Advertisement

A systematic review of the effect of gastric pouch and/or gastrojejunostomy (stoma) size on weight loss outcomes with Roux-en-Y gastric bypass

  • Kamal MahawarEmail author
  • Alistair J. Sharples
  • Yitka Graham
Review Article

Abstract

Background

The effect of the gastric pouch or Gastrojejunostomy (GJ or stoma) size on weight loss outcomes after Roux-en-Y gastric bypass (RYGB) is unclear with studies reporting conflicting results. The purpose of this systematic review was to determine the impact of the gastric pouch or stoma size on weight loss outcomes with RYGB.

Methods

An online search of PubMed was carried out to identify all articles evaluating the effect of the gastric pouch and/or gastric stoma size at the time of surgery on outcomes associated with RYGB. Quality and heterogeneity of data precluded a meta-analysis. So a systematic review was performed without a meta-analysis.

Results

This review found a total of 14 studies (two of which were randomised) evaluating the effect of pouch sizes on weight loss outcomes after RYGB. Nine of these studies did not find any significant association between pouch size and weight loss outcomes whereas five studies found larger pouches to be associated with poorer weight loss outcomes. No study found larger pouches to be associated with better weight loss outcomes. Out of the ten studies (one of which was randomised) that evaluated the effect of stoma size on weight loss outcomes after RYGB, six studies did not show any significant effect of stoma size on weight loss outcomes and four found larger stoma sizes to be associated with significantly poorer weight loss outcomes. No study found larger stoma to be associated with better weight loss outcomes.

Conclusions

This review finds that a larger pouch or stoma size may be associated with adverse weight loss outcomes but the quality of data does not allow us to precisely determine optimum pouch or stoma size with RYGB. There is a need for more randomised data comparing long-term weight loss outcomes with pouches or stoma of different sizes.

Keywords

Bariatric surgery Gastric pouch size Roux-en-Y gastric bypass Gastrojejunostomy size Stoma size Weight loss 

Abbreviations

RYGB

Roux-en-Y gastric bypass

GJ

Gastrojejunostomy

PRISMA

Preferred reporting items for systematic reviews and meta-analyses

AL

Alimentary limb

BPL

Bilio-pancreatic limb

EWL

Excess weight loss

EBMIL

Excess body mass index loss

TWL

Total weight loss

GJA

Gastrojejunal anastomosis

BMI

Body mass index

Notes

Author contributions

KM conceived the topic, performed the review, and wrote most of the manuscript. KM and YG independently searched for all relevant articles. All authors participated in discussions on the topic and contributed to manuscript writing. All authors have seen the final version and approve of it.

Funding

None.

