Received: 16 May 2020 Revised: 8 June 2020 Accepted: 7 July 2020

DOI: 10.1111/cob.12394

REVIEW

Correlation of weight loss with residual gastric volume on

computerized tomography in patients undergoing sleeve
gastrectomy: A systematic review

Vitish Singla1 | Sandeep Aggarwal1 | Samagra Aggarwal2 | Mehul Gupta1 |

1
Deepti Singh

1
Department of Surgical disciplines, All India
Institute of Medical Sciences, New Delhi, India
2
Department of Gastroenterology, All India
Institute of Medical Sciences, New Delhi, India
Correspondence
Dr. (Prof) Sandeep Aggarwal, Department of
Surgical Disciplines, All India Institute of
Medical Sciences, New Delhi, India.
Email: sandeep_aiims@yahoo.co.in
Summary
Laparoscopic Sleeve gastrectomy (LSG) is the most commonly performed bariatric
surgical procedure worldwide. There is wide variation however in post-operative
weight loss on long term follow-up, and residual gastric volume (RGV) is believed to
be an important variable. Multiple studies have correlated RGV as assessed by Com-
puterized Tomography volumetry with excess weight loss (EWL%) following LSG, but
definite consensus is lacking. This article systematically reviews the published studies
in English literature to ascertain whether any correlation exists between the RGV and
EWL% following LSG. Ten studies were included in this review, and significant differ-
ences were noted in the technique of RGV assessment, and timing of RGV and EWL
% assessment. Five studies found a statistically significant correlation between the
RGV and EWL%. One study found a correlation which did not reach statistical signifi-
cance. Two additional studies reported that the resected volume rather than RGV
correlated with the EWL%. Meta-analysis of studies reporting correlation between
RGV and EWL% showed that up to 26.3% (95% CI: 5.1%-56.1%) of variability in
EWL% can be explained by variations in RGV. A lower RGV is likely to result in a bet-
ter post-operative weight loss following LSG. There is need for standardization of
technique and timing of RGV assessment.

KEYWORDS

bariatric surgery, CT volumetry, LSG, residual gastric volume, RGV, sleeve gastrectomy,
weight loss

1 | I N T RO DU CT I O N high number of surgeries being performed. Rate of weight regain after

Laparoscopic Sleeve Gastrectomy (LSG) has become the most com-
monly performed bariatric procedure worldwide. According to the
fifth International Federation for the Surgery of Obesity and meta-
bolic disorders (IFSO) 2019 report, 305 242 LSG procedures were
performed during 2015-2018,1 accounting for 58.6% of all bariatric
procedures. Studies with long term follow-up have reported an excess
weight loss varying from 40% to 57%.2-4 Inadequate weight loss and
weight regain following LSG remains a concern especially with the
LSG ranges from 14% to 37% in the long term5 and can cause signifi-
cant concern, even though the weight rarely reaches preoperative
values. This can lead to a requirement for revisional surgery after LSG
in 11.8% of the patients over a 5-year follow-up period.6
LSG however still remains a popular procedure as apart from
being a restrictive procedure, it also results in decreased levels of
Ghrelin, increased levels of GLP-1 (Glucagon like peptide-1), and
faster gastric emptying, contributing to weight loss and an improve-
ment in metabolic profile.7 The residual sleeve volume and the size of

Clin Obes. 2020;e12394. wileyonlinelibrary.com/journal/cob © 2020 World Obesity Federation 1 of 8

https://doi.org/10.1111/cob.12394
2 of 8
the resected stomach are commonly discussed parameters concerning
inadequate weight loss or weight regain following LSG. There has
been significant interest in the association of the volume of the
resected specimen with weight loss. Studies in the past have shown
divergent results, with strength of correlation between volume of
resected specimen and excess weight loss varying from large8-10 to no
11,12
correlation. Current understanding is that the residual gastric vol-
ume (RGV) might be a more reliable variable to study, as the volume
of the resected stomach might vary significantly with the preoperative
stomach volume. RGV has previously been measured using mathemat-
ical models on upper gastrointestinal contrast study, but this method
suffers from a lack of standardization and technical errors.
Volumetry of the residual stomach after LSG using Computerized
Tomography (CT) is an emerging tool to measure RGV. It is a more
easily reproducible and reliable technique and is being increasingly
used to study the association between weight loss and RGV. However
again, the results vary across different studies with no definitive con-
clusion. This prompted us to conduct a systematic review on the cur-
rent literature for association between RGV measured using CT
volumetry and weight loss after LSG and identify avenues for future
research.
2 | METHODS
2.1 | Search strategy and selection criteria
The literature search was performed by two authors across PubMed
and Google Scholar using a combination of keywords including “Bar-
iatric”, “Obesity”, “CT”, “Computerized Tomography”, “sleeve”, “LSG”,
“sleeve volume”, “volumetry”, “weight loss”, and “residual volume”. All
articles published in English were identified with the last search being
carried out on ninth May 2020. Additional relevant articles were also
SINGLA ET AL.
identified from the references of the articles obtained throughout
the search. Studies were included irrespective of the design, number
of participants, or year of publication. Articles having unpublished
data like thesis, review articles, editorials and non-human studies
were excluded. The studies in which the residual volume was mea-
sured by a technique other than CT volumetry and those describing
the experience of CT volumetry with revision surgery were excluded.
For systematic review, only the articles describing the correlation of
weight loss with the residual gastric volume as assessed on CT vol-
umetry were included. Ten such studies were finally identified for
inclusion (Figure 1). The sample size of studies was not taken into
consideration for inclusion in the systematic review due to paucity
of data.
2.2 | Data extraction
Two investigators extracted the relevant data from included studies
independently, and disagreements were resolved by mutual consen-
sus. The following information was extracted from each of the study:
first author, year of publication, design of the study, number of
participants, mean pre-operative body mass index (BMI) of partici-
pants, bougie size used during surgery, distance of margin from pylo-
rus, timing of CT volumetry following surgery, mean RGV, EWL,
timing of assessment of EWL and correlation coefficient between
weight loss and CT volumetry.
Our primary objective was to study the overall correlation
between RGV and EWL%. There was however significant heterogene-
ity throughout the included studies in timing of reporting of excess
weight loss and protocol of CT volumetry for RGV. Four studies
divided patients into two cohorts based on the RGV and reported
Excess weight loss (EWL) of the respective cohorts.13-16 All of these
studies used a different cut off for the RGV to divide patients into
FIGURE 1 PRISMA flowchart
TABLE 1 Studies comparing Weight Loss with Residual Gastric Volume (RGV) on Computerized Tomography (CT) volumetry

Correlation between An inverse correlation A higher EWL% was seen RGV increased significantly A positive correlation No significant correlation was An inverse correlation
weight loss and CT seen between weight when the RGV < 100 mL at follow-up CT scan seen between failure seen between RGV and of RGV and residual
SINGLA ET AL.

