title: Observed Variability in Sleeve Gastrectomy Volume and Compliance Does Not Correlate to Postoperative Outcomes.
abstract: BACKGROUND
  Restrictive bariatric procedures reduce gastric capacity as a primary mechanism of action. Intraoperatively, surgeons observe variability in size and compliance of specimens. We hypothesized that higher gastric specimen volume or tissue compliance would respond better to restrictive procedures.
  
  
  METHODS
  Consecutive patients undergoing laparoscopic sleeve gastrectomy between September 2012 and September 2013 were enrolled. Specimens were insufflated at graduated pressure points creating pressure volume curves, and compliance was calculated. Postoperative weight loss and a hunger scores were recorded. Correlations were determined by Spearman correlation.
  
  
  RESULTS
  Eighty-four patients consented to enrollment. Mean age, weight, and body mass index (BMI) were 45 ± 12 years, 126 ± 23 kg, and 45.4 ± 6 m/kg2, respectively. The resected specimens varied in insufflated capacity from 0.3 to 1.8 (0.71 ± 0.32) L and compliance varied from 14.3 to 85.7 (36.1 ± 14.7) cc/mm Hg. Male patients had a larger greater curvature length (GCL) (P < 0.001), staple line length (SLL) (P = 0.03), gastric volume (GV) (P = 0.002), and gastric compliance (GC) (P < 0.001). Neither GV nor GC correlated to excess body weight loss (EBWL%) as hypothesized. There was an inverse correlation between hunger score and GV (P = 0.010). The mean 1-month, 3-month, 6-month, and 12-month EBWL was 17.4%, 33.2%, 43.7%, and 54.1%, respectively. Follow-up was 71.4% at 1 month, 39.3% at 3 months, 54.8% at 6 months, and 42.9% at 12 months.
  
  
  CONCLUSIONS
  Sleeve gastrectomy specimens exhibit nearly 6-fold variability in both volume and compliance. A large GC is anticipated in male and tall subjects. These observations do not appear to be correlated to %EBWL.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Toro
authors.forename: Ankit D
authors.initials: AD
authors.lastname: Patel
authors.forename: Nathaniel W
authors.initials: NW
authors.lastname: Lytle
authors.forename: Sebastian
authors.initials: S
authors.lastname: Perez
authors.forename: Lin
authors.initials: L
authors.lastname: Edward
authors.forename: Arvinpal
authors.initials: A
authors.lastname: Singh
authors.forename: S Scott
authors.initials: SS
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010349:Patient Compliance; D011184:Postoperative Period; D011446:Prospective Studies; D012371:Robotics; D017792:Surgical Stapling; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult