Is a "retained fundus" seen on postoperative upper gastrointestinal series after laparoscopic sleeve gastrectomy predictive of inferior weight loss?

Background: Postoperative upper gastrointestinal series (UGI) has never been shown to be effective in ruling out leaks or obstruction after gastric bypass or sleeve gastrectomy. In sleeve gastrectomies, UGI will define the shape of the sleeve and rule out a retained fundus that was not optimally excised during surgery.

Objectives: We aimed to investigate the impact of a "retained fundus" on weight loss to determine whether UGIs can be used to gauge success of the operation and predict outcome.

Setting: Urban community teaching hospital, United States.

Methods: Retrospective study analyzing routine UGIs performed on 203 consecutive patients. Exclusion criteria included low quality UGI (absence of a still image of complete fill with contrast), revisions from gastric band to sleeve, absence of weight-loss data, postoperative leak, and postoperative stenosis.

Results: A total of 149 patients were included. Mean excess weight loss at one year for groups 1 through 4 was 67.3%, 72.7%, 67.8%, and 65.9%, respectively. There was no significant statistical difference in excess weight loss between the optimal group and the group of both mild and severe retained fundus (P = .22). The weight loss remained equivalent even when comparing the optimal sleeves with only those with severe retained fundus (P = .19). There was a statistically significant difference in quality of sleeve gastrectomies on UGI with surgical experience showing less retained fundus on the UGIs (P = .006) in the latter half of the series.

Conclusion: Retained fundus does not seem to cause inferior weight loss in the early postoperative period. Thus, UGI cannot predict weight loss outcomes in the short term.