Correlation of weight loss with residual gastric volume and morphology after sleeve gastrectomy: A CT-Based Analysis

Correlation of weight loss with residual gastric volume and morphology after sleeve gastrectomy: A CT-Based Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Correlation of weight loss with residual gastric volume and morphology after sleeve gastrectomy: A CT-Based Analysis Mahmoud EL Azawy, Islam Taha, Ayman Kamal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6797676/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Laparoscopic sleeve gastrectomy (LSG) has been accepted as a primary bariatric procedure. The aim of the study was to evaluate the volume and the morphologies of remnant stomachs after LSG and their association with weight loss. Methods Twenty patients who underwent Laparoscopic sleeve gastrectomy (LSG) were followed prospectively and evaluated at 12 months after operation using computed tomography CT with 3D reconstruction to evaluate the shape and volume of the residual stomach after LSG. Total sleeve volume (TSV), tube volume (TV), antral volume (AV) and tube/antral volume ratio (TAVR) were included. Results Mean %EWL (excess weight loss) at 12 months postop was 57 .57 ± 15.82 , The majority of sleeve morphology was tubular sleeve (35%) and mean TSV, TV, AV, and TAVR were 376.39 ± 114.2 cc, 194.81 ± 65.7 cc, 179.09 ± 58.4 cc ,1.48 ± 0.51 respectively. Dumbbell Shaped sleeve was significantly associated with Vomiting and protein intolerance, p= (0.013 ,0.018). No significant association between morphology of sleeve and EWL, p = .07 but tubular sleeve had adequate weight loss. TV and T/A volume were significantly higher among patients who had dumping, p = 0.004, 0.028 respectively. A V was significantly lower in patients with protein intolerance, p = 0.023 . TSV was not correlated significantly with %EWL at 12 months postop (r = 0.1, p = 0.64) but patients with lower TV showed significantly adequate weight loss , p = 0.021 Conclusions Although there is no clear association between sleeve morphology or volume and EWL at 12 months, tubular sleeve and lower TV had adequate weight loss. shape Sleeve gastrectomy inadequate weight loss volumetry Figures Figure 1 Figure 2 Figure 3 Introduction Laparoscopic sleeve gastrectomy (LSG) has been accepted as a primary bariatric procedure. 1 There is a significant heterogeneity in weight loss after LSG although patients rarely regain weight to their preoperative levels, long-term weight regain occurs in approximately 14–37% of cases. As a result, about 11.8% of patients may require revisional surgery within five years following laparoscopic sleeve gastrectomy (LSG). 2 Causes of failure to achieve adequate excess loss or of weight regain remain a subject of debate; most of the literature emphasizes the role of the volume of the gastric remnant, others consider the resultant sleeve as a complex anatomical shape with a cylindrical proximal component (gastric body) and a truncated conical distal portion (the antrum). 3 Volumetry of the residual stomach after LSG using Computerized Tomography (CT) is a more reliable technique and is used to study the association between weight loss and residual gastric volume RGV 4 , however the results vary across different studies. 5 Regarding the timing of CT volumetry following LSG, there was also marked variability, with time of assessment ranging from 7 days to 36 months. 6 In our study, we used the CT volumetry technique to evaluate the shape and volume of the residual stomach after LSG. Study AIM AND OBJECTIVES The aim of the study was to evaluate the volume and the morphologies of remnant stomachs after LSG and their association with weight loss. Methodology Twenty patients who underwent LSG were evaluated prospectively at 12 months after operation using computed tomography CT with 3D reconstruction. This work has been reported in line with the STROCSS criteria. 7 The surgical procedure in all cases was standardized and two surgeons participated in all these cases, either as main surgeon or as first assistant. A four-port technique were used; a 36-French bougie was employed for calibration and after separating the greater omentum from the stomach, gastric transection was started from 4 cm proximal to the pylorus using a surgical stapler with green loads in the two initial firings and blue loads for the next applications, up to a point about 1 cm lateral to the angle of His. The last 2 loads of staple line were sutured with polydioxanone 2–0. The patients were clinically evaluated at 7 and 15 days after operation then every month in the first year. CT with 3D reconstruction were performed at 12th month and weight loss parameters were recorded (body mass index in Kg/m2) (BMI), excess weight loss (EWL). For the realization of the CT scan, all patients had at least 8 hours of fasting period; they were given a single dose (one packet 4 mg) of effervescent Sodium Bicarbonate granules packets diluted in 5 ml of water to distend the gastric remnant with carbon dioxide. The distention that was obtained was standardized using the same preparation and technique in every case. the tomographic images were acquired in supine position on the table before taking the effervescent and immediately after swallowing the effervescent solution, then the patients laid in prone position. The 3D collection of reconstructed images was transferred via a network to a Philips Intellispace workstation. Two-dimensional (2D) axial pictures were the primary data source for analysis of images.3D Multiplanar reformatted (MPR) and virtual gastroscopy (VG) images were created. The total sleeve volume (TSV) from the cardia to the pylorus, the proximal tube volume ( TV) from cardia to incisura and the antral volume ( AV) were estimated after multiplanar reconstruction and 3D volume rendering. Data management Statistical analysis Version 20.0 of the IBM SPSS application was utilized to describe quantitative data, the range (minimum and maximum), mean, and standard deviation were used. Qualitative data are presented as frequency and percentage and were compared by Chi-square test. P value < 0.05 were