volumetry (RGV— loss and RGV at (P < .05). Weak correlation without weight regain. of LSG (EWL < 50%) weight loss at 3 months. antral volume was
Residual Gastric Volume) 6 months (P < .05) between percentage of No significant correlation and RGV (P < .05) Correlation between seen with weight
resected stomach and between the weight and resected volume and weight loss at 18 months
EWL% increase in the RGV loss was found. (P < .05) (P < .05)
Weight Loss EWL 68.37 ± 15.86% EWL 51.6 ± 11.3% Mean weight loss 45.5 EWL 60% (1.6-105) at EWL 31% (6-61%) at Not reported for the
Mean ± SD at 6 months at 6 months ± 5.2% kg at 6 months 24-36 months 3 months whole cohort
Mean (Range) (refer to text)
Mean RGV 108.7 ± 84.9 140.8 ± 61.7 after LSG third day 116.2 ± 78.2 255 (65-571) 217 ± 74.9 after LSG 221 ± 11
(ml) Mean ± SD / Range >24 months 254 ± 56.8 (Remaining antrum 73
± 7 mL)
Timing of CT Volumetry After 180 days Before and within 7 days First on the third post- 24–36 months 3 days before surgery and After 180 days
post-surgery after surgery operative day and 3 months post operatively
then after
24-36 months
Distance from pylorus 2 cm 4 cm 2-3 cm 6 cm 5 cm 5 cm
Bougie size: 36 36 32 34 36 37
French
Sample size 32 47 15 76 20 67
F:M F:M 24:8 F:M 44:3 F:M 12:3 F:M 61:15 Female 64%
Study characteristics Hanssen et al 201813 Elbanna et al 201914 Braghetto et al 200917 Deguines et al 201215 Pawanindra et al 20149 Robert et al 201616
Prospective Retrospective Prospective Prospective Prospective Prospective
Mean BMI: 39.1 Mean Age: 37.5 ± 6.3 years Mean Age 34.6 years Mean BMI 46 (27-55) Mean Age 37.7 ± 8.9 Mean Age 43 ± 11
(32.52-45.68) Mean BMI: 50.4 ± 5.9 (23-48) BMI > 40 of all patients Mean BMI 47.9 ± 8.3
Mean BMI 39.7 (32.8-48).
Correlation between A weak correlation seen No significant difference in the weight loss No significant correlation present No significant correlation between RGV and
weight loss and CT between the weight loss and between patients with or without gastric between RGV and weight loss at EWL at 3 or 6 months. Correlation between
volumetry (RGV— increase in the RGV from dilatation as assessed by follow-up CT time of CT volumetry or after resected volume and weight loss was found.
Residual Gastric 1-12 months. volumetry 12 months of surgery (P < .05)
Volume)
Weight Loss 66.14 ± 5.64 at 12 months Not reported for whole cohort EWL 55.9 ± 17.4% EWL 48.1 ± 13.3% at 6 months
Mean ± SD At 12 months
Mean (Range)
Mean RGV 1 month 110.6 ± 40.52 3 months Median 160 (55 to 340) 128.5 ± 11.9 after LSG
(ml) Mean ± SD or Range 12 months 220 ± 12
142.1 ± 39.63 12 months
300 ± 17

(Continues)
3 of 8
 4 of 8 SINGLA ET AL.

two cohorts. Lack of uniformity precluded inclusion of all studies for

quantitative synthesis.
3 days before surgery and within 1 month

2.3 | Statistical analysis and assessment of study

quality

Salman et al 201810

Mean BMI 43.5 ± 4.3

Most of the studies included had non-randomized data with non-

Mean Age 30.5 ± 8.6

postoperatively

uniform methods of assessment and reporting, and formal risk of bias

assessment could not be done. For studies reporting correlation coef-
Prospective
F:M 26:14

ficients between RGV post-surgery and EWL%, the Pearson's correla-

3-5 cm

tion coefficient itself was used as the measure of effect size.

36

40

Correlation coefficient (r statistic) was transformed using the Fisher's

z transformation and random effects meta-analysis was performed
using this index. Random-effects model was chosen considering sig-
nificant heterogeneity in estimates of correlation and their trans-
8.0 ± 4.1 months (range 1-18)

formed values. The summary estimates of correlation were converted

back to r statistic for reporting, and R2 with 95% confidence intervals
Baumann et al 201118

Mean Age 44.2 (28-67)

was estimated to assess degree of variability in EWL% explained by

RGV. Heterogeneity was calculated using the Higgins Chi2 test and
Mean BMI 53.6
Retrospective

inconsistency was quantified by I2. A Chi2 test with a P value <0.10

F:M 22:5

was considered to indicate the presence of heterogeneity, and an

6 cm

I2 > 50% was considered to suggest marked inconsistency in effect

32

27

between studies. Forest plot of z-transformed r statistic was gener-

ated for visual representation.
All data was entered using Microsoft Excel 2011 and was
analysed using OpenMeta[Analyst] version 10.10. OpenMeta[Analyst]
3 and 12 months postoperatively

is an open-source, cross-platform software developed by centre for

evidence synthesis in health, Brown School of Public Health, Rhode
Island that allows advanced meta-analysis options. Z-transformations
and conversion of transformed summary estimate back to r-statistic
Mean BMI 47.5 ± 8.5
Mean Age 43.3 ± 11
Disse et al 201720

were done on Microsoft Excel.