Compliance with ethical standards

Disclosures

Prof. Mahawar has been paid honoraria by Medtronic, Gore, Olympus, and NHS for educational activities, outside the submitted work. Mr. Sharples and Dr. Graham have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Angrisani L, Santonicola A, Iovino P, Vitiello A, Zundel N, Buchwald H et al (2017) Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg 27(9):2279–2289CrossRefGoogle Scholar
  2. 2.
    Griffen WO Jr (1984) Gastric bypass. Am Surg 50(9):496–501PubMedGoogle Scholar
  3. 3.
    Flickinger EG, Sinar DR, Swanson M (1987) Gastric bypass. Gastroenterol Clin North Am 16(2):283–292PubMedGoogle Scholar
  4. 4.
    Mahawar KK, Sharples AJ (2017) Contribution of malabsorption to weight loss after Roux-en-Y gastric bypass: a systematic review. Obes Surg 27(8):2194–2206CrossRefGoogle Scholar
  5. 5.
    Manning S, Pucci A, Batterham RL (2015) Roux-en-Y gastric bypass: effects on feeding behavior and underlying mechanisms. J Clin Invest 125(3):939–948CrossRefGoogle Scholar
  6. 6.
    Roberts K, Duffy A, Kaufman J, Burrell M, Dziura J, Bell R (2007) Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc 21(8):1397–1402CrossRefGoogle Scholar
  7. 7.
    Heneghan HM, Yimcharoen P, Brethauer SA, Kroh M, Chand B (2012) Influence of pouch and stoma size on weight loss after gastric bypass. Surg Obes Relat Dis 8(4):408–415CrossRefGoogle Scholar
  8. 8.
    Edholm D, Ottosson J, Sundbom M (2016) Importance of pouch size in laparoscopic Roux-en-Y gastric bypass: a cohort study of 14,168 patients. Surg Endosc 30(5):2011–2015CrossRefGoogle Scholar
  9. 9.
    Cottam DR, Fisher B, Sridhar V, Atkinson J, Dallal R (2009) The effect of stoma size on weight loss after laparoscopic gastric bypass surgery: results of a blinded randomized controlled trial. Obes Surg 19(1):13–17CrossRefGoogle Scholar
  10. 10.
    Kirkpatrick JR, Siegel T (1982) Critical determinants of a successful gastric bypass: reservoir versus stoma. Am J Gastroenterol 77(7):464–466PubMedGoogle Scholar
  11. 11.
    Campos GM, Rabl C, Mulligan K, Posselt A, Rogers SJ, Westphalen AC et al (2008) Factors associated with weight loss after gastric bypass. Arch Surg 143(9):877–883CrossRefGoogle Scholar
  12. 12.
    Flanagan L (1996) Measurement of functional pouch volume following the gastric bypass procedure. Obes Surg 6(1):38–43CrossRefGoogle Scholar
  13. 13.
    Yi B, Jiang J, Zhu L, Li P, Im I, Zhu S (2015) Comparison of the effects of Roux-en-Y gastrojejunostomy and LRYGB with small stomach pouch on type 2 diabetes mellitus in patients with BMI < 35 kg/m2. Surg Obes Relat Dis 11(5):1061–1068CrossRefGoogle Scholar
  14. 14.
    Madan AK, Tichansky DS, Phillips JC (2007) Does pouch size matter? Obes Surg 17(3):317–320CrossRefGoogle Scholar
  15. 15.
    Maud R, Pechoux A, Marion D, Laville M, Gouillat C, Disse E (2015) Relevance of Roux-en-Y gastric bypass volumetry using 3-dimensional gastric computed tomography with gas to predict weight loss at 1 year. Surg Obes Relat Dis 11(1):26–31CrossRefGoogle Scholar
  16. 16.
    Nishie A, Brown B, Barloon T, Kuehn D, Samuel I (2007) Comparison of size of proximal gastric pouch and short-term weight loss following routine upper gastrointestinal contrast study after laparoscopic Roux-en-Y gastric bypass. Obes Surg 17(9):1183–1188CrossRefGoogle Scholar
  17. 17.
    O’Connor EA, Carlin AM (2008) Lack of correlation between variation in small-volume gastric pouch size and weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 4(3):399–403CrossRefGoogle Scholar
  18. 18.
    Ren Y, Yang W, Yang J, Wang C (2015) Effect of Roux-en-Y gastric bypass with different pouch size in Chinese T2DM patients with BMI 30-35 kg/m2. Obes Surg 25(3):457–463CrossRefGoogle Scholar
  19. 19.
    Riccioppo D, Santo MA, Rocha M, Buchpiguel CA, Diniz MA, Pajecki D et al (2018) Small-volume, fast-emptying gastric pouch leads to better long-term weight loss and food tolerance after Roux-en-Y gastric bypass. Obes Surg 28(3):693–701CrossRefGoogle Scholar
  20. 20.
    Topart P, Becouarn G, Ritz P (2011) Pouch size after gastric bypass does not correlate with weight loss outcome. Obes Surg 21(9):1350–1354CrossRefGoogle Scholar
  21. 21.
    Abu Dayyeh BK, Jirapinyo P, Thompson CC (2017) Plasma Ghrelin levels and weight regain after Roux-en-Y gastric bypass surgery. Obes Surg 27(4):1031–1036CrossRefGoogle Scholar
  22. 22.
    Abu Dayyeh BK, Lautz DB, Thompson CC (2011) Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol 9(3):228–233CrossRefGoogle Scholar
  23. 23.
    Gould JC, Garren M, Boll V, Starling J (2006) The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 20(7):1017–1020CrossRefGoogle Scholar
  24. 24.
    Ramos AC, Marchesini JC, de Souza Bastos EL, Ramos MG, de Souza MDG, et al. The role of gastrojejunostomy size on gastric bypass weight loss. Obes Surg 2017.  https://doi.org/10.1007/s11695-017-2686-6 CrossRefGoogle Scholar
  25. 25.
    Näslund I (1986) The size of the gastric outlet and the outcome of surgery for obesity. Acta Chir Scand 152:205–210PubMedGoogle Scholar
  26. 26.
    Sima E, Hedberg J, Sundbom M (2016) Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis. Surg Endosc 30(4):1553–1558CrossRefGoogle Scholar
  27. 27.
    Smith C, Garren M, Gould J (2011) Impact of gastrojejunostomy diameter on long-term weight loss following laparoscopicgastric bypass: a follow-up study. Surg Endosc 25(7):2164–2167CrossRefGoogle Scholar
  28. 28.
    Silen W, Eiseman B, Brown WH Jr (1958) The role of stomal size in the postgastrectomy. Surg Forum 9:464–466PubMedGoogle Scholar
  29. 29.
    Markar SR, Penna M, Venkat-Ramen V, Karthikesalingam A, Hashemi M (2012) Influence of circular stapler diameter on postoperative stenosis after laparoscopic gastrojejunal anastomosis in morbid obesity. Surg Obes Relat Dis 8(2):230–235CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Bariatric UnitSunderland Royal HospitalSunderlandUK
  2. 2.Faculty of Health Sciences and WellbeingUniversity of SunderlandSunderlandUK
  3. 3.Department of Upper GI and Bariatric SurgeryUniversity Hospital of North MidlandsStoke-on-TrentUK

Personalised recommendations