Gastric remnant shape following laparoscopic sleeve gastrectomy correlates with weight loss: A retrospective cohort study

Background: Laparoscopic sleeve gastrectomy (LSG) is a safe and effective bariatric surgical procedure. Sleeve configuration is believed to be an important outcome of good operative technique, yet the relationship of sleeve shape to clinical outcomes including weight loss and postoperative symptoms is not clearly defined. This study aims to identify whether gastric remnant anatomical shape is associated with short-term postoperative weight loss or symptoms of reflux, regurgitation, or dysphagia. Methods: 207 LSG patients were identified from a prospective, multicentre unit database who had surgery between June 2015 and June 2019. Routine postoperative upper gastrointestinal gastrograffin contrast studies were performed between postoperative days one to five and analyzed using a standardized protocol. Gastric remnant shape was classified as either tubular, proximal pouch or distal pouch consistent with previous studies. ANOVA Kruskal − Wallis and Mann − Whitney U-tests were performed to determine the effect of gastric remnant anatomy on weight loss. Descriptive statistics examined the symptoms of reflux, regurgitation, and dysphagia. Results: Gastric remnant anatomy was classified as tubular in 159/207 (78%), proximal pouch in 15/207 (7%), and distal pouch in 33/207 (16%). Patients with a tubular shape had a significantly greater reduction in median body mass index at 12 months postoperatively compared to those with a proximal pouch (11.3 kg/m2 vs. 10.2 kg/m2, P = 0.01). There was no relationship identified between gastric remnant shape and postoperative reflux, regurgitation, or dysphagia. Conclusion: A tubular-shaped gastric remnant is associated with increased weight loss. This suggests that tubular shape should be considered the desired LSG shape for greatest weight loss.