Antral Preserving Versus Antral Resecting Laparoscopic Sleeve Gastrectomy for Patients with Severe Obesity: A Randomized Controlled Trial.

Background: This study aimed to compare outcomes following antral preserving (AP) and antral resecting (AR) laparoscopic sleeve gastrectomy (LSG) in terms of weight loss, gastric emptying time, gastroesophageal reflux disease (GERD), resolution of associated medical problems, and complications.

Methods: Patients were prospectively randomized into two groups: the AR group (resection starting 2 cm from the pylorus) and the AP group (resection at 5 cm from the pylorus). Follow-up evaluations included assessments of weight loss using percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL), gastric emptying, GERD symptoms, associated medical problem resolution, residual gastric volume, and complications. Upper gastrointestinal endoscopy, gastric scintigraphy, and residual sleeve volumetry were conducted at 12 months.

Results: One hundred patients who met inclusion criteria were enrolled, with comparable baseline parameters such as BMI, age, and comorbidities between the groups. Ninety-five patients underwent randomization (49 in AP group and 46 in the AR group), and outcomes were compared. %EWL was higher in the AR group at 12 and 24 months, although this difference was not statistically significant (AP vs. AR: 64.5 ± 20.6 vs. 72.9 ± 20.8, p = 0.1, and 66.3 ± 21.8 vs. 74 ± 22.2, p = 0.2, respectively). %TWL at 12 months was significantly different between the groups (AP: 28.4 ± 6.4 vs. AR: 32 ± 8, p = 0.01), as was %TWL at 24 months (AP: 29.1 ± 8.4 vs. AR: 33 ± 8.3, p = 0.01). Gastric emptying increased postoperatively in both groups, with significantly higher residual gastric volume in the AP group. Reflux symptoms decreased in both groups compared to baseline, and associated medical problem resolution and major complication rates were similar between the groups.

Conclusions: AR-LSG leads to better weight loss without increasing reflux symptoms compared to AP-LSG. Both procedures showed similar resolution of associated medical problems and complication rates.

Trial Registration: CTRI (CTRI/2018/08/015191).