considered significant. Results Mean ± SD of age was 37.55±10.79, females were majority with 85.0%, mean ± SD of EWL at 12 months postoperative was 57.57±15.82. Concomitant laparoscopic cholecystectomy was done in 6 patients 30%. (table 1,2) Sleeve shapes were classified as dumbbell shape (A): stomach with dilated portions proximally and distally and narrow in the middle, upper pouch(B): proximal dilation of the sleeve, lower pouch(C): upper portion of sleeve but retention of a good portion of antrum, Tubular (D): uniform tube-shaped stomach, and dilated sleeve (E). The majority was tubular sleeve (35%) (table 3), Fig.1. Mean ± SD of TSV was 376.39±114.2 cc, TV 194.81±65.7 cc, AV 179.09±58.4 cc and T/A v ratio 1.48±0.51. (table 4) Postoperative follow up showed one case had gall stones, 2 cases had dumping also vomiting occurred in 2 cases, also 9 cases had protein intolerance. Mean of BMI significantly decreased from 50.0±6.93 to 35.45±5.87 at 12 th month follow up, p <.001, hypertension significantly decreased p=.012, 3 patients had gastroesophageal reflux(GERD) 15%. (table 5,6,7) Shape A was significantly associated with vomiting and protein intolerance, p= (0.013 ,0.018) respectively also E shape was significantly associated with protein intolerance, p = 0.018. No significant association between morphology of sleeve and EWL, p = .07 but type D associated with highest EWL 69.35±11.19 ( table 8,9) We divided the patients into adequate EWL ≥ 50% and inadequate EWL < 50%. We reported that there was no significant association between adequate weight loss and shape, p=0.11 but all patients of type D had adequate weight loss and, no significant association between GERD and shape, p = 0.55. (table 10,11) TV and T/A volume were significantly higher among patients who had dumping, p = 0.004, 0.028 (table 12). Total volume & Tubal v were significantly lower among cases with vomiting=0.001, 0.019. Antral V was significantly lower in patients with protein intolerance , p=0.023 (table 13,14). No significant correlation between EWL and volume, TSV: r= 0.1, p=0.64, TV: r = 0.28, p=0.22 AV: r=0.24, p-0.29 and T/A V: r=0.26, p=0.25, but patients with lower TV showed significantly adequate weight loss, p=0.021 (table 15,16), Fig.2. ROC curve for suggested cutoff of TV for detection of adequate weight loss was <201.5 cc with sensitivity 83.3% and specificity 60.0%. Fig.3, (table 17) No significant relation between GERD and volume (TSV, TV, AV, T/A V) p=.3,.9,.5,.8 respectively (table 18) Discussion The explanation of inadequate EWL after LSG is controversial. RGV was studied as possible cause of inadequate weight loss, however weight loss and food tolerance after LSG is not only attributable to the restrictive effect of RGV, but also to the certain morphological and anatomical changes of the new stomach. Hanssen A et al and Robert M et al measured RGV at 3 months by CT volumetry and positive correlation was reported with the EWL% either at 6 months or 18 months respectively. 2 , 3 . Also, Robert M et al reported that the mean RGV of the whole population after 3 months was 221 ± 11 cc and the estimated residual antrum volume on CT volumetry correlated with the weight loss and not the volume of the rest of the sleeve. 3 Vidal et al. described a significant increase in RGV (124.8 ± 58.7 and 188.6 ± 76.4 mL at 1 and 12 months respectively p = 0.001). The %EWL at 18 months was inversely correlated with RGV at 12 months p = 0.006. 8 Deguines et al reported the mean RGV was 255 cc after 2years furthermore they found better weight loss in patients with a lower RGV when evaluated 24–36 months postoperatively. 9 On the contrary study by Disse et al assessed RGV at 3 months and 12 months postoperatively and observed more favorable weight loss in patients without elevated RGV, however, the findings did not reach statistical significance, and no definitive correlation between RGV and weight loss was established. and the dilatation of the gastric sleeve was not necessarily linked to insufficient weight loss p = 0.42. 4 RGV increased from 220 ± 12 at 3months, to 300 ± 17 at 12 months p < 0.00001 which was like our RGV at 12 months. 4 Their technique was similar to Robert M et al with a less radical antrectomy starting at 5 cm from pylorus but in our study the starting point of stapling was 3 cm from pylorus. 3 Braghetto et al reported similar early RGV to previous studies, but there was no correlation between RGV and EWL over 24–36 months. They described post-operative increase in RGV measured at 3 days and 24 months after LSG from 116.2 ± 78.24 to 254 ± 56.8 respectively. 10 Baumann et al did not find any correlation between the RGV and weight loss 12 months following LSG. RGV correlated significantly with the time interval after surgery. EWL at 12 month was similar to our study 55.9 ± 17.4% although RGV was 186.5 ± 88.4 ml lesser than our RGV. So, it is clear that at least to a certain extent this initial dilation seems to be a normal behavior after LSG and was not correlated with insufficient weight loss. 11 Although most patients in the previous studies who dilated their sleeve had early smaller RGV and similar surgical technique indicating that sleeve dilatation could be an adaptive process Moreover, the role of high pressure in the proximal narrow gastric tube could contribute to its enlargement especially if there is abnormal sleeve design. It seems critical to understand RGV anatomy which is divided into tubal volume and antral volume to assess its functional and morphologic features. Choi et al reported that the mean TSV, TV, AV, and T/A v were 188.3 ± 67.3 ml, 81.3 ± 38.5 ml. 107.0 ± 45.1 ml, and 0.846 ± 0.514 respectively, RGV was not correlated significantly with %TWL at 12 months postop (r = − 0.140, p = 0.164). The only significant difference found was that T/A v was greater in patients with a %TWL of < 25% (suboptimal weight loss). 