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Pouch Size After Gastric Bypass Does not Correlate with Weight Loss Outcome

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Abstract

A large gastric pouch is a classic explanation for weight loss problems after gastric bypass. However, several reports have emphasized the role of others, essentially behavorial, factors. We reviewed the outcomes of 151 patients who were operated on over a period of nearly 2 years. 132 patients who had not been reoperated on were assessed between June and September 2009. A barium swallow was available to assess the gastric pouch volume which was determined by the radiologist. %EWL was compared to the pouch volume using ANOVA test. Pouch volumes were compared using t test. The gastric pouch was dilated when >50 ml and failure to lose enough weight was defined by a %EWL<50%. 107 patients (81%) had a complete follow up of 35.7 ± 5.8 months. Mean pouch volume was 68 ± 4.5 ml with a %EWL of 68 ± 26.1%. 59 patients had a large pouch with a weight loss similar to those with a normally sized pouch (68 ± 3.6 vs 66 ± 3.6%EWL). 25 patients (23.3%) had weight loss failure with a similar pouch volume. No correlation was found between the %EWL and the pouch volume. Pouch size probably plays a role in the weight loss process of RYGB. However, 3 years later, pouch volume does not appear to be the most important factor. Behavorial factors such as recurrent eating disorders and failure to adapt to the changes induced by the surgery may explain at least in part weight loss failure.

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References

  1. Fobi MAL, Lee H, Holness R, DeGaulle C. Gastric bypass operation for obesity. World J Surg. 1998;22:925–35.

    Article  PubMed  CAS  Google Scholar 

  2. Campos GM, Rabl C, Mulligan K, et al. Factors associated with weight loss after gastric bypass. Arch Surg. 2008;143:877–84.

    Article  PubMed  Google Scholar 

  3. Chin P, Ali M, Francis K, LePort PC. Adjustable gastric band placed around gastric bypass pouch as revision operation for failed gastric bypass. Surg Obes Relat Dis. 2009;5:38–42.

    Article  PubMed  Google Scholar 

  4. Madan AK, Tichansky DS, Phillipps JC. Does pouch size matter? Obes Surg. 2007;17:317–20.

    Article  PubMed  Google Scholar 

  5. Muller MK, Wildi S, Scholz T, Clavien PA, Weber M. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg. 2005;15:1089–95.

    Article  PubMed  Google Scholar 

  6. Roberts K, Duffy A, Kaufman J, Burrell M, Dziura J, Bell R. Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:1397–402.

    Article  PubMed  CAS  Google Scholar 

  7. Bessler M, Daud A, DiGiorgi MF, et al. Adjustable gastric banding as a revisional bariatric procedure after failed gastric bypass. Obes Surg. 2005;15:1443–8.

    Article  PubMed  Google Scholar 

  8. Higa KD, Boone K, Nimeri A, et al. Gastric bypass: increased restriction for poor weight loss. Surg Endosc. 2007;21:1922–3.

    Article  PubMed  CAS  Google Scholar 

  9. Horgan S, Jacobsen G, Weiss D, et al. Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicenter registry results. Surg Obes Relat Dis 2010, in press.

  10. Parikh M, Pomp A, Gagner M. Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes. Surg Obes Relat Dis. 2007;3:611–8.

    Article  PubMed  Google Scholar 

  11. Christou NV, Look D, MacLean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244:734–40.

    Article  PubMed  Google Scholar 

  12. Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: A 5-year prospective study. Obes Surg. 2008;18:648–51.

    Article  PubMed  Google Scholar 

  13. Meguid MM, Glade MJ, Middleton FA. Weight regain after Roux-en-Y: a significant 20% complication related to PYY. Nutrition. 2008;24:832–42.

    Article  PubMed  CAS  Google Scholar 

  14. Pories WJ. Bariatric surgery: risks and rewards. J Clin Endocrinol Metab. 2008;93:S89–96.

    Article  PubMed  CAS  Google Scholar 

  15. Lutfi R, Torquati A, Sekhar N, et al. Predictors of success after laparoscopic gastric bypass: a multivariate analysis of socioeconomic factors. Surg Endosc. 2006;20:864–7.