Females 61%

Prospective
5 cm

3 | RE SU LT S
37

54

3.1 | Cumulative data

Our initial literature search revealed a total of 914 articles. For various
Mean BMI 49.89 ± 5.08
Mean Age 33.50 ± 7.43
Sabry et al 201819

reasons, as listed in Figure 1, a total of 10 studies were included for

postoperatively
1 and 12 months

systematic review. We found records of 428 patients from the

10 included studies studying the correlation of RGV after sleeve gas-
Prospective
5-6 cm

F:M 42:8

trectomy with weight loss. Table 1 shows the important characteris-

tics of these studies.9,10,13-20 The mean age and BMI of the patients
36

50

were 38.57 years and 44.99 kg/m2, respectively. The mean RGV and
EWL% are shown in Tables 2 and 3, respectively.
Timing of CT Volumetry
(Continued)

Distance from pylorus

Study characteristics
post-surgery

3.1.1 | Major characteristics of the studies

Bougie size:

Sample size
TABLE 1

The important characteristics of included studies are summarized

French

F:M

below. A 32-37 French bougie was used for the creation of the sleeve,
with 36 French bougie being most common. The distance of stapling
SINGLA ET AL. 5 of 8

TABLE 2 Timing of Computerized Tomography (CT) volumetry in relation to Laparoscopic Sleeve Gastrectomy (LSG)

Timing of CT volumetry in relation to LSG

Before Within 7 days Within 1 month After 3 months After 12 months After 24-36 months
Residual gastric volume (RGV) ml 914.6 (254.2) 134.8 (66.2) 118.6 (32.34) 199.5 (62.3) 224.1 (84.73) 254.8
combined mean (SD)
Sample size 107 62 90 173 104 91
Studies included Three9,10,14 Two14,17 Two10,19 Four9,13,16,20 Two19,20 Two15,17

T A B L E 3 Excess weight loss (EWL)

Excess weight loss (EWL) after LSG
after laparoscopic sleeve
gastrectomy (LSG) 3 months 6 months 12 months 24–36 months
EWL% Combined Mean (SD) 31% 54.9% (15.6) 62.5% (12.17) 60%
Sample size 20 119 77 76
9 10,13,14 18,19
Studies included One Three Two One15

