Vol.:(0123456789) 1 3 Surgical Endoscopy https://doi.org/10.1007/s00464-017-5972-4 Infuence of antrum size on gastric emptying and weight-loss outcomes after laparoscopic sleeve gastrectomy (preliminary analysis of a randomized trial) Meritxell Garay 1  · Carmen Balagué 1  · Carlos Rodríguez‑Otero 1  · Berta Gonzalo 1  · Anna Domenech 2  · Juan Carlos Pernas 3  · Ignasi J. Gich 4  · Inka Miñambres 5  · Sonia Fernández‑Ananín 1  · Eduardo M. Targarona 1 Received: 13 March 2017 / Accepted: 29 October 2017 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Background Laparoscopic sleeve gastrectomy (LSG) has increased in popularity in recent years as a defnitive bariatric procedure. Despite its growing popularity worldwide, the surgical technique is not well standardized. There is a lack of evi- dence on the matter of the antrum size and its relation to gastric emptying and weight-loss outcomes. The aim of the study is to evaluate the infuence of antrum size over gastric emptying and weight-loss outcomes. Methods Twenty-fve patients were prospectively randomized according to the distance between the frst fring and the pylorus: AR group (antrum resection—2 cm from the pylorus) and AP group (antrum preservation—5 cm from the pylorus). Gastric emptying (%GE) was evaluated by a gastric emptying scintigraphy before surgery, 2 months and 1 year after LSG. Antrum volume was measured using a MultiSlice CT Scan performed 2 months and 1 year after surgery. The percent of excess weight loss (%EWL) was calculated after 1 year follow-up. Results At 2 months after LSG the mean %GE was 69.7 ± 18 in the AR group and 72.8 ± 20 in the AP group (p = 0.69). At 1 year it was 66.5 ± 21 and 74.2 ± 16 in the AR and AP groups, respectively (p = 0.30). A signifcant accelerated gastric emptying was observed at 2 months (p = 0.025) and at 1 year (p = 0.013) in the AP group. Meanwhile in the AR group this increase was not signifcant (p = 0.12 at 2 months and p = 0.21 at 1 year). Diferences regarding the %EWL between groups were no statistically signifcant (p = 0.74). Conclusions After LSG there is a global tendency to an accelerated gastric emptying, although only signifcant in the antrum preservation group; however, no diferences were observed regarding the %EWL between groups after 1 year follow-up. Keywords Bariatric surgery · Sleeve gastrectomy · Gastric emptying scintigraphy · Pyloric antrum · Antrum size · Weight loss Laparoscopic sleeve gastrectomy (LSG) has increased in popularity in recent years as a defnitive bariatric procedure. It originated as the restrictive frst-stage procedure in high risk patients before duodenal switch or Roux-en-Y gastric bypass, but nowadays it has been established as a stand- alone bariatric operation due to its safety, feasibility, and remarkable results in terms of weight loss [1, 2]. LSG involves removing approximately 80% of the stom- ach, mainly the body and fundus, in order to reduce the gas- tric volume to 75–120 ml. The new narrow tube is designed to decrease appetite by reducing the distensibility of the new stomach thus increasing the intra-luminal pressure produc- ing the sensation of satiety with minimal oral intake [2]. Although the degree of restriction performed seems to play the most important role, the mechanisms of weight loss after and Other Interventional Techniques * Meritxell Garay mgaray@santpau.cat 1 Surgical Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain 2 Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain 3 Department of Radiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain 4 Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain 5 Department of Endocrinology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain