Weight Loss After Laparoscopic Sleeve Gastrectomy: Does Size Matter?

Scharf Keith, MD, Nayna Lodhia, BS, Anit Kaushal, PhD, Homero Rivas, MD, John M Morton, MD MPH. Stanford School of Medicine

Background: Sleeve gastrectomy is a successful weight loss procedure. However; there are still technical variations in creating the sleeve including what size bougie or endoscope should be employed in sizing. We sought to objectively determine if a certain gastric volume removed resulted in adequate excess body weight loss.

Methods: We retrospectively analyzed data from 100 patients who underwent sleeve gastrectomy from 2007-2011. Data analyzed included age, gender, BMI, weight and volume of gastric specimen removed, and percent excess weight loss (%EWL) at 3, 6, and 12 months postoperatively. Volumes were calculated by multiplying length, width, and height of pathology specimens.

Results:  Median volume of stomach removed was 245 cubic centimeters (cc) with a range of 103cc to 729cc. Volume removed was not found to be correlated to age, initial BMI, sex, or race. For all subjects, we compared volume of stomach removed to absolute weight lost and percent excess weight loss at 3, 6, and 12 months. The only significant relationship with volume occurred at 12 months, with absolute volume of stomach removed. Using logistic regression, we determined that at volumes of approximately 200 cc, patients are more likely to have EWL of 60% or greater while below this volume they are more likely to have EWL 40% or less. With a volume of 300cc removed, there is an 80% chance that patients will have EWL 60% or greater.

Conclusion: One year percent excess weight loss had a statistically significant correlation to gastric volume removed. It appears that gastric volume removed >200cc correlates to acceptable excess weight loss and could be a quality metric in determining an adequate resection volume in patients undergoing sleeve gastrectomy. 
 

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