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Surgical Endoscopy

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01-03-2020 | Enterostomy | Review Article

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

Authors: Kamal Mahawar, Alistair J. Sharples, Yitka Graham

Published in: Surgical Endoscopy | Issue 3/2020

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.

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):2279–2289CrossRef

Griffen WO Jr (1984) Gastric bypass. Am Surg 50(9):496–501PubMed

Flickinger EG, Sinar DR, Swanson M (1987) Gastric bypass. Gastroenterol Clin North Am 16(2):283–292PubMed

Mahawar KK, Sharples AJ (2017) Contribution of malabsorption to weight loss after Roux-en-Y gastric bypass: a systematic review. Obes Surg 27(8):2194–2206CrossRef

Manning S, Pucci A, Batterham RL (2015) Roux-en-Y gastric bypass: effects on feeding behavior and underlying mechanisms. J Clin Invest 125(3):939–948CrossRef

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):1397–1402CrossRef

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):408–415CrossRef

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):2011–2015CrossRef

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):13–17CrossRef

10.

Kirkpatrick JR, Siegel T (1982) Critical determinants of a successful gastric bypass: reservoir versus stoma. Am J Gastroenterol 77(7):464–466PubMed

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):877–883CrossRef

12.

Flanagan L (1996) Measurement of functional pouch volume following the gastric bypass procedure. Obes Surg 6(1):38–43CrossRef

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):1061–1068CrossRef

14.

Madan AK, Tichansky DS, Phillips JC (2007) Does pouch size matter? Obes Surg 17(3):317–320CrossRef

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):26–31CrossRef

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):1183–1188CrossRef

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):399–403CrossRef

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):457–463CrossRef

