Abstract
Background
Laparoscopic sleeve gastrectomy (LSG) is an accepted bariatric procedure. Swallow studies (SS) after LSG are not uniform and display different patterns with regard to contrast passage through the gastric sleeve. The impact of immediate postoperative contrast transit time on weight loss has not been studied. The influence of immediate fluid tolerance on weight loss after LSG is herein reported.
Methods
Ninety-nine patients after LSG were included. There were 67 females, mean age 41 (range 17–67), mean BMI 44.4 (range 37–75). A routine SS was performed on postoperative day (POD) 1. Pattern of contrast transit was noted. Patients were followed-up in our bariatric clinic.
Results
Percent excess weight loss was significantly lower in the patients with rapid contrast passage (Group 1, n = 50) than those with delayed passage (Group 2, n = 49). Group 1 achieved 62, 58, and 53 % at 1, 2, and 3 years, respectively, while Group 2 attained 69, 74, and 75 % at the same time points (p = 0.05, 0.001, and 0.04, respectively). Group 1 patients displayed a negative weight loss trend after 1 year whereas Group 2 patients plateaued after 2 years.
Conclusions
Tolerance of fluid intake after LSG is crucial for patient recovery and discharge. Distinct radiologic appearance on POD 1 helps predict this behavior. Mid-term weight loss after LSG appears to be dependent on immediate postoperative contrast transit time, whereas patients with slow contrast passage tend to lose more weight. Long-term follow-up will reveal whether this finding will hold true.
Similar content being viewed by others
References
Ferrer-Marquez M, Belda-Lozano R, Ferrer-Ayza M. Technical controversies in laparoscopic sleeve gastrectomy. Obes Surg. 2012;22:182–7.
Keren D, Matter I, Rainis T, et al. Getting the most from the sleeve: the importance of post-operative follow-up. Obes Surg. 2011;21:1887–93.
Ortega E, Morinigo R, Flores L, et al. Predictive factors of excess body weight loss 1 year after laparoscopic bariatric surgery. Surg Endosc. 2012;26:1744–50.
Roa PE, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16:1323–6.
Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.
Dallal RM, Bailey L, Nahmias N. Back to basics--clinical diagnosis in bariatric surgery. Routine drains and upper GI series are unnecessary. Surg Endosc. 2007;21:2268–71.
Kolakowski Jr S, Kirkland ML, Schuricht AL. Routine postoperative upper gastrointestinal series after Roux-en-Y gastric bypass: determination of whether it is necessary. Arch Surg. 2007;142:930–4. discussion 934.
Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.
Goitein D, Goitein O, Feigin A, et al. Sleeve gastrectomy: radiologic patterns after surgery. Surg Endosc. 2009;23:1559–63.
NIH Conference. Gastrointestinal surgery for severe obesity. Consensus development conference panel. Ann Intern Med. 1991;115:956–61.
Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18:1083–8.
Bohdjalian A, Langer FB, Shakeri-Leidenmuhler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.
Buchholz V, Berkenstadt H, Goitein D, et al. Gastric emptying is not prolonged in obese patients. Surg Obes Relat Dis. 2012. doi:10.1016/j.soard.2012.03.008
Bernstine H, Tzioni-Yehoshua R, Groshar D, et al. Gastric emptying is not affected by sleeve gastrectomy—scintigraphic evaluation of gastric emptying after sleeve gastrectomy without removal of the gastric antrum. Obes Surg. 2009;19:293–8.
Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy—a "food limiting" operation. Obes Surg. 2008;18:1251–6.
Shah S, Shah P, Todkar J, et al. Prospective controlled study of effect of laparoscopic sleeve gastrectomy on small bowel transit time and gastric emptying half-time in morbidly obese patients with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010;6:152–7.
Gagner M. Leaks after sleeve gastrectomy are associated with smaller bougies: prevention and treatment strategies. Surg Laparosc Endosc Percutan Tech. 2010;20:166–9.
Rosenthal RJ. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8:8–19.
Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy–influence of sleeve size and resected gastric volume. Obes Surg. 2007;17:1297–305.
Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15:1124–8.
Goitein D, Lederfein D, Tzioni R, et al. Mapping of ghrelin gene expression and cell distribution in the stomach of morbidly obese patients-a possible guide for efficient sleeve gastrectomy construction. Obes Surg 2012;22:617–22.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Goitein, D., Zendel, A., Westrich, G. et al. Postoperative Swallow Study as a Predictor of Intermediate Weight Loss after Sleeve Gastrectomy. OBES SURG 23, 222–225 (2013). https://doi.org/10.1007/s11695-012-0836-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-012-0836-4