patients were analyzed into group 1 with BMI ≤50 kg/m2 and group 2 >50 kg/m2.

Results

Females represented 74 % of cases. Mean age was 32.9 ± 9.5 years; preoperative BMI = 48.7 ± 7.9 kg/m2. The mean resected gastric volume was 1525 ± 408 ml, and it was significantly lower in females compared to that in males (1443 ± 311 vs 1824 ± 502 ml, p < 0.001). Data were analyzed in two groups: group 1 with BMI ≤5050 kg/m2 and group 2 >50 kg/m2. Both groups were similar in preoperative BMI (p = 0.399) and excess weight percent (EW%) (p = 0.33). Group 2 had a resected gastric volume (1663 ± 424.7 ml) greater than that of group 1 (1440 ± 347 ml; p < 0.001). The percentage of excess weight loss (EWL%) was 57.9 ± 14.5 % at 6 months (62.7 ± 13.5 % vs 48.34 ± 11.29 %, p < 0.001), 77 ± 19 % at 12 months (84 ± 19.6 % vs 68 ± 14.2 %, p = 0.001), 76.6 ± 7.4 % at 18 months (79.7 ± 4.8 vs 74.7 ± 8.2 %, p = 0.5), and 75.8 ± 11.5 % at 24 months (81.7 ± 11.17 vs 70 ± 11 %, p = 0.8) (group 1 vs group 2, respectively). At 12 months, 86 % patients achieved more than 50 % EWL% (100 % of group 1 vs 60 % of group 2). Preoperative BMI correlated with resected gastric volume (r = 0.239, p = 0.004). In multiple regression, the initial BMI was a predictor of EWL% at 6 and 12 months (r partial = −0.65, p < 0.0001) while the resected gastric volume was not.

