Antral Preservation in Sleeve Gastrectomy Appears to Protect Against Prolonged Vomiting and Gastroesophageal Reflux Disease. A Meta-Analysis of Randomized Controlled Trials

Obes Surg. 2023 Dec;33(12):4103-4114. doi: 10.1007/s11695-023-06884-w. Epub 2023 Oct 14.

Abstract

The optimal distance between the starting point of gastric transection and the pylorus during laparoscopic sleeve gastrectomy (LSG), which can be referred to as the distance from pylorus (DFP), is controversial. No consensus exist for what DFP is considered antral preservation, and what DFP is considered antral resection. Some surgeons prefer shorter DFP to maximize excess weight loss percentage (EWL%), while others prefer longer DFP because they believe that it shortens length of stay (LOS) and protects against leaks, prolonged vomiting, and gastroesophageal reflux disease (GERD). We sought to compare 6-cm DFP and 2-cm DFP in postoperative outcomes. In addition, we sought to evaluate the magnitude of any observed benefit through number needed to treat (NNT) analysis.

Keywords: Antral preservation; Antral resection; Antrectomy; Distance; Pylorus; Sleeve gastrectomy.

Publication types

  • Review

MeSH terms

  • Gastrectomy / adverse effects
  • Gastroesophageal Reflux* / etiology
  • Gastroesophageal Reflux* / prevention & control
  • Gastroesophageal Reflux* / surgery
  • Humans
  • Laparoscopy* / adverse effects
  • Obesity, Morbid* / surgery
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Treatment Outcome