Patient-reported outcomes after antrum resection versus antrum preservation in laparoscopic sleeve gastrectomy patients: A retrospective cohort study

Background: Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric procedure, though the optimal distance from the pylorus for gastric transection remains debated. Differences in antral size may influence postoperative symptoms, complications, and weight outcomes, yet comparative evidence remains limited. This study compares LSG with antrectomy versus antrum preservation using real-world data from a high-volume center. Methods: A retrospective review of 157 patients who underwent primary LSG between 2019 and 2023 was conducted. Patients were categorized into antrum resection and antrum preservation groups based on standardized surgeon techniques. Outcomes included weight change, metabolic markers, complications, and patient-reported symptoms documented through structured EMR fields. Multivariable regression analyses were conducted after adjusting for age, sex, and surgeon. Results: Both groups achieved significant reductions in BMI and weight over 18 months, with no statistically significant differences at any follow-up time point (3-month P = 0.366, 6-month P = 0.932, 12-month P = 0.924, 18-month P = 0.445). Percentage total weight loss (%TWL) was comparable between groups at 1 year (34.3% vs. 30.6%, P = 0.088) and 18 months (40.6% vs. 31.8%, P = 0.076). Postoperative complications were significantly higher in the antrectomy group (9.6% vs. 1.4%, P = 0.036). Nausea was more frequently reported in the antrum-preserving group, while psychological symptoms, particularly feelings of failure, were more common following antrectomy. Conclusion: Both surgical techniques produced similar medium-term weight loss and metabolic outcomes. Antrum preservation demonstrated a more favorable safety profile and fewer negative psychological symptoms, whereas antrectomy was associated with increased complications. Larger prospective studies are required to determine long-term clinical and quality-of-life implications.