Outcomes of laparoscopic sleeve gastrectomy with and without antrectomy in severely obese subjects. Evidence from randomized controlled trials

ABSTRACT BACKGROUND Laparoscopic sleeve gastrectomy (SG) has been proven safe and effective in achieving weight loss. However, the distance from the pylorus where resection should begin has been debated. OBJECTIVES To compare the clinical outcomes of laparoscopic SG with antrum resection (AR) versus preservation (AP) for bariatric purposes by conducting a meta-analysis of randomized controlled trials (RCT). SETTING Academic Hospital, United States. METHODS PubMed and Cochrane Library were queried for RCTs from establishment to August 2020. The following key search terms were used: “sleeve gastrectomy” AND (“antrectomy” OR “antrum”) AND (“randomized” OR “random”). The following data were extracted: author, publication year, country, sample size, follow-up duration, and clinical outcomes, including weight-related: excess weight loss (EWL), total weight loss (TWL), body mass index (BMI), operation time, length of hospital stay, complication rates, and resolution of obesity-related comorbidities. RESULTS A total of nine unique RCTs including 492 AR and 385 AP patients were screened and included in the final quantitative analysis. Patients who underwent SG with AR showed higher EWL and TWL at 6 months (EWL: p 3, resolution of comorbidities (hypertension, diabetes, hyperlipidemia, arthritis/back pain), and de novo gastroesophageal reflux disease (GERD, p>0.05). AP was associated with a slightly shorter post-operative hospital stay (4.0 vs 3.1 days, p=0.039). CONCLUSION Laparoscopic SG with AR is associated with superior weight loss in the short-term when compared to AP. However, mid-term follow-up beyond one year showed no significant differences in BMI or incidence of de novo GERD.