from the pylorus ranged from two to six centimetres, with majority of
these studies not reporting regarding staple line reinforcement. Three
studies reported oversewing of the staple line,16,17,20 and in one
study, sewing of omentum to the staple line was performed.13 In
9
another study, no staple line reinforcement was used. In majority of
the included studies, CT volumetry was performed using an efferves-
cent solution of 4 mg of Sodium Bicarbonate granules or tartaric acid/
sodium hydrogen carbonate salts to distend the stomach remnant
with gas. Ioxithalamate and diluted Urografin were used instead in
two studies.10,18 Other agents used included plain water one study17
and negative oral contrast in another.19 Of these latter four studies,
only one study found a correlation seen between the weight loss and
RGV, with strength of that correlation being weak. 19
Robert et al16 divided the patients based on the RGV into “small
sleeve group (SSG)” and “without small sleeve group (WSSG)”, the
mean RGV being 133 ± 7 mL and 264 ± 11 mL in the SSG and WSSG
groups, respectively. Percent excess BMI loss (%EBMIL) was 72.4% in
the SSG group and 60.5% in the WSSG at 18 months postoperatively.
Further, the study concluded that the volume of the residual stomach
and antrum but not the gastric tube had a significant impact on weight
13
loss. Hanssen et al categorized patients into three groups: 25% to
50% (low), 51% to 75%(mid), and >75% (high), based on the EWL%. In
total, 100%, 62.5%, and 14.3% of the patients in the low, mid, and
high EWL% had an RGV <100 mL, respectively. The study by Deguines
15
et al had a mean RGV of 225 mL in patients with EWL >50%, and
309 mL in patients with an EWL <50%. Moreover, the success rate of
LSG was only 14.8% when the RGV was more than 225 mL. Elbanna
et al14 found that the mean EWL was 61.4 ± 6.1%and 37.8 ± 4.8% in
patients with a RGV of <100 mL and RGV >200 mL, respectively.
Disse et al20 divided patients into the groups namely: “patients with
gastric dilatation” and “patients without gastric dilatation” based on
the evolution of RGV from 3 to 12 months. An increase in the RGV by
at least 25% from baseline was defined as gastric dilatation. The mean
excess BMI loss (EBMIL) at 1 year was 63.8 ± 4% and 64.5 ± 5% and
Total weight loss was 27.7 ± 2.1% and 31.2 ± 4.5% in patients with
and without gastric dilatation, respectively. Although weight loss was
better in patients “without gastric dilatation,” no significant difference
was seen between the evolution of BMI in the two groups, and dilata-
tion of the sleeve did not relate to insufficient weight loss.
3.2 | Quantitative synthesis
Five studies reporting correlation between RGV post-surgery and
EWL% were included for analysis, including a total of 262 patients.
Significant heterogeneity was noted (I2 = 99.4%) in correlation coeffi-
cients and their z transformed values, because of which random
effects meta-analysis was conducted. Summary r statistic was −0.472
(95% CI: −0.634 to −0.223), translating to a summary R2 estimate of
0.263 (95% CI: 0.051-0.561) as shown in Figure 2. This indicated that
up to 26.3% variability in EWL% following LSG could be explained by
variability in RGV achieved.
4 | DI SCU SSION
In this review, we found extremely variable estimates of correlation
between RGV and weight loss, with several studies reporting a signifi-
cant correlation13-16 to one reporting weak correlation.19 Two studies
reported that the resected gastric volume rather than the RGV has a
significant correlation with excess weight loss.9,10 The sample size in
one of these studies was small and the correlation between the RGV
and weight loss was studied at a short follow-up of 3 months which
might be the reason for not finding any correlation between RGV and
weight loss.9 Overall, around a quarter of variability in EWL% seemed
to be related to differences in RGV. Disse et al did not find a signifi-
cant difference in the evolution of BMI in patients with and without
gastric dilatation. However, the total weight loss and excess BMI loss
was higher in patients without gastric dilatation.20 Thus, majority of
studies showed a trend towards better weight loss in patients with a
6 of 8
FIGURE 2 Forest plot depicting the summary R2 estimate
tighter sleeve with lower RGV, reinforcing the importance of a narrow
banana-shaped “restrictive” sleeve to achieve a better weight loss.
CT volumetry of the stomach is a reliable and reproducible tech-
nique to assess RGV after surgery. There is evolving consensus in
technique of performing CT volumetry, with use of an effervescent
solution of Sodium Bicarbonate granules or tartaric acid/ sodium
hydrogen carbonate salts to adequately distend the stomach likely
being most reliable. This was used in 6 out of 10 studies, and even
