title: Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study.
abstract: BACKGROUND
  Pre- and post-operative stomach volumes can be important determinants for effectiveness of laparoscopic sleeve gastrectomy (LSG) in causing weight loss. There is little existing data on the volumes of stomach preoperatively and that excised during LSG. This study was designed to evaluate the change in gastric volume after LSG using multi-detector CT and to correlate it with early post-operative weight loss.
  
  
  METHODS
  Twenty consecutive patients with BMI ≥ 40 kg/m(2) and medical comorbidities underwent LSG between October 2011 and October 2013 and were analysed prospectively. The pre-operative stomach volume was measured by MDCT done 1-3 days before the surgery. LSG was performed in the standard manner using a 36F bougie. The volume of excised stomach was measured by distending the specimen with saline. MDCT of the upper abdomen was repeated 3 months postoperatively to calculate the gastric sleeve volume. Weight loss and resolution of comorbidities were documented.
  
  
  RESULTS
  The mean pre-operative weight of patients was 123.90 kg, and the mean pre-operative stomach volume on MDCT was 1,067 ml. The stomach volume on pre-operative MDCT correlated with pre-operative weight and BMI. The mean volume of the excised stomach was 859 ml when measured by distension of the specimen and 850 ml on MDCT. After 3 months post surgery, the mean volume of gastric sleeve on MDCT was 217 ml, and the mean weight of the patients was 101.22 kg. The volume of the excised stomach calculated by MDCT correlated with the weight loss achieved 3 months postoperatively. However, no correlation was seen between the gastric sleeve volume 3 months postoperatively and weight loss during this period.
  
  
  CONCLUSIONS
  MDCT is a good method to measure gastric volume before and after LSG. Early post-operative weight loss (3 months) correlates well with the volume of the excised stomach but not with that of the gastric sleeve.
authors.affiliation: Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College, University of Delhi, New Delhi, 110002, India. profplal@gmail.com.|, B - 90 Swasthya Vihar, New Delhi, 110092, India. profplal@gmail.com.
authors.forename: Lal
authors.initials: L
authors.lastname: Pawanindra
authors.affiliation: Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College, University of Delhi, New Delhi, 110002, India. anubhav.vindal@gmail.com.
authors.forename: Anubhav
authors.initials: A
authors.lastname: Vindal
authors.affiliation: Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College, University of Delhi, New Delhi, 110002, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Midha
authors.affiliation: Department of Radiodiagnosis, Maulana Azad Medical College, University of Delhi, New Delhi, 110002, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Nagpal
authors.affiliation: Department of Radiodiagnosis, Maulana Azad Medical College, University of Delhi, New Delhi, 110002, India.
authors.forename: Alpana
authors.initials: A
authors.lastname: Manchanda
authors.affiliation: Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College, University of Delhi, New Delhi, 110002, India.
authors.forename: Jagdish
authors.initials: J
authors.lastname: Chander
mesh_terms: D000328:Adult; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009767:Obesity, Morbid / Q000601:surgery; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D013270:Stomach / Q000000981:diagnostic imaging* / Q000601:surgery; D015431:Weight Loss; D055815:Young Adult
keywords: Bariatric surgery; Gastric sleeve volume; Laparoscopic sleeve gastrectomy; MDCT; Volume of excised stomach; Weight loss