Effects of 6cm versus 2cm Resection Margin from Pylorus on Excess Weight Loss & Complication Rate for Laparo- Scopic Sleeve Gastrectomy: A Nine-Year Experience

Abstract

Introduction: LSG is the gold standard sole bariatric procedure for morbid obesity. Small (2cm) and large (6cm) distance of resection margin from pylorus are both being used for neogastric sleeve formation however what is optimal distance remains controversial. Aims & Objectives: To assess excess weight loss results and complication rate with 6cm and 2cm distance of staple line from pylorus during a prolonged surveillance period. Place and Duration of Study: This retrospective cohort study was conducted at Fatima Memorial Hospital from Dec 2013 to Dec 2022 spanning 9 years. Material & Methods: Medical records of 50 morbidly obese patients aged 41- 50 yrs were segregated into two groups of 25 each based on the LSG procedure conducted. Group 1 had LSG with 6cm resection margin from pylorus while group 2 had a staple line distance of 2cm from pylorus for neogastric sleeve formation. The patients were subsequently followed up for excess weight loss (EXL) and BMI at 6 months, 1 year, 2 years, 3 years & 4-year interval. Data was entered and analyzed using SPSS version 21.P value ? 0.05 was considered significant. Results: EWL in Group 1 & 2 was 39.2± 6.77kg & 41.9± 4.35kg at 6 months,73.64± 6.49kg & 71.06± 7.77kg at 1 year, 65.52± 5.53kg & 63.92± 7.07kg at 2 years,58.16± 4.97kg & 57.28± 5.75kg at 3 years and 55.48± 3.39kg & 55.36± 3.72kg for 4 years were, not significant statistically. BMI in group 1 & 2 were 39.47± 5.11 & 35.88± 4.40 at 6 months, 29.22± 2.68 & 29.12± 2.00 at 1 year, 25.44± 1.96 & 24.73± 2.86 at 2 years, 22.84± 1.79 & 22.40±2.20 at 3 years and 21.66± 1.32, 21.67± 1.62 at 4 years were found to be statistically insignificant. Conclusion: With regards to extra weight loss, distance of resection margin from pylorus of 2cm or 6cm have identical effects but the latter has lowest complication incidence after 4 yrs of surveillance. Hence, a distance of 6cm is favoured to ensure safety of LSG for morbidly obese patients. And the findings of this study will help bariatric surgeons to improve technique of LSG in a safe and successful way for effective weight loss in morbidly obese patients.