12 In this study our RGV was bigger than Choi et al and other studies, we think that the cause was not the calibration tube, or the starting point of stapling but the dietary habits of our patients. No significant correlation between EWL and volume, TSV: r = 0.1,p = 0.64 ,TV: r = 0.28,p = 0.22 AV: r = 0.24,p = 0.29, T/A V: r = 0.26,p = 0.25.Similar to Choi et al study we reported that TV in the first 12 months played important role for weight loss ,we found the patients with higher TV showed significantly inadequate weight loss ,p = 0.021. Our ROC curve for suggested cutoff of TV for detection of adequate weight loss was < 201.5 cc with sensitivity 83.3% and specificity 60.0%. We reported TSV and Tv were significantly lower among cases with vomiting p = 0.001, 0.019 respectively and A V was significantly lower in patients with protein intolerance, p = 0.023. Similar to Choi et al also they reported positive correlation between total food tolerance score vs. TV (r = 0.237, p = 0.018), AV (r = 0.269, p = 0.007), and TSV (r = 0.316, p = 0.001). In contrast we found TV and T/A volume were significantly higher among patients had dumping, p = 0.004, 0.028 respectively so we observed that not only the lower size of the residual antrum but also the ratio of tubal to antrum size may play important role in protein tolerance and dumping with decreased satiety in these patients. In our study there was no significant association between morphology of sleeve and EWL, p = .07 but tubular sleeve associated with highest EWL 69.35 ± 11.19. We reported that there was no significant association between adequate weight loss and shape, p = 0.11 but all patients of tubular sleeve had adequate weight loss. Few studies have looked at the final sleeve shape as it relates to outcomes after weight loss surgery. A study by Alhaj et al assessed sleeve shape by upper gastrointestinal (UGI) study. the majority was lower pouch 39.2% unlike our study the majority was tubular shape 35%. The study showed a trend toward decreased reflux and improved weight loss at 12 months with the lower pouch shape. 13 Similar results in our study we reported lower sized antrum in relation to tubal volume precipitate to dumping with decreased sensation of satiety p = 0.028. We reported that Dumbbell shaped sleeve was significantly associated with Vomiting and protein intolerance, p= (0.013 ,0.018) respectively also dilated sleeve was surprising significantly associated with protein intolerance, p = 0.018, so it may be because of bad dietary habits in these group of patients who suffered from protein intolerance. We reported 3 cases of gerd post operative one case was dumbbell shape ,other 2 cases had higher t/a ratio 2.1,2.5.so restriction either functional or mechanical at incisura increases reflux symptoms and also similar to Alhaj et al study lower size antrum or higher T/A volume may play a role in gerd symptoms however, statistical significance was not achieved due to the limited number of the patients. Similar results by Toro et al study revealed by (UGI) study 1 year after LSG that UP shape had the higher severity of reflux symptoms (P = 0.02). similar to our study, The T shape was the most common subtype 37%, no statistically significant differences regarding weight loss and shape. 14 There were some limitations in our study including the short-term follow-up (1 year) as RGV may increase in some patients in the long-term follow-up and the relatively small number of cases. Conclusion There is no clear association between the final sleeve morphology or RGV and EWL at 12 months but gastric sleeve shape and the volumes of the new stomach which divided into tubal and antral parts and the ratio between them on the CT volumetry may predict clinical outcomes as the tubular shaped had highest EWL and dumbbell shaped significantly associated with protein intolerance and vomiting. T/A volume and lower antrum had dumping, and protein intolerance respectively also higher TV had significant inadequate weight loss, so this group of patients must remain under close nutritional indications to avoid regain of body weight. Declarations Availability of data and materials All datasets used and analyzed are available from the corresponding author upon reasonable request . Acknowledgements None. Funding Declaration The authors received no financial support for the research. Ethics declarations This study is in accordance with the Declaration of Helsinki . The approval was given by the research ethics committee of faculty of medicine of Helwan university, Egypt, Serial 84-2024. Each participant in the study signed an informed consent upon his agreement on participating in the study after thorough explanation of the aim and beneficial outcomes of the study. Patient details were kept strictly confidential throughout the study. Maintaining the privacy of participants was ensured by allowing only the study team to be able to access their data. All patients were totally free of accepting or refusing participation in the study with complete equal care to both. Codes were used instead of names for identification of participants. Consent to participate Informed consent was obtained from every human participant in the study. Consent for publication Not Applicable. Conflicts of interest disclosure : The authors declare that they have no competing interests for this manuscript. Provenance and peer review Not commissioned, externally peer reviewed. Clinical registration number Not Applicable Author Contribution Mahmoud El Azawy was the main principal author, contributed the data collection, analysis, interpretation and wrote the main manuscript, Islam Taha performed the volumetry studies, Ayman kamal revised the manuscript. All authors read and approved the final version of the manuscript. References Singla V, et al. Correlation of weight loss with residual gastric volume on computerized tomography in patients undergoing sleeve gastrectomy: a systematic review. Clin Obes. 2020;10:e12394. Hanssen A, Plotnikov S, Acosta G, et al. 3D Volumetry and its correlation between postoperative gastric volume and excess weight loss after sleeve gastrectomy. Obes Surg. 2018;28:775–80. Robert M, Pasquer A, Pelascini E, Valette P-J, Gouillat C, Disse E. Impact of sleeve gastrectomy volumes on weight loss results: a prospective study. Surg Obes Relat Dis. 2016;12:1286–91. Disse E, Pasquer A, Pelascini E, et al. Dilatation of