Prospective Evaluation of Conventional and Novel Factors Influencing Gastric Wall Thickness in Bariatric Surgery Patients.

Abstract

Introduction: Obesity prevalence has nearly doubled globally in the past 30 years. Among treatment options, surgery remains the most effective. Staple line leaks are a major complication in bariatric surgery, often linked to mismatched stapler cartridge and gastric wall thickness (GWT). Understanding factors influencing this thickness is critical. This study evaluates previously known variables and additionally investigates waist circumference, duration of obesity, alcohol use, and asthma.

Methods: Between December 2024 and July 2025, patients who underwent bariatric surgery for obesity were evaluated. A total of 58 patients were included in the study. Immediately following laparoscopic sleeve gastrectomy (LSG), the freshly resected gastric specimens were assessed in the operating room. Prior to measurement, a standardized pressure of 8 g/mm² was applied to the gastric tissue for 15 seconds.

Results: Male sex was associated with increased thickness in the corpus and fundus, smoking with the fundus, and body mass index (BMI) with the antrum. Height affected all regions, while weight influenced the antrum and fundus. Waist circumference increased thickness in all areas. Overall, thickness decreased from antrum to fundus, but in 10% of patients, the corpus was thicker than the antrum.

Conclusion: There are few and conflicting studies in the literature regarding factors affecting GWT. In this study, waist circumference was found to increase GWT in all regions, while duration of obesity, alcohol consumption, and asthma had no significant effects. It may be reasonable for surgeons to consider waist circumference, in addition to BMI, height, weight, and male sex, when selecting staplers.