Laparoscopic Sleeve Gastrectomy at 2 or 4 cm from the pylorus, does it change outcomes, if any?

Suleyman Bozkurt, MD, Halil Coskun, MD, Gokhan Cipe, MD, Naim Memmi, MD, Yeliz Emine Ersoy, MD, Oguzhan Karatepe, MD, Mustafa Hasbahceci, MD, Erhan Aysan, MD, Adem Akcakaya, MD, Mahmut Muslumanoglu, MD

Bezmialem Vakif University School of Medicine Department of Surgery, Istanbul Turkey

Laparoscopic Sleeve Gastrectomy (LSG) has been became a primary surgical treatment for obesity and associated diseases. The staple line can be started 2 or more cm from the pylorus. The purpose of this study is to compare the outcomes of two different starting distances, 4 and 2 cm from pylorus in LSG.

Fifty nine morbidly obese patients were submitted for LSG. Thirty six patients had LSG started 4 cm from the pylorus (group A) and 23 had the sleeve started at 2 cm from the pylorus (group B). All the sleeves were calibrated on a 39 Fr orogastric bougie. The primary outcomes of patients such as weight loss, BMI change, EWL %, remission in comorbidities were analysed at 12 months. Secondary outcomes included the operative time, hospital stay and early and late complications were also compared.

The demographic properties of the two groups were statistically comparable. The lenght of hospital stay, duration of operative time and complication rates were not different between groups. The mean weight loss was 42,8 kg for group A and 44,6 kg for group B respectively. BMI changes and EWL% for group A were not statistically different from group B (-15,6 vs -16,2 and 73,4% vs 76,8% respectively). There were 41 patients with at least 1 metabolic syndrome criteria. After a year remission of DM was 77,8% for group A and 85,8% for B. The remission rates for hyperlipidemia and hypertension were comparable between groups (95% vs 97% and 71% vs 68% respectively).

LSG from 2 cm and 4 cm from the pylorus are equally effective in terms of weight loss and EWL%, but LSG from 2 cm from the pylorus seems to be more effective in remission of comorbidities especially diabetes mellitus. Controlled long-term comparisons are needed to standardize the optimal distance from the pylorus in LSG.

Session: Poster Presentation

Program Number: P430

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