sleeve gastrectomy: myth or reality? Obes Surg. 2017;27:30–7. Nam K, Hyun SJ, Choi. Morphologic Study of Gastric Sleeves by CT Volumetry at One Year after Laparoscopic Sleeve Gastrectomy. J Metabolic Bariatr Surg. 2020;9(2):42. Golomb I, Ben David M, Glass A, et al. Long-term metabolic effects of laparoscopic sleeve gastrectomy. JAMA Surg. 2015;150(11):1051–7. Rashid R, Sohrabi C, Kerwan A, et al. The STROCSS 2024 guideline: strengthening the reporting of cohort, cross-sectional and case-control studies in surgery. Int J Surg. 2024;110(6):3151–65. Vidal P, Ramón JM, Busto M, Domínguez-Vega G, Goday A, Pera M, Grande L. Residual gastric volume estimated with a new radiological volumetric model: relationship with weight loss after laparoscopic sleeve gastrectomy. Obes Surg. 2014;24:359–63. Deguines JB, Verhaeghe P, Yzet T, Robert B, Cosse C, Regimbeau JM. Is the residual gastric volume after laparoscopic sleeve gastrectomy an objective criterion for adapting the treatment strategy after failure? Surg Obes Relat Dis. 2013;9(5):660–6. Braghetto I, Cortes C, Herquiñigo D, Csendes P, Rojas A, Mushle M, Papapietro K. Evaluation of the radiological gastric capacity and evolution of the BMI 2–3 years after sleeve gastrectomy. Obes Surg. 2009;19:1262–9. Baumann T, Grueneberger J, Pache G, Kuesters S, Marjanovic G, Kulemann B, Karcz WK. Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration. Surg Endosc. 2011;25:2323–9. Choi SJ, Kim SM. Intrathoracic migration of gastric sleeve affects weight loss as well as GERD–an analysis of remnant gastric morphology for 100 patients at one year after laparoscopic sleeve gastrectomy. Obes Surg. 2021;31:2878–86. Alhaj Saleh A, Janik MR, Mustafa RR, Alshehri M, Khan AH, Motamedi K, Khaitan SM, L. Does sleeve shape make a difference in outcomes? Obes Surg. 2018;28:1731–7. Toro JP, Lin E, Patel AD, Davis Jr SS, Sanni A, Urrego HD, Moreno CC. Association of radiographic morphology with early gastroesophageal reflux disease and satiety control after sleeve gastrectomy. J Am Coll Surg. 2014;219(3):430–8. Tables Tables 1 to 18 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6797676","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475872106,"identity":"447a55aa-5409-4490-8d90-0916dcf8ee0c","order_by":0,"name":"Mahmoud EL Azawy","email":"data:image/png;base64,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","orcid":"","institution":"Helwan University","correspondingAuthor":true,"prefix":"","firstName":"Mahmoud","middleName":"EL","lastName":"Azawy","suffix":""},{"id":475872107,"identity":"f925e584-2606-47b3-b84e-adcf948639a7","order_by":1,"name":"Islam Taha","email":"","orcid":"","institution":"Helwan University","correspondingAuthor":false,"prefix":"","firstName":"Islam","middleName":"","lastName":"Taha","suffix":""},{"id":475872108,"identity":"fda7d38f-0c02-4391-b93d-899c99a7c0da","order_by":2,"name":"Ayman Kamal","email":"","orcid":"","institution":"Helwan University","correspondingAuthor":false,"prefix":"","firstName":"Ayman","middleName":"","lastName":"Kamal","suffix":""}],"badges":[],"createdAt":"2025-06-01 21:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6797676/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6797676/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85735256,"identity":"977528f0-b9be-4ed4-b6bb-0b3f678da1af","added_by":"auto","created_at":"2025-07-01 07:56:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":271590,"visible":true,"origin":"","legend":"\u003cp\u003e3D reconstruction with volumetry: dumbbell shape (A), upper pouch(B), lower pouch(C), Tubular (D) and dilated sleeve (E).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6797676/v1/77034c6b7844263e9cf14f64.png"},{"id":85735254,"identity":"95a1bc4c-3bea-44ea-88b0-b8a6d8cc29d5","added_by":"auto","created_at":"2025-07-01 07:56:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23651,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdequate weight loss\u003c/strong\u003e group was sig lower regard Tubal V\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6797676/v1/286766bd52a4db36c09855ae.png"},{"id":85736015,"identity":"d68d38f1-86a7-4330-b93d-2a09f3214c89","added_by":"auto","created_at":"2025-07-01 08:04:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":31557,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve for suggested cutoff of Tubal V for detection of adequate weight loss\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6797676/v1/a29ff402240444430aaec4db.png"},{"id":85993290,"identity":"eeb42c7c-0feb-451e-97e0-06e69ecc39c9","added_by":"auto","created_at":"2025-07-04 05:38:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":905977,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6797676/v1/90faa9fc-bd1d-4409-b3c7-616be5e4d03d.pdf"},{"id":85735257,"identity":"f8c60ad2-3a47-4cd2-8c82-5fa3809a0fbc","added_by":"auto","created_at":"2025-07-01 07:56:59","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":41429,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6797676/v1/2e7ce524a295fc9ddd65f305.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlation of weight loss with residual gastric volume and morphology after sleeve gastrectomy: A CT-Based Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLaparoscopic sleeve gastrectomy (LSG) has been accepted as a primary bariatric procedure.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003eThere is a significant heterogeneity in weight loss after LSG although patients rarely regain weight to their preoperative levels, long-term weight regain occurs in approximately 14\u0026ndash;37% of cases. As a result, about 11.8% of patients may require revisional surgery within five years following laparoscopic sleeve gastrectomy (LSG). \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCauses of failure to achieve adequate excess loss or of weight regain remain a subject of debate; most of the literature emphasizes the role of the volume of the gastric remnant, others consider the resultant sleeve as a complex anatomical shape with a cylindrical proximal component (gastric body) and a truncated conical distal portion (the antrum). \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eVolumetry of the residual stomach after LSG using Computerized Tomography (CT) is a more reliable technique and is used to study the association between weight loss and residual gastric volume RGV \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, however the results vary across different studies. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Regarding the timing of CT volumetry following LSG, there was also marked variability, with time of assessment ranging from 7 days to 36 months. \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In our study, we used the CT volumetry technique to evaluate the shape and volume of the residual stomach after LSG.\u003c/p\u003e\n\u003ch3\u003eStudy AIM AND OBJECTIVES\u003c/h3\u003e\n\u003cp\u003eThe aim of the study was to evaluate the volume and the morphologies of remnant stomachs after LSG and their association with weight loss.\u003c/p\u003e "},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cp\u003eTwenty patients who underwent LSG were evaluated prospectively at 12 months after operation using computed tomography CT with 3D reconstruction. This work has been reported in line with the STROCSS criteria. \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe surgical procedure in all cases was standardized and two surgeons participated in all these cases, either as main surgeon or as first assistant.\u003c/p\u003e \u003cp\u003eA four-port technique were used; a 36-French bougie was employed for calibration and after separating the greater omentum from the stomach, gastric transection was started from 4 cm proximal to the pylorus using a surgical stapler with green loads in the two initial firings and blue loads for the next applications, up to a point about 1 cm lateral to the angle of His. The last 2 loads of staple line were sutured with polydioxanone 2\u0026ndash;0.\u003c/p\u003e \u003cp\u003eThe patients were clinically evaluated at 7 and 15 days after operation then every month in the first year. CT with 3D reconstruction were performed at 12th month and weight loss parameters were recorded (body mass index in Kg/m2) (BMI), excess weight loss (EWL).\u003c/p\u003e \u003cp\u003eFor the realization of the CT scan, all patients had at least 8 hours of fasting period; they were given a single dose (one packet 4 mg) of effervescent Sodium Bicarbonate granules packets diluted in 5 ml of water to distend the gastric remnant with carbon dioxide. The distention that was obtained was standardized using the same preparation and technique in every case. the tomographic images were acquired in supine position on the table before taking the effervescent and immediately after swallowing the effervescent solution, then the patients laid in prone position.\u003c/p\u003e \u003cp\u003eThe 3D collection of reconstructed images was transferred via a network to a Philips Intellispace workstation. Two-dimensional (2D) axial pictures were the primary data source for analysis of images.3D Multiplanar reformatted (MPR) and virtual gastroscopy (VG) images were created.\u003c/p\u003e \u003cp\u003eThe total sleeve volume \u003cb\u003e(TSV)\u003c/b\u003e from the cardia to the pylorus, the proximal tube volume (\u003cb\u003eTV)\u003c/b\u003efrom cardia to incisura and the antral volume (\u003cb\u003eAV)\u003c/b\u003ewere estimated after multiplanar reconstruction and 3D volume rendering.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData management\u003c/h3\u003e\n\u003cp\u003eStatistical analysis Version 20.0 of the IBM SPSS application was utilized to describe quantitative data, the range (minimum and maximum), mean, and standard deviation were used. Qualitative data are presented as frequency and percentage and were compared by Chi-square test. P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eMean \u0026plusmn; SD of age was 37.55\u0026plusmn;10.79, females were majority with 85.0%, mean \u0026plusmn; SD of EWL at 12 months postoperative was 57.57\u0026plusmn;15.82. Concomitant laparoscopic cholecystectomy was done in 6 patients 30%. (table 1,2)\u003c/p\u003e\n\u003cp\u003eSleeve shapes were classified as dumbbell shape (A): stomach with dilated portions proximally and distally and narrow in the middle, upper pouch(B): proximal dilation of the sleeve, lower pouch(C): upper portion of sleeve but retention of a good portion of antrum, Tubular (D): uniform tube-shaped stomach, and dilated sleeve (E). The majority was tubular sleeve (35%) (table 3), Fig.1. Mean \u0026plusmn; SD of TSV was 376.39\u0026plusmn;114.2 cc, TV 194.81\u0026plusmn;65.7 cc, AV 179.09\u0026plusmn;58.4 cc and T/A v ratio 1.48\u0026plusmn;0.51. (table 4)\u003c/p\u003e\n\u003cp\u003ePostoperative follow up showed one case had gall stones, 2 cases had dumping also vomiting occurred in 2 cases, also 9 cases had protein intolerance. Mean of BMI significantly decreased from 50.0\u0026plusmn;6.93 to 35.45\u0026plusmn;5.87 at 12\u003csup\u003eth\u003c/sup\u003e month follow up, p \u0026lt;.001, hypertension significantly decreased p=.012, 3 patients had gastroesophageal reflux(GERD) 15%. (table 5,6,7)\u003c/p\u003e\n\u003cp\u003eShape A was significantly associated with vomiting and protein intolerance, p= (0.013 ,0.018) respectively also E shape was significantly associated with protein intolerance, p = 0.018. No significant association between morphology of sleeve and EWL, p = .07 but type D associated with highest EWL 69.35\u0026plusmn;11.19\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003etable 8,9)\u003c/p\u003e\n\u003cp\u003eWe divided the patients into adequate EWL \u0026ge; 50% and inadequate EWL \u0026lt; 50%. We reported that there was no significant association between adequate weight loss and shape, p=0.11 but all patients of type D had adequate weight loss and, no significant association between GERD and shape, p = 0.55. (table 10,11)\u003c/p\u003e\n\u003cp\u003eTV and T/A volume were significantly higher among patients who had dumping, p = 0.004, 0.028 (table 12). Total volume \u0026amp; Tubal v were significantly lower among cases with vomiting=0.001, 0.019. Antral V was significantly lower in patients with protein