BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has been proven to be an effective surgical method for managing morbid obesity. However, the extent of the antral excision remains controversial. In this meta-analysis, we evaluated the safety and efficacy of LSG with antral resection (AR) and antral preservation (AP). MATERIALS AND METHODS: The PubMed, Embase, Cochrane Library, and Google Scholar databases were systematically searched for randomized clinical trials (RCTs) from their inception dates to March 2024. The main outcomes were the percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), and BMI at 3, 6, 12, and 24 months postsurgery. RESULTS: Fourteen RCTs comprising 1222 patients were included in the study. The %EWL was significantly lower in the AP group at 6 (mean difference [MD]: -5.65 and p = 0.003), 12 (MD: -5.08 and p <
0.00001), and 24 (MD: -5.23 and p = 0.0004) months. The %TWL was significantly lower in the AP group at 3 (MD: -4.63 and p = 0.02), 6 (MD: -3.98 and p <
0.0001), and 12 (MD: -4.63 and p <
0.00001) months. BMI was lower in the AR group at 3 (MD: 1.81 and p = 0.007) and 6 (MD: 2.39 and p = 0.002) months. No significant difference was found in surgical time and de novo gastroesophageal reflux disease
however, the AP group demonstrated significantly longer hospital stays and a lower rate of late vomiting. CONCLUSION: LSG with AR yields better weight loss than LSG with AP but may lead to a higher rate of late vomiting.