Conclusions

The resected gastric volume is related to the total gastric volume when the technique is standardized and the residual volume is calibrated using a consistent technique. It is not in itself a predictor of weight loss, but it is related to the initial BMI which predicts the weight loss.
Literatur
1.
Zurück zum Zitat No author. Epidemic of obesity fuels demand among payers for alternatives to bariatric surgery. Dis Manag Advis. 2003;9(11):146–9, 1. No author. Epidemic of obesity fuels demand among payers for alternatives to bariatric surgery. Dis Manag Advis. 2003;9(11):146–9, 1.
2.
Zurück zum Zitat Billington CJ, Epstein LH, Goodwin NJ, Hill JO, Pi-Sunyer FX, Rolls BJ, et al. Overweight, obesity, and health risk. National Task Force on the Prevention and Treatment of Obesity. Arch Intern Med. 2000;160(7):898–904. Billington CJ, Epstein LH, Goodwin NJ, Hill JO, Pi-Sunyer FX, Rolls BJ, et al. Overweight, obesity, and health risk. National Task Force on the Prevention and Treatment of Obesity. Arch Intern Med. 2000;160(7):898–904.
3.
Zurück zum Zitat Wang SS, Brownell KD, Wadden T. The influence of the stigma of obesity on overweight individuals. Int J Obes (Lond). 2004;28(10):1333–7.CrossRef Wang SS, Brownell KD, Wadden T. The influence of the stigma of obesity on overweight individuals. Int J Obes (Lond). 2004;28(10):1333–7.CrossRef
4.
Zurück zum Zitat Clapham JC. Treating obesity: pharmacology of energy expenditure. Curr Drug Targets. 2004;5(3):309–23.CrossRefPubMed Clapham JC. Treating obesity: pharmacology of energy expenditure. Curr Drug Targets. 2004;5(3):309–23.CrossRefPubMed
5.
Zurück zum Zitat Oviedo G, Pompetti D, Quines M, et al. Effect of intragastric balloon as an alternative method for weight loosing in obese patients. Nutr Hosp. 2009;24(1):40–5.PubMed Oviedo G, Pompetti D, Quines M, et al. Effect of intragastric balloon as an alternative method for weight loosing in obese patients. Nutr Hosp. 2009;24(1):40–5.PubMed
6.
Zurück zum Zitat Yu JC. Bariatric surgery and multidisciplinary treatment for obesity. Zhongguo Yi Xue Ke Xue Yuan Xue Bao Acta Acad Med Sinicae. 2011;33(3):219–23. Yu JC. Bariatric surgery and multidisciplinary treatment for obesity. Zhongguo Yi Xue Ke Xue Yuan Xue Bao Acta Acad Med Sinicae. 2011;33(3):219–23.
7.
Zurück zum Zitat Abeles D, Shikora SA. Bariatric surgery: current concepts and future directions. Aesthet Surg J/Am Soc Aesthet Plast Surg. 2008;28(1):79–84.CrossRef Abeles D, Shikora SA. Bariatric surgery: current concepts and future directions. Aesthet Surg J/Am Soc Aesthet Plast Surg. 2008;28(1):79–84.CrossRef
8.
Zurück zum Zitat Bult MJ, van Dalen T, Muller AF. Surgical treatment of obesity. Eur J Endocrinol/Eur Fed Endocr Soc. 2008;158(2):135–45.CrossRef Bult MJ, van Dalen T, Muller AF. Surgical treatment of obesity. Eur J Endocrinol/Eur Fed Endocr Soc. 2008;158(2):135–45.CrossRef
9.
Zurück zum Zitat Rebibo L, Dhahri A, Badaoui R, Dupont H, Regimbeau JM. Laparoscopic sleeve gastrectomy as day-case surgery (without overnight hospitalization). Surg Obes Relat Dis. 2014;11(2):335–42. Rebibo L, Dhahri A, Badaoui R, Dupont H, Regimbeau JM. Laparoscopic sleeve gastrectomy as day-case surgery (without overnight hospitalization). Surg Obes Relat Dis. 2014;11(2):335–42.
10.
Zurück zum Zitat Fischer L, Hildebrandt C, Bruckner T, et al. Excessive weight loss after sleeve gastrectomy: a systematic review. Obes Surg. 2012;22(5):721–31.CrossRefPubMed Fischer L, Hildebrandt C, Bruckner T, et al. Excessive weight loss after sleeve gastrectomy: a systematic review. Obes Surg. 2012;22(5):721–31.CrossRefPubMed
11.
Zurück zum Zitat Boza C, Gamboa C, Salinas J, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: a case–control study and 3 years of follow-up. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2012;8(3):243–9.CrossRef Boza C, Gamboa C, Salinas J, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: a case–control study and 3 years of follow-up. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2012;8(3):243–9.CrossRef
12.
Zurück zum Zitat Benaiges D, Goday A, Ramon JM, et al. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2011;7(5):575–80.CrossRef Benaiges D, Goday A, Ramon JM, et al. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2011;7(5):575–80.CrossRef
13.
Zurück zum Zitat Andersen JR, Aadland E, Nilsen RM, et al. Predictors of weight loss are different in men and women after sleeve gastrectomy. Obes Surg. 2014;24(4):594–8.CrossRefPubMed Andersen JR, Aadland E, Nilsen RM, et al. Predictors of weight loss are different in men and women after sleeve gastrectomy. Obes Surg. 2014;24(4):594–8.CrossRefPubMed
14.
Zurück zum Zitat Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg. 2007;17(10):1297–305.CrossRefPubMed Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg. 2007;17(10):1297–305.CrossRefPubMed
15.
Zurück zum Zitat Parikh M, Gagner M, Heacock L, et al. Laparoscopic sleeve gastrectomy: does bougie size affect mean% EWL? Short-term outcomes. Surg Obes Relat Dis. 2008;4(4):528–33.CrossRefPubMed Parikh M, Gagner M, Heacock L, et al. Laparoscopic sleeve gastrectomy: does bougie size affect mean% EWL? Short-term outcomes. Surg Obes Relat Dis. 2008;4(4):528–33.CrossRefPubMed
16.
Zurück zum Zitat Baraki YM, Traverso P, Elariny HA, et al. Preoperative prediction of stomach weight to be removed in laparoscopic sleeve gastrectomy procedure. Surg Technol Int. 2010;20:167–71.PubMed Baraki YM, Traverso P, Elariny HA, et al. Preoperative prediction of stomach weight to be removed in laparoscopic sleeve gastrectomy procedure. Surg Technol Int. 2010;20:167–71.PubMed
17.
Zurück zum Zitat Bekheit M, Katri K, Abdel-Salam W, et al. Technical tips associated with reduction in leak rate after laparoscopic sleeve gastrectomy: lessons to learn from a nested case–control study. Egypt J Surg. 2014;33:125–30.CrossRef Bekheit M, Katri K, Abdel-Salam W, et al. Technical tips associated with reduction in leak rate after laparoscopic sleeve gastrectomy: lessons to learn from a nested case–control study. Egypt J Surg. 2014;33:125–30.CrossRef
