title: Radical resection of the pyloric antrum and its effect on gastric emptying after sleeve gastrectomy.
abstract: BACKGROUND
  The surgical technique of laparoscopic sleeve gastrectomy (LSG) has not been fully standardized yet and there is the unresolved question of what is the optimum size of retained pyloric antrum. The aim of our research was to prove that even after a radical resection of the pyloric antrum the physiological stomach evacuation function can still be preserved.
  
  
  METHODS
  Our study was based on 12 patients, who were randomly divided into two groups. Patients undergoing radical antrum resection (RA group) underwent gastric emptying scintigraphy to determine the evacuation half-time (T1/2) and food retention in the 90th minute of the test (%GE) both before the operation and 3 months afterward. Patients in whom the antrum was preserved (PA group) served as a control group for comparison of postoperative weight loss (in kilogram), decrease in body mass index (BMI), and decline in excess weight (%EWL). The resulting changes were statistically processed.
  
  
  RESULTS
  In the RA group, the average time T1/2 declined from 57.5 to 32.25 min (p = 0.016) and average retention %GE dropped from 20.5 to 9.5% (p = 0.073). Differences in the average values of weight, BMI, or %EWL between both groups were of no statistical significance (p > 0.8).
  
  
  CONCLUSIONS
  In the RA group, an increase in gastric emptying postoperatively was noted. Complications such as failure of stomach evacuation were not observed in the RA group. Our results suggest that even more radical resection of the pyloric antrum performed by LSG is possible without concerns of postoperative disorder of the stomach evacuation function.
authors.affiliation: First Surgical Department, General Faculty Hospital and First Faculty of Medicine, Charles University, U nemocnice 2, 128 08, Prague 2, Czech Republic. david1m@volny.cz
authors.forename: David
authors.initials: D
authors.lastname: Michalsky
authors.forename: Petr
authors.initials: P
authors.lastname: Dvorak
authors.forename: Jaromir
authors.initials: J
authors.lastname: Belacek
authors.forename: Mojmir
authors.initials: M
authors.lastname: Kasalicky
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015992:Body Mass Index; D001835:Body Weight; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D010865:Pilot Projects; D011706:Pyloric Antrum / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011877:Radionuclide Imaging; D016896:Treatment Outcome; D015431:Weight Loss