intolerance\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003ep=0.023 (table 13,14). No significant correlation between EWL and volume, TSV: r= 0.1, p=0.64, TV: r = 0.28, p=0.22 AV: r=0.24, p-0.29 and T/A V: r=0.26, p=0.25, but patients with lower TV showed significantly adequate weight loss, p=0.021 (table 15,16), Fig.2. ROC curve for suggested cutoff of TV for detection of adequate weight loss was \u0026lt;201.5 cc with sensitivity 83.3% and specificity 60.0%. Fig.3, (table 17)\u003c/p\u003e\n\u003cp\u003eNo significant relation between GERD and volume (TSV, TV, AV, T/A V) p=.3,.9,.5,.8 respectively (table 18)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe explanation of inadequate EWL after LSG is controversial. RGV was studied as possible cause of inadequate weight loss, however weight loss and food tolerance after LSG is not only attributable to the restrictive effect of RGV, but also to the certain morphological and anatomical changes of the new stomach.\u003c/p\u003e \u003cp\u003eHanssen A et al and Robert M et al measured RGV at 3 months by CT volumetry and positive correlation was reported with the EWL% either at 6 months or 18 months respectively. \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Also, Robert M et al reported that the mean RGV of the whole population after 3 months was 221\u0026thinsp;\u0026plusmn;\u0026thinsp;11 cc and the estimated residual antrum volume on CT volumetry correlated with the weight loss and not the volume of the rest of the sleeve.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Vidal et al. described a significant increase in RGV (124.8\u0026thinsp;\u0026plusmn;\u0026thinsp;58.7 and 188.6\u0026thinsp;\u0026plusmn;\u0026thinsp;76.4 mL at 1 and 12 months respectively p\u0026thinsp;=\u0026thinsp;0.001). The %EWL at 18 months was inversely correlated with RGV at 12 months \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006. \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Deguines et al reported the mean RGV was 255 cc after 2years furthermore they found better weight loss in patients with a lower RGV when evaluated 24\u0026ndash;36 months postoperatively. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOn the contrary study by Disse et al assessed RGV at 3 months and 12 months postoperatively and observed more favorable weight loss in patients without elevated RGV, however, the findings did not reach statistical significance, and no definitive correlation between RGV and weight loss was established. and the dilatation of the gastric sleeve was not necessarily linked to insufficient weight loss p\u0026thinsp;=\u0026thinsp;0.42. \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e RGV increased from 220\u0026thinsp;\u0026plusmn;\u0026thinsp;12 at 3months, to 300\u0026thinsp;\u0026plusmn;\u0026thinsp;17 at 12 months p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001 which was like our RGV at 12 months. \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Their technique was similar to Robert M et al with a less radical antrectomy starting at 5 cm from pylorus but in our study the starting point of stapling was 3 cm from pylorus. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Braghetto et al reported similar early RGV to previous studies, but there was no correlation between RGV and EWL over 24\u0026ndash;36 months. They described post-operative increase in RGV measured at 3 days and 24 months after LSG from 116.2\u0026thinsp;\u0026plusmn;\u0026thinsp;78.24 to 254\u0026thinsp;\u0026plusmn;\u0026thinsp;56.8 respectively. \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Baumann et al did not find any correlation between the RGV and weight loss 12 months following LSG. RGV correlated significantly with the time interval after surgery. EWL at 12 month was similar to our study 55.9\u0026thinsp;\u0026plusmn;\u0026thinsp;17.4% although RGV was 186.5\u0026thinsp;\u0026plusmn;\u0026thinsp;88.4 ml lesser than our RGV. So, it is clear that at least to a certain extent this initial dilation seems to be a normal behavior after LSG and was not correlated with insufficient weight loss. \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough most patients in the previous studies who dilated their sleeve had early smaller RGV and similar surgical technique indicating that sleeve dilatation could be an adaptive process Moreover, the role of high pressure in the proximal narrow gastric tube could contribute to its enlargement especially if there is abnormal sleeve design. It seems critical to understand RGV anatomy which is divided into tubal volume and antral volume to assess its functional and morphologic features.\u003c/p\u003e \u003cp\u003e \u003cb\u003eChoi et al\u003c/b\u003e reported that the mean TSV, TV, AV, and T/A v were 188.3\u0026thinsp;\u0026plusmn;\u0026thinsp;67.3 ml, 81.3\u0026thinsp;\u0026plusmn;\u0026thinsp;38.5 ml. 107.0\u0026thinsp;\u0026plusmn;\u0026thinsp;45.1 ml, and 0.846\u0026thinsp;\u0026plusmn;\u0026thinsp;0.514 respectively, RGV was not correlated significantly with %TWL at 12 months postop (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.140, p\u0026thinsp;=\u0026thinsp;0.164). The only significant difference found was that T/A v was greater in patients with a %TWL of \u0026lt;\u0026thinsp;25% (suboptimal weight loss).\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn this study our RGV was bigger than \u003cb\u003eChoi et al\u003c/b\u003e and other studies, we think that the cause was not the calibration tube, or the starting point of stapling but the dietary habits of our patients. No significant correlation between EWL and volume, TSV: r\u0026thinsp;=\u0026thinsp;0.1,p\u0026thinsp;=\u0026thinsp;0.64 ,TV: r\u0026thinsp;=\u0026thinsp;0.28,p\u0026thinsp;=\u0026thinsp;0.22 AV: r\u0026thinsp;=\u0026thinsp;0.24,p\u0026thinsp;=\u0026thinsp;0.29, T/A V: r\u0026thinsp;=\u0026thinsp;0.26,p\u0026thinsp;=\u0026thinsp;0.25.Similar to \u003cb\u003eChoi et al\u003c/b\u003e study we reported that TV in the first 12 months played important role for weight loss ,we found the patients with higher TV showed significantly inadequate weight loss ,p\u0026thinsp;=\u0026thinsp;0.021. Our ROC curve for suggested cutoff of TV for detection of adequate weight loss was \u0026lt;\u0026thinsp;201.5 cc with sensitivity 83.3% and specificity 60.0%.