Comparative study between antral resection and antral preservation during laparoscopic sleeve gastrectomy for morbid obese patients: A prospective randomized clinical controlled trial

Purpose
The aim of this study was to compare between antral resection (gastrectomy begins 2 cm from pylorus) and antral preservation (gastrectomy begins 6 cm from pylorus) during laparoscopic sleeve gastrectomy regarding the weight loss, postoperative complications, and nutritional and elemental deficiencies.
Patients and methods
This was a randomized controlled trial, in which 40 adult obese patients (assigned to undergo laparoscopic sleeve gastrectomy) were randomly allocated into two groups: one group was assigned to antral resection (gastrectomy begins 2 cm from pylorus), whereas the other group was assigned to antral preservation (gastrectomy begins 6 cm from pylorus). Weight and BMI of the participants was measured during follow-up at 3, 6, and 12 months to compare the weight loss between the two groups. Other outcomes that were compared between the two groups included resolution of comorbidities, gastric emptying, short-term postoperative complications, and nutritional deficiencies (iron, vitamin b12, and calcium).
Results
There were no significant differences between the antral resection and antral preservation groups regarding postoperative complications (both short term and long term), resolution of comorbidities, or weight loss. The only significant difference was in the postoperative gastric emptying time, which was significantly delayed in the antral resection group (=0.02).
Conclusions
The surgical approach regarding the size of the antrum does not affect the safety and postoperative complications, but it is still not clear whether or not there is a difference regarding the weight loss. Our study suggests that there is no significant difference in the weight loss after surgery during the first year of follow-up. The significant difference in postoperative gastric emptying shows the importance of the pyloric antrum in the normal physiology of the stomach.