Mohamed Sarhan, MRCS, MD, Mohamed Elmasry, MD, Mohamed Ghobashy, MSc, Omar A Hamada, Mostafa Elshazly, MD, Fahim Elbassiony, MD. General Surgery Department, Cairo University Hospital.
Sleeve Gastrectomy has gained wide popularity in the past few years; however there has been no accurate method for assessing the changes in remnant gastric pouch volume and impact on weight loss.
Prospective, single group Cohort study including 50 morbidly obese patients in Cairo University with a mean BMI of 47.4. CT Volumetry was done 1 and 6 months postoperative to assess the gastric pouch volume changes. A plain multi-slice abdominal CT with 5mm reconstruction software was used to calculate the volume in each section and finally summates them.
The mean 1st month postoperative pouch Volume was 107 cm3 which increased to 155 cm3 after 6 months. The mean Pouch Volume increase after 6 months was 48 cm3 (55% volume increase). Six months postoperative, the mean BMI dropped from 47.4 to 33.8 with 62.7% EBWL.
We found that there is a non Significant weak negative correlation (r= -0.3, P= 0.07) between the initial pouch volume and EBWL. Also no statistical correlation was found between % 6m pouch volume increase and EBWL (r= 0.16, P= 0.35) and this signifies there is no need to decrease the size of the bougie to establish a better EBWL.
CT Volumetry is a non invasive, feasible and relatively accurate method for the follow up of laparoscopic sleeve gastrectomy, yet more patients and longer periods of follow up are needed for wider use of this new technique.
Use of a bigger size bougie (40 Fr or more) can be adopted as it has a lower incidence of leak and at the same time doesn’t affect the EBWL.
Restrictive factors such as initial pouch volume and rate of pouch volume increase are important but not the only factors determining weight loss following sleeve gastrectomy.