Evaluation of gastric emptying after sleeve gastrectomy

Abstract

Obesity is the most common form of malnutrition in developed countries. Prevalence of obesity is rising to an epidemic proportion around the world.Many morbidities are underlying causes for the earlier mortality associated with obesity including coronary artery disease, hypertension, impaired cardiac function, adult onset diabetes mellitus, venous stasis and hypercoagulability leading to an increased risk of pulmonary embolism.The most widely accepted measure of obesity is the body mass index (BMI) which equals patient weight in kilograms divided by the square of his or her height in meters, a normal BMI ranges from 18.5-24.5 kg/m2 , overweight equals BMI between 25-29.5 kg/m2 , obesity equals BMI 30 kg/m2 or higher. Treatment of morbid obesity should begin with simple lifestyle changes, including moderation of diet and initiation of regular exercise such as walking and pharmacological management. Bariatric surgery offers the only means of delivering sustained weight loss. Bariatric surgical techniques are divided into two groups: malabsorptive and restrictive procedures. In general, restrictive procedures are simpler to perform and are accompanied by less procedural complications than malabsorptive procedures. Laparoscopic sleeve gastrectomy (LSG), in creating a narrow tube-like stomach, is a restrictive procedure designed to decrease appetite by reducing the ability of the stomach to distend and producing the sensation of fullness with minimal oral intake. As it consists of creating a maximal gastric reservoir or tube of 150 to 200 ml but, as an isolated procedure, the gastric pouch size usually varies from 60 to 120 ml.By resecting 80-90% of the stomach and leaving behind only a sleeve restricts the amount of the food that can be ingested and gives the sensation of fullness with minimal oral intake. The concept that the SG is a purely restrictive procedure is gradually changing. The significant reduction of large parts of the ghrelin-producing stomach mass and changes in gastric emptying may account for its superiority to other restrictive procedures in terms of weight loss and sustained decrease of hunger.Complete removal of the greater curvature and fundus produces lower levels of ghrelin, which enhances the results on the control of food intake.Following SG, gastric emptying is faster as compared to the preoperative state, and symptoms of vomiting after eating are either absent or very mild.