18.
Zurück zum Zitat Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15(7):1024–9.CrossRefPubMed Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15(7):1024–9.CrossRefPubMed
19.
Zurück zum Zitat Delgado-aros S, Cremonini F, Castillo JE, et al. Independent influences of body mass and gastric volumes on satiation in humans. Gastroenterology. 2004;126(2):432–40.CrossRefPubMed Delgado-aros S, Cremonini F, Castillo JE, et al. Independent influences of body mass and gastric volumes on satiation in humans. Gastroenterology. 2004;126(2):432–40.CrossRefPubMed
20.
Zurück zum Zitat Toro JP, Patel AD, Lytle NW, et al. Observed variability in sleeve gastrectomy volume and compliance does not correlate to postoperative outcomes. Surg Laparosc Endosc Percutan Tech. 2015;25(4):324–30.CrossRefPubMed Toro JP, Patel AD, Lytle NW, et al. Observed variability in sleeve gastrectomy volume and compliance does not correlate to postoperative outcomes. Surg Laparosc Endosc Percutan Tech. 2015;25(4):324–30.CrossRefPubMed
21.
Zurück zum Zitat Chial H, Camilleri C, Delgado‐Aros S, et al. A nutrient drink test to assess maximum tolerated volume and postprandial symptoms: effects of gender, body mass index and age in health. Neurogastroenterol Motil. 2002;14(3):249–53.CrossRefPubMed Chial H, Camilleri C, Delgado‐Aros S, et al. A nutrient drink test to assess maximum tolerated volume and postprandial symptoms: effects of gender, body mass index and age in health. Neurogastroenterol Motil. 2002;14(3):249–53.CrossRefPubMed
22.
Zurück zum Zitat Parikh RM, Joshi SR, Menon PS, et al. Index of central obesity—a novel parameter. Med Hypotheses. 2007;68(6):1272–5.CrossRefPubMed Parikh RM, Joshi SR, Menon PS, et al. Index of central obesity—a novel parameter. Med Hypotheses. 2007;68(6):1272–5.CrossRefPubMed
23.
Zurück zum Zitat Bekheit M, Katri K, Ashour MH, et al. Gender influence on long-term weight loss after three bariatric procedures: gastric banding is less effective in males in a retrospective analysis. Surg Endosc. 2014;28(8):2406–11.CrossRefPubMed Bekheit M, Katri K, Ashour MH, et al. Gender influence on long-term weight loss after three bariatric procedures: gastric banding is less effective in males in a retrospective analysis. Surg Endosc. 2014;28(8):2406–11.CrossRefPubMed
24.
Zurück zum Zitat Vidal P, Ramón J, Busto M, et al. Residual gastric volume estimated with a new radiological volumetric model: relationship with weight loss after laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(3):359–63.CrossRefPubMed Vidal P, Ramón J, Busto M, et al. Residual gastric volume estimated with a new radiological volumetric model: relationship with weight loss after laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(3):359–63.CrossRefPubMed
25.
Zurück zum Zitat Obeidat F, Shanti H, Mismar A, et al. Volume of resected stomach as a predictor of excess weight loss after sleeve gastrectomy. Obes Surg. 2014;24(11):1904–8.CrossRefPubMed Obeidat F, Shanti H, Mismar A, et al. Volume of resected stomach as a predictor of excess weight loss after sleeve gastrectomy. Obes Surg. 2014;24(11):1904–8.CrossRefPubMed
26.
Zurück zum Zitat Yehoshua R, Eidelman L, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.CrossRefPubMed Yehoshua R, Eidelman L, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.CrossRefPubMed
27.
Zurück zum Zitat Deguines J-B, Verhaeghe P, Yzet T, et al. Is the residual gastric volume after laparoscopic sleeve gastrectomy an objective criterion for adapting the treatment strategy after failure? Surg Obes Relat Dis. 2013;9(5):660–6.CrossRefPubMed Deguines J-B, Verhaeghe P, Yzet T, et al. Is the residual gastric volume after laparoscopic sleeve gastrectomy an objective criterion for adapting the treatment strategy after failure? Surg Obes Relat Dis. 2013;9(5):660–6.CrossRefPubMed
28.
Zurück zum Zitat Arias E, Martínez PR, Li VKM, et al. Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obes Surg. 2009;19(5):544–8.CrossRefPubMed Arias E, Martínez PR, Li VKM, et al. Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obes Surg. 2009;19(5):544–8.CrossRefPubMed
29.
Zurück zum Zitat Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20(5):535–40.CrossRefPubMed Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20(5):535–40.CrossRefPubMed
30.
Zurück zum Zitat ElGeidie A, ElHemaly M, Hamdy E, El Sorogy M, AbdelGawad M, GadElHak N, et al. The effect of residual gastric antrum size on the outcome of laparoscopic sleeve gastrectomy; a prospective randomized trial. Surg Obes Relat Dis. 2014. doi:10.1016/j.soard.2014.12.025. ElGeidie A, ElHemaly M, Hamdy E, El Sorogy M, AbdelGawad M, GadElHak N, et al. The effect of residual gastric antrum size on the outcome of laparoscopic sleeve gastrectomy; a prospective randomized trial. Surg Obes Relat Dis. 2014. doi:10.​1016/​j.​soard.​2014.​12.​025.
31.
Zurück zum Zitat Obeidat F, Shanti H, Mismar A, Albsoul N, Al-Qudah M, et al. The magnitude of antral resection in laparoscopic sleeve gastrectomy and its relationship to excess weight loss. Obes Surg. 2015;25(10):1928–32. Obeidat F, Shanti H, Mismar A, Albsoul N, Al-Qudah M, et al. The magnitude of antral resection in laparoscopic sleeve gastrectomy and its relationship to excess weight loss. Obes Surg. 2015;25(10):1928–32.
Metadaten
Titel
Influence of the Resected Gastric Volume on the Weight Loss After Laparoscopic Sleeve Gastrectomy
verfasst von
Mohamed Bekheit
Tamer Nabil Abdel-Baki
Mostafa Gamal
Wael Abdel-salam
Mohamed Samir
ElSaied ElKayal
Khaled Katri
Publikationsdatum
24.11.2015
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 7/2016
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-1981-3

Weitere Artikel der Ausgabe 7/2016

Obesity Surgery 7/2016 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.