\u003c/p\u003e \u003cp\u003eWe reported TSV and Tv were significantly lower among cases with vomiting p\u0026thinsp;=\u0026thinsp;0.001, 0.019 respectively and A V was significantly lower in patients with protein intolerance, p\u0026thinsp;=\u0026thinsp;0.023. Similar to \u003cb\u003eChoi et al\u003c/b\u003e also they reported positive correlation between total food tolerance score vs. TV (r\u0026thinsp;=\u0026thinsp;0.237, p\u0026thinsp;=\u0026thinsp;0.018), AV (r\u0026thinsp;=\u0026thinsp;0.269, p\u0026thinsp;=\u0026thinsp;0.007), and TSV (r\u0026thinsp;=\u0026thinsp;0.316, p\u0026thinsp;=\u0026thinsp;0.001). In contrast we found TV and T/A volume were significantly higher among patients had dumping, p\u0026thinsp;=\u0026thinsp;0.004, 0.028 respectively so we observed that not only the lower size of the residual antrum but also the ratio of tubal to antrum size may play important role in protein tolerance and dumping with decreased satiety in these patients.\u003c/p\u003e \u003cp\u003eIn our study there was no significant association between morphology of sleeve and EWL, p\u0026thinsp;=\u0026thinsp;.07 but tubular sleeve associated with highest EWL 69.35\u0026thinsp;\u0026plusmn;\u0026thinsp;11.19. We reported that there was no significant association between adequate weight loss and shape, p\u0026thinsp;=\u0026thinsp;0.11 but all patients of tubular sleeve had adequate weight loss.\u003c/p\u003e \u003cp\u003eFew studies have looked at the final sleeve shape as it relates to outcomes after weight loss surgery. A study by \u003cb\u003eAlhaj et al\u003c/b\u003e assessed sleeve shape by upper gastrointestinal (UGI) study. the majority was lower pouch 39.2% unlike our study the majority was tubular shape 35%. The study showed a trend toward decreased reflux and improved weight loss at 12 months with the lower pouch shape. \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Similar results in our study we reported lower sized antrum in relation to tubal volume precipitate to dumping with decreased sensation of satiety p\u0026thinsp;=\u0026thinsp;0.028.\u003c/p\u003e \u003cp\u003eWe reported that Dumbbell shaped sleeve was significantly associated with Vomiting and protein intolerance, p= (0.013 ,0.018) respectively also dilated sleeve was surprising significantly associated with protein intolerance, p\u0026thinsp;=\u0026thinsp;0.018, so it may be because of bad dietary habits in these group of patients who suffered from protein intolerance.\u003c/p\u003e \u003cp\u003eWe reported 3 cases of gerd post operative one case was dumbbell shape ,other 2 cases had higher t/a ratio 2.1,2.5.so restriction either functional or mechanical at incisura increases reflux symptoms and also similar to \u003cb\u003eAlhaj et al\u003c/b\u003e study lower size antrum or higher T/A volume may play a role in gerd symptoms however, statistical significance was not achieved due to the limited number of the patients. Similar results by \u003cb\u003eToro et al\u003c/b\u003e study revealed by (UGI) study 1 year after LSG that UP shape had the higher severity of reflux symptoms (P\u0026thinsp;=\u0026thinsp;0.02). similar to our study, The T shape was the most common subtype 37%, no statistically significant differences regarding weight loss and shape. \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThere were some limitations in our study including the short-term follow-up (1 year) as RGV may increase in some patients in the long-term follow-up and the relatively small number of cases.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere is no clear association between the final sleeve morphology or RGV and EWL at 12 months but gastric sleeve shape and the volumes of the new stomach which divided into tubal and antral parts and the ratio between them on the CT volumetry may predict clinical outcomes as the tubular shaped had highest EWL and dumbbell shaped significantly associated with protein intolerance and vomiting. T/A volume and lower antrum had dumping, and protein intolerance respectively also higher TV had significant inadequate weight loss, so this group of patients must remain under close nutritional indications to avoid regain of body weight.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll datasets used and analyzed are available from the corresponding author upon reasonable request\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is in accordance with the \u003cstrong\u003eDeclaration of Helsinki\u003c/strong\u003e. The approval was given by the research ethics committee of faculty of medicine of Helwan university, Egypt, Serial 84-2024. \u0026nbsp;Each participant in the study signed an informed consent upon his agreement on participating in the study after thorough explanation of the aim and beneficial outcomes of the study. Patient details were kept strictly confidential throughout the study. Maintaining the privacy of participants was ensured by allowing only the study team to be able to access their data. All patients were totally free of accepting or refusing participation in the study with complete equal care to both. Codes were used instead of names for identification of participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from every human participant in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest disclosure\u003c/strong\u003e: The authors declare that they have no competing interests for this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProvenance and peer review Not commissioned, externally peer reviewed.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical registration number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMahmoud El Azawy was the main principal author, contributed the data collection, analysis, interpretation and wrote the main manuscript, Islam Taha performed the volumetry studies, Ayman kamal revised the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSingla V, et al. Correlation of weight loss with residual gastric volume on computerized tomography in patients undergoing sleeve gastrectomy: a systematic review. Clin Obes. 2020;10:e12394.