Pawanindra Lal, MS, DNB, MNAMS, FRCSEd, FRCSGlas, FRCSEn, FACS, Manoj K Midha, MBBS, Anubhav Vindal, MS, DNB, MRCSEd, MNAMS, Jagdish Chander, MS. Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College (University of Delhi), New Delhi, India.
Obesity has reached epidemic proportions in India in the 21st century, with morbid obesity affecting 5% people. Laparoscopic sleeve gastrectomy (LSG) has emerged as a definitive and standalone bariatric procedure resulting in stable and adequate weight loss in high percentage of patients with morbid obesity. Pre and postoperative stomach volumes can be important determinants to find out the effectiveness of LSG in effecting weight loss. There is little data on preoperative stomach volumes and that excised during LSG. This study was designed to evaluate the change in gastric volume after LSG using multi slice CT and to correlate it with postoperative weight loss.
Methods and Procedures
Twenty consecutive patients with BMI ≥ 33 kg/m2 and comorbidities like diabetes mellitus, hypertension, dyslipidemia, atherosclerotic heart disease and sleep apnoea syndrome, undergoing LSG between October 2011 and June 2013 were included in the study. The patients were evaluated by a multi disciplinary team and optimized for anaesthesia and surgery. All patients underwent a multi detector CT scan (MDCT) of the upper abdomen, one week before the surgery. The stomach was distended with a negative contrast, volume rendered images were generated, and the stomach volume was calculated by the MDCT software. LSG was performed in all the patients, fashioning the gastric tube over a 36F bougie. An MDCT of the upper abdomen was repeated at 3 months postoperatively to calculate the gastric sleeve volume. Weight loss and resolution of comorbid conditions were documented in each case.
The age of patients was in the range of 21 to 54 years with a male to female ratio of 1.14:1. The mean weight of patients at enrolment was 126.67 kg (range 86-168 kg). The mean stomach volume measured by MDCT before LSG was 1048 ml (range 601-1469 ml). All the surgeries were performed laparoscopically with no conversion to open surgery. Mean resected stomach volume measured immediately postoperatively by distension of specimen with water was 898 ml and that on MDCT was 820 ml (p = 0.191). The mean volume of gastric sleeve on MDCT 3 months post operatively was 228 ml with a reduction in stomach volume by 76%. The mean weight 3 months after surgery was 103 kg. The stomach volume on preoperative MDCT correlated with preoperative weight (p< 0.05, r = 0.661) and BMI (p< 0.05, r = 0.569). Correlation was also seen between volume of the excised stomach on MDCT and weight loss achieved 3 months post operatively (p< 0.05, r = 0.606). No correlation was seen between the volume of gastric sleeve 3 months post operatively and weight loss during this period (p = 0.980). At 3 months, all the patients had a complete resolution of their hypertension, diabetes and sleep apneoa, and 3 patients showed significant improvement in serum lipid profile.
MDCT is a good method to measure gastric volume before and after LSG. Early postoperative weight loss (at 3 months) correlates well with the volume of the stomach excised but not with the volume of the sleeve.