Obesity Surgery

, Volume 17, Issue 3, pp 317–320 | Cite as

Does Pouch Size Matter?

  • Atul K. Madan
  • David S. Tichansky
  • Jerry C. Phillips
Article

Background

Mechanical restriction, malabsorption, and hormonal changes appear to play a role in weight loss after Roux-en-Y gastric bypass (RYGBP). This investigation chose to investigate one aspect of the restrictive role of gastric bypass: the pouch size. Our hypothesis was that a small pouch size with no fundus after laparoscopic RYGBP (LRYGBP) would lead to greater loss of excess weight and weight loss success.

Methods

Upper gastrointestinal radiological (UGI) studies were retrospectively reviewed by three blinded experts (2 bariatric surgeons and 1 expert radiologist), to determine pouch size and fundus size. The following grading system was utilized: Size I - smaller than average pouch, Size II - average pouch, Size III - larger than average pouch, and Size IV - over 3 times the size of an average pouch. Fundus 0 - no fundus appreciated, Fundus I - slight amount of fundus barely noted, Fundus II - fundus noted, Fundus III - large amount of fundus noted, and Fundus IV - majority of the pouch was fundus. Percentage of excess weight loss (%EWL) and successful weight loss (A. >50% EWL, B. within 50% of ideal body weight, C. loss of >25% of preoperative weight) were calculated.

Results

There were 59 patients in this study with 97% follow-up of >1 year. No Size IV or Fundus IV were noted. There were no statistically significant differences between in %EWL or success for either pouch size or fundus size.

Conclusions

While there may be a trend for the mean %EWL to be lower with larger pouches and larger amounts of fundus, no significant differences were found. Larger pouches and the presence of fundus (within reason) still result in a high rate of success after LRYGBP.

Key words

Morbid obesity Roux-en-Y gastric bypass laparoscopy pouch size measurement 

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References

  1. 1.
    Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg 2004; 14: 1157–64.PubMedCrossRefGoogle Scholar
  2. 2.
    Maggard MA, Shugarman LR, Suttorp M et al. Metaanalysis: Surgical treatment of obesity. Ann Intern Med 2005; 142: 547–59.PubMedGoogle Scholar
  3. 3.
    Sjostrom L, Lindroos AK, Peltonen M et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683–93.PubMedCrossRefGoogle Scholar
  4. 4.
    Madan AK, Frantzides CT. Triple-stapling technique for jejunojejunostomy in laparoscopic gastric bypass. Arch Surg 2003; 138: 1029–32.PubMedCrossRefGoogle Scholar
  5. 5.
    Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg 2003; 13: 159–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Flanagan L Jr. Measurement of functional pouch volume following the gastric bypass procedure. Obes Surg 1996;6:38–43.PubMedCrossRefGoogle Scholar
  7. 7.
    Bechtold DL. Pouch size in failed vertical banded gastroplasty: comparison of upper GI and surgical measurements. American Society for Bariatric Surgery, Iowa City, IA, June 3,1988 (Poster 11).Google Scholar
  8. 8.
    Miskowiak J, Fleckenstein P, Anderson B. Radiologic findings and weight loss following gastroplasty for morbid obesity. Acta Radiol Diagn 1986; 27: 553–5.Google Scholar
  9. 9.
    Salmon PA. Failure of gastroplasty pouch and stoma size to correlate with postoperative weight loss. Can J Surg 1986; 29: 60–3.PubMedGoogle Scholar
  10. 10.
    Anderson T, Pedersen BH, Henriksen JH et al. Food intake in relation to pouch volume, stoma diameter, and pouch emptying after gastroplasty for morbid obesity. Scan J Gastroenterol 1988; 23: 1057–62.Google Scholar
  11. 11.
    Andersen T, Pedersen BH. Pouch volume, stoma diameter, and clinical outcome after gastroplasty for morbid obesity. A prospective study. Scand J Gastroenterol 1984; 19: 643–9.PubMedGoogle Scholar
  12. 12.
    Backman L, Rosenborg M. The significance of gastric pouch size and emptying time for results of gastric surgery for massive obesity. Acta Chir Scand 1984; 150: 549–55.PubMedGoogle Scholar
  13. 13.
    Lundell L, Forssell H, Jensen J et al. Measurement of pouch volume and stoma diameter after gastroplasty. Int J Obes 1987; 11: 169–74.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Atul K. Madan
    • 1
  • David S. Tichansky
    • 1
  • Jerry C. Phillips
    • 2
  1. 1.Section of Minimally Invasive Surgery, Department of SurgeryUniversity of Tennessee Health Science CenterMemphisUSA
  2. 2.Department of Radiology–Gastrointestinal and DiagnosticUniversity of Tennessee Health Science CenterMemphisUSA

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