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanssen A, Plotnikov S, Acosta G, et al. 3D Volumetry and its correlation between postoperative gastric volume and excess weight loss after sleeve gastrectomy. Obes Surg. 2018;28:775\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobert M, Pasquer A, Pelascini E, Valette P-J, Gouillat C, Disse E. Impact of sleeve gastrectomy volumes on weight loss results: a prospective study. Surg Obes Relat Dis. 2016;12:1286\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDisse E, Pasquer A, Pelascini E, et al. Dilatation of sleeve gastrectomy: myth or reality? Obes Surg. 2017;27:30\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNam K, Hyun SJ, Choi. Morphologic Study of Gastric Sleeves by CT Volumetry at One Year after Laparoscopic Sleeve Gastrectomy. J Metabolic Bariatr Surg. 2020;9(2):42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGolomb I, Ben David M, Glass A, et al. Long-term metabolic effects of laparoscopic sleeve gastrectomy. JAMA Surg. 2015;150(11):1051\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRashid R, Sohrabi C, Kerwan A, et al. The STROCSS 2024 guideline: strengthening the reporting of cohort, cross-sectional and case-control studies in surgery. Int J Surg. 2024;110(6):3151\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVidal P, Ram\u0026oacute;n JM, Busto M, Dom\u0026iacute;nguez-Vega G, Goday A, Pera M, Grande L. Residual gastric volume estimated with a new radiological volumetric model: relationship with weight loss after laparoscopic sleeve gastrectomy. Obes Surg. 2014;24:359\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeguines JB, Verhaeghe P, Yzet T, Robert B, Cosse C, Regimbeau JM. Is the residual gastric volume after laparoscopic sleeve gastrectomy an objective criterion for adapting the treatment strategy after failure? Surg Obes Relat Dis. 2013;9(5):660\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraghetto I, Cortes C, Herqui\u0026ntilde;igo D, Csendes P, Rojas A, Mushle M, Papapietro K. Evaluation of the radiological gastric capacity and evolution of the BMI 2\u0026ndash;3 years after sleeve gastrectomy. Obes Surg. 2009;19:1262\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaumann T, Grueneberger J, Pache G, Kuesters S, Marjanovic G, Kulemann B, Karcz WK. Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration. Surg Endosc. 2011;25:2323\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi SJ, Kim SM. Intrathoracic migration of gastric sleeve affects weight loss as well as GERD\u0026ndash;an analysis of remnant gastric morphology for 100 patients at one year after laparoscopic sleeve gastrectomy. Obes Surg. 2021;31:2878\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlhaj Saleh A, Janik MR, Mustafa RR, Alshehri M, Khan AH, Motamedi K, Khaitan SM, L. Does sleeve shape make a difference in outcomes? Obes Surg. 2018;28:1731\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToro JP, Lin E, Patel AD, Davis Jr SS, Sanni A, Urrego HD, Moreno CC. Association of radiographic morphology with early gastroesophageal reflux disease and satiety control after sleeve gastrectomy. J Am Coll Surg. 2014;219(3):430\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 18 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"shape, Sleeve gastrectomy, inadequate weight loss, volumetry","lastPublishedDoi":"10.21203/rs.3.rs-6797676/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6797676/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLaparoscopic sleeve gastrectomy (LSG) has been accepted as a primary bariatric procedure. The aim of the study was to evaluate the volume and the morphologies of remnant stomachs after LSG and their association with weight loss.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTwenty patients who underwent Laparoscopic sleeve gastrectomy (LSG) were followed prospectively and evaluated at 12 months after operation using computed tomography CT with 3D reconstruction to evaluate the shape and volume of the residual stomach after LSG. Total sleeve volume (TSV), tube volume (TV), antral volume (AV) and tube/antral volume ratio (TAVR) were included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMean %EWL (excess weight loss) at 12 months postop was 57\u003cstrong\u003e.57 ± 15.82\u003c/strong\u003e, The majority of sleeve morphology was tubular sleeve (35%) and mean TSV, TV, AV, and TAVR were 376.39 ± 114.2 cc, 194.81 ± 65.7 cc, 179.09 ± 58.4 cc ,1.48 ± 0.51 respectively. Dumbbell Shaped sleeve was significantly associated with Vomiting and protein intolerance, p= (0.013 ,0.018). No significant association between morphology of sleeve and EWL, p = .07 but tubular sleeve had adequate weight loss. TV and T/A volume were significantly higher among patients who had dumping, p = \u003cstrong\u003e0.004, 0.028\u003c/strong\u003e respectively. A\u003cstrong\u003eV\u003c/strong\u003e was significantly lower in patients with protein \u003cstrong\u003eintolerance, p = 0.023\u003c/strong\u003e. TSV was not correlated significantly with %EWL at 12 months postop (r = 0.1, p = 0.64) but patients with lower TV showed significantly \u003cstrong\u003eadequate weight loss\u003c/strong\u003e, p = \u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough there is no clear association between sleeve morphology or volume and EWL at 12 months, tubular sleeve and lower TV had adequate weight loss.\u003c/p\u003e","manuscriptTitle":"Correlation of weight loss with residual gastric volume and morphology after sleeve gastrectomy: A CT-Based Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 07:56:55","doi":"10.21203/rs.3.rs-6797676/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7cefe700-0978-42b4-a869-a46c697cc94f","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-04T05:38:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-01 07:56:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6797676","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6797676","identity":"rs-6797676","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}