Ratioing the resected gastric volume (RGV) to the number of staplers fired (SF) could be used to predict midterm weight loss, according to researchers from Turkey, who called for further studies to examine the effect of RGV to number of SF ratio on postoperative complications.
Although laparoscopic sleeve gastrectomy (LSG) is the most commonly used bariatric procedure, an estimated 25% of patients regain weight and up to 5% experience operative complications, including stapler line leakage (SLL), haemorrhage or gastric stricture.
The initial theory behind the LSG is decreasing the gastric volume, therefore the researchers stated, RGV is a crucial factor affecting the outcome of the surgery. The number of SF is an operative parameter directly affected by the patient characteristics, dimensions of the stomach and the surgeon. Its relationship with short-term complications has been reported, but there are no significant data on its midterm bariatric results. Therefore, their study assessed the relationship between the ratio of RGV/SF and clinical outcomes.
All 407 patients 391 (96.1% female, mean age 35.29) were operated on by the same surgeon who completed 12 months of follow-up and gave written consent to participate in the study. The RGV was measured by insufflating the specimen with CO2 through the antrum until the internal pressure reached 10mmHg.
The patients with >725mL RGV, >123.57 RGV/SF and ≥50% %EWL had a higher mean age (p<0.001, p=0.002 and p=0.008, respectively). The mean age of patients in the 5 SF group was lower than 6 SF and > 6 SF groups (p=0.018). The mean preoperative BMI was 45.57 kg/m2. Patients with <50% %EWL and <725mL RGV had higher BMI (p=0.009 and p=0.002, respectively). On the first preoperative visit, 230 (56.5%) patients had at least one obesity-related comorbidity.
The rate of patients with comorbidities was higher in those with ≥50% %EWL and those who experienced any complications (p=0.01 and p=0.002, respectively). The rate of any obesity-related disease was lower in the 5 SF group (p<0.001).
The mean RGV was 766mL. Higher RGV/SF ratio, experiencing complication, and >6 SF were associated with increased RGV (p<0.001, p=0.031 and p<0.001, respectively). The mean SF was 6.05. There was a statistically significant but clinically insignificant increase in SF in patients with <50% %EWL and experienced complications (p<0.001, and p<0.001, respectively). The mean RGV/SF ratio was 127.46. Patients with >725mL RGV and ≥50% %EWL were prone to have an increased RGV/SF ratio (p<0.001 and p<0.001, respectively).
Forty-two (10.3%) patients experienced complications in total. 24 (57.1%) of these were bleeding, 15 (35.7%) were nausea-vomiting, and 3 (7.2%) were gastric twists or stenosis.
The mean BMI at the 6th month postoperatively was 33.53kg/m2, and the mean BMI loss (%BMIL) since the operation was 26.42%. There was no significant difference in %BMIL at the 6th month postoperatively. Patients with <725mL RGV were prone to have a higher BMI at the 6th month postoperatively, but there was no difference in %BMIL (p=0.017 and p=0.615, respectively).
At the 12th month postoperatively, the mean BMI was 28.76kg/m2, and the mean %BMIL since the operation was 36.74%. Patients with >103.57 RGV/SF ratio were prone to have an increased %BMIL (p=0.001). A <725mL RGV and a <103.57 RGV/SF ratio were associated with higher BMI at the 12th month follow-up (p=0.003 and p=0.002, respectively).
At the 12th month postoperative follow-up, the mean %EWL was 68.6%. Having <725mL RGV and >103.57 RGV/SF ratio were favourable prognostic factors in achieving %EWL (p=0.01 and p<0.001, respectively).
A significant negative and weak correlation exists between the initial BMI and %EWL (r=0.301, p<0.001). A significant positive and weak correlation was also between RGV and RGV/SF and %EWL (r=0.128, p=0.01 and r=0.152, p=0.002, respectively). While a significant negative correlation was found between the BMI and %EWL at 6 months postoperatively, there was a positive relationship between the %EWL and the %BMIL (r=-0.612, p<0.001 and r=0.581, p<0.001, respectively) at 6 months. At 12 months postoperatively %EWL had a negative correlation with the BMI and a positive correlation with the %BMIL (r=-0.893, p=< 0.001 and r=0.85, p<0.001, respectively).
In achieving the target %EWL, decreased baseline BMI, decreased SF, increased age, and increased RGV/SF ratio were associated with increased achievement. Each increase in the SF reduces the probability of reaching the target %EWL by 72.6%.
In the univariate analysis, RGV and SF were found to be independent factors that affect the complication rate [OR = 1,001 (1,000–1,002), p = 0.012 and [OR = 3,067 (1,898-4,956), p<0.001, respectively]. In multivariant analyses of RGV and SF, SF was found to be the most decisive factor affecting the rate of complication [OR = 2,820 (1,725-4,610),p<0.001).
“In our research, the %EWL was higher than in the before mentioned study in all groups, and there was a significant difference between the RGV and RGV/SF subgroups. In addition to the 12-month postoperative %EWL, the %BMIL at both 6 and 12 months was analyzed to monitor the total weight loss and change in the obesity grade of the patients,” the researcher noted. “We reported that the %BMIL at 6 months wasn’t associated with the RGV, RGV/SF ratio, or SF.”
The findings were reported in the paper, ‘Resected gastric volume/number of staplers fired ratio as a tool in predicting complication and midterm results in sleeve gastrectomy’, published in Scientific Reports. To access this paper, please click here
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