though two of these six studies did not report any correlation of RGV
9,20
with weight loss, one of these assessed outcomes at a relatively
short follow-up of three months in a small sample size of 20 patients,
which may preclude reliable conclusions.9 The remaining 4 out of
10 included studies used Ioxithalamate, diluted Urografin, plain water,
10,17-19
or a negative oral contrast, and 3 of these 4 studies did not find
any correlation of RGV with weight loss, with fourth19 reporting only
a weak correlation which was not statistically significant. The use of
contrast other than the effervescent solution might have resulted in
an inadequate distention of the residual stomach and hence an inade-
quate assessment of the residual volume, leading to a false negative
conclusion in these studies. This suggests that there is a need to stan-
dardize the CT volumetry technique to assess the RGV after LSG.
With regard to the timing of CT volumetry following LSG, there
was again marked variability, with time of assessment ranging from
7 days to 36 months. A significant correlation was reported by
Elbanna et al, where the RGV was measured within 7 days of LSG and
correlated with EWL% at 6 months. 14
CT volumetry was performed at
3 months postoperatively in three studies9,13,16 with two of these
studies showing good correlation between RGV at 3 months with the
EWL% either at 6 months13 or 18 months.16 A similar correlation was
not seen in the third study where RGV was correlated with the EWL%
9
at 3 months, short follow-up being the likely reason. Disse et al
assessed RGV at 3 months and 12 months postoperatively, and
showed better weight loss in patients without “gastric dilatation”,
however, statistical significance was not achieved and a correlation
between RGV and weight loss was not established. Similarly Baumann
et al did not find any correlation between the RGV and weight loss
12 months following LSG.18 Deguines et al found better weight loss
in patients with a lower RGV when evaluated 24-36 months postop-
eratively.15 The evolution of RGV was studied over time and corre-
lated with the weight loss 12 months postoperatively in two
SINGLA ET AL.
studies,19,20 and the weight loss was found to be better when there
was lesser change in RGV in both the studies. However, a similar ini-
tial study by Braghetto et al suggested no correlation of increase in
the volume of stomach remnant with weight regain over
24-36 months.17 In another study, the RGV was correlated with the
weight loss at the time of CT volumetry and 12 months following
LSG.18 No significant relation between the RGV and EWL% was
observed. The CT volumetry was performed at varying points in time
ranging from 1-18 months postoperatively, which might be the reason
for the results. The findings of this review suggest that a better corre-
lation between RGV and EWL% is expected when the weight loss is
measured after a longer follow-up of at least 6-12 months. As RGV is
a dynamic construct, there is still no consensus on the timing of RGV
assessment, although it might be prudent to delay assessment to
6-12 months, to prevent inaccurate estimates. Thus, of the 10 studies
included in this review, five studies clearly showed some correlation
between RGV and weight loss. In addition to the confounders listed
above, the study by Lal et al correlated the RGV with EWL% at a short
follow-up of three months, which might be the reason for finding no
correlation due to insufficient weight loss at three months.
In this review, we found that a lower RGV is likely to result in a
better weight loss. Variability in RGV is itself the result of wide varia-
tions in the technique of LSG. These include the size of bougie used,
preservation or resection of the antrum during the creation of the
sleeve, over-sewing of the sleeve, and remnant fundus. In a recent
meta-analysis, it was seen that LSG with a bougie ≤36 Fr resulted in a
significantly higher EWL% as compared to a bougie >36 Fr21 without
an increased risk of leak or reflux. A narrow sleeve not only restricts
the calorie intake but also results in a faster gastric emptying with a
better incretin response.7 All the studies in this review used a bougie
size ≤36 Fr, except two which used a 37 Fr bougie.16,20 One of these
found a significant negative correlation between RGV and EWL%16
and the other20 did not find any correlation between the evolution of
RGV and weight loss. Further studies are needed to evaluate if the
use of smaller bougie is an independent predictor of weight loss even
after taking into account the RGV. The stapling was started at 5 cm
from the pylorus and the mean RGV was around 220 mL after
3 months of surgery in both the studies. There has also been a debate
