Analysis of Early Dilation of the Residual gastric After Laparoscopic Sleeve Gastrectomy: Insights from a 3D CT Reconstruction Study

Abstract Background Laparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric surgery due to its effective weight loss and low complication rates. However, some patients experience weight regain or insufficient weight loss due to residual gastric dilation, the factors of which are unclear. This study uses 3D CT reconstruction to measure changes in residual gastric volume after LSG and investigates factors contributing to gastric dilation and its impact on weight loss. Method This retrospective study involved 50 LSG patients. Preoperative clinical and laboratory data were collected. Residual gastric volume was measured using 3D CT reconstruction at 1 and 3 months post-surgery. The study assessed total sleeve volume (TSV), tube volume (TV), and antral volume (AV). Resected gastric volume and staple line length were measured during surgery. Weight metrics and laboratory indices were recorded at 1, 3, 6, and 12 months post-surgery. The Three-Factor Eating Questionnaire-R21 (TFEQ-R21), the Eating Behavior and Belief Scale Questionnaire (EBBS-Q), and the Gastroesophageal Reflux Disease Questionnaire (GERD-Q) were used to assess patients' postoperative dietary behavior, treatment adherence, and reflux condition, respectively. Correlations between weight metrics, residual gastric dilation, and the aforementioned factors were analyzed. Results The 50 patients had a mean preoperative BMI of 42.27 ± 7.19 kg/m² and an average total weight loss (%TWL) of 34 ± 7% one year post-LSG. One month post-LSG, mean TV, AV, and TSV were 45.93 ± 16.75 mL, 115.85 ± 44.92 mL, and 161.77 ± 55.37 mL, respectively. %TWL at one year significantly correlated with residual gastric dilation (p < 0.05). Three months post-surgery, the degree of residual gastric dilation was 13.50 ± 17.35%. Initial residual gastric volume, preoperative diabetes, and postoperative reflux were associated with dilation. Conclusion Residual gastric dilation post-LSG significantly affects weight loss efficacy. Factors including initial residual residual gastric volume, preoperative diabetes, and postoperative reflux are associated with residual gastric dilation.