    Article  PubMed  CAS  Google Scholar 

  16. Pajecki D, Dalcanalle L, Souza de Oliveira CP, et al. Follow-up of Roux-en-Y gastric bypass patients at 5 or more years postoperatively. Obes Surg. 2007;17:601–7.

    Article  PubMed  Google Scholar 

  17. Rheinhold RB. Critical analysis of long-term weight loss following gastric bypass. Surg Gynecol Obstet. 1982;155:385–94.

    Google Scholar 

  18. Mali JJ, Valezi AC, de Menezes MC. Weight loss outcome after silastic ring Roux-en-Y gastric bypass: five years of follow-up. Obes Surg. 2007;17:1287–91.

    Article  PubMed  Google Scholar 

  19. Cottam DR, Fisher B, Sridhar V, Atkinson J, Dallal R. The effect of stoma size on weight loss after laparoscopic gastric bypass surgery: results of a blinded randomized controlled trial. Obes Surg. 2009;19:13–7.

    Article  PubMed  Google Scholar 

  20. Gould JC, Garren M, Boll V, Starling J. The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2006;20:1017–20.

    Article  PubMed  Google Scholar 

  21. Akkary E, Sidani S, Boonsiri J, et al. The paradox of the pouch: prompt emptying predicts improved weight loss after laparoscopic Roux-Y gastric bypass. Surg Endosc. 2009;23:790–4.

    Article  PubMed  Google Scholar 

  22. Perugini RA, Mason R. Czerniach DRet al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg. 2003;138:541–5.

    Article  PubMed  Google Scholar 

  23. te Riele WW, Sze YK, Wiezer MJ, et al. Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients. Surg Obes Relat Dis. 2008;4:735–9.

    Article  Google Scholar 

  24. Topart P, Becouarn G, Ritz P. One-year weight loss after primary or revisional Roux-en-Y gastric bypass for failed adjustable gastric banding. Surg Obes Relat Dis. 2009;5:459–62.

    Article  PubMed  Google Scholar 

  25. Lanyon RI, Maxwell BM, Kraft AJ. Prediction of long-term outcome after gastric bypass surgery. Obes Surg. 2009;19:439–45.

    Article  PubMed  Google Scholar 

  26. Kinzl JF, Schrattenecker M, Traweger C, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;161609–14.

  27. Mitchell JE, Lancaster KL, Burgard MA, et al. Long-term follow-up of patients’ status after gastric bypass. Obes Surg. 2001;11:464–8.

    Article  PubMed  CAS  Google Scholar 

  28. Ray EC, Nickels MW, Sayeed S, Sax HC. Predicting success after gastric bypass: the role of psychosocial and behavioral factors. Surgery. 2003;134:555–63.

    Article  PubMed  Google Scholar 

  29. Hsu LK, Benotti PN, Dwyer J, et al. Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60:338–46.

    PubMed  CAS  Google Scholar 

  30. Karcz WK, Kuesters S, Marjanovic G, et al. 3D-MSCT gastric pouch volumetry in bariatric surgery-preliminary clinical results. Obes Surg. 2009;19:508–16.

    Article  PubMed  CAS  Google Scholar 

  31. Alva S, Eisenberg D, Duffy A, Roberts K, et al. Virtual three-dimensional computed tomography assessment of the gastric pouch following laparoscopic Roux-Y gastric bypass. Obes Surg. 2008;18:364–6.

    Article  PubMed  Google Scholar 

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Correspondence to Philippe Topart.

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Topart, P., Becouarn, G. & Ritz, P. Pouch Size After Gastric Bypass Does not Correlate with Weight Loss Outcome. OBES SURG 21, 1350–1354 (2011). https://doi.org/10.1007/s11695-011-0460-8

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