regarding the antral preserving and antrum resecting LSG. In a ran-
domized trial, the antrum-resecting group had fewer suboptimal
SINGLA ET AL.
results with regard to excess BMI loss, despite there being no differ-
ence in RGV in both the groups at 12 months.22 Similarly, a meta-
analysis showed that antrum resecting sleeve had a trend towards
better weight loss at 12 months and significantly higher EWL% at
24 months of follow-up when compared to the antrum preserving
sleeve23 with similar rates of leak, bleed, and reflux.
In the review, two of the five studies showing a significant corre-
lation of RGV with weight loss reported the start of stapling at 4 cm
or less from the pylorus.13,14 An interesting observation made by
Robert et al was that the estimated residual antrum volume on CT vol-
umetry correlated with the weight loss and not the volume of the rest
of the sleeve. Moreover, the volume of the rest of the sleeve had no
such correlation. The total sleeve RGV was still found to have a signif-
icant negative correlation with weight loss. The distance of stapling
16
from the pylorus was 5 cm in their study. Our study shows that
RGV is responsible for up to 26% of the variability in the weight loss.
We believe that a proper surgical technique of LSG resulting in a nar-
row “banana” shaped sleeve is likely important for a better weight
loss. Both the use of a smaller sized bougie and resection of antrum
resulted in better weight loss following sleeve gastrectomy.
In addition to the variation in the technique of sleeve gastrectomy
including the bougie size, distance of stapling from the pylorus, and
oversewing of the staple line, there were significant differences in
technique of RGV assessment, and RGV, excess weight loss, and cor-
relation between them were not reported at consistent time intervals,
precluding the performance of a rigorous quantitative synthesis. Two
studies used the values of 100 mL and 200 mL to divide patients into
groups based on RGV13,14 and one study used a threshold of 225 mL
for RGV.15 Another study divided the patients based on the RGV into
tertiles: the “SSG” or “WSSG”.16 In some of the studies, the CT scan
was performed at two time points in the postoperative period. An
increase in the RGV was the correlated with the weight loss.17,19,20
The only consistent parameter reported in five of the ten studies was
the correlation coefficient.10,13-16 Quantitative analysis using this rev-
ealed that 26% of the variability in weight loss was explained by RGV.
There was quite a heterogeneity in the studies, still they were
included because they provide important insight in studying the corre-
lation between RGV and EWL%. A standardized reporting protocol
shall be followed while reporting the correlation of RGV and weight
loss. The patients might be divided into those with a low RGV (eg,
<100 mL or <200 mL) and those with a higher RGV. Weight loss
should be reported separately for these groups in further studies to
have a homogeneity in the published literature. The timing of weight
loss assessment following surgery is also important as discussed ear-
lier. It was observed in this review that the correlation between RGV
and EWL% is better when the EWL% was measured after a longer
follow-up of at least 6-12 months.
This is the first attempt made to systematically analyse the data
published relating to this topic. With increasing understanding of
changes in RGV after surgery and its impact on weight loss, it might
be possible to establish consensus recommendations regarding timing
of CT volumetry that is likely to provide maximum information regard-
ing future course of weight regain.
7 of 8
5 | CONC LU SION
A lower RGV after Sleeve gastrectomy is likely to result in improved
weight loss. There is a need for further studies with standardized mea-
surement and reporting to confirm these findings and establish use of
CT volumetry in routine clinical practice.
CONFLIC T OF INT ER E ST
The authors declare no conflicts of interests.
AUTHOR CONTRIBU TIONS
Vitish Singla: Investigation; methodology; data curation; original draft
preparation; data analysis. Sandeep Aggarwal: Conceptualization; data
curation; original draft preparation; reviewing and editing. Samagra
Aggarwal: Methodology; reviewing and editing; data analysis. Mehul
Gupta: Reviewing and editing. Deepti Singh: Reviewing and editing.
OR CID
Sandeep Aggarwal https://orcid.org/0000-0001-9540-0303
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How to cite this article: Singla V, Aggarwal S, Aggarwal S,
Gupta M, Singh D. Correlation of weight loss with residual
gastric volume on computerized tomography in patients
undergoing sleeve gastrectomy: A systematic review. Clin
Obes. 2020;e12394. https://doi.org/10.1111/cob.12394