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



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.


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.


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.


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.


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



Roux-en-Y gastric bypass




Preferred reporting items for systematic reviews and meta-analyses


Alimentary limb


Bilio-pancreatic limb


Excess weight loss


Excess body mass index loss


Total weight loss


Gastrojejunal anastomosis


Body mass index


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.



Compliance with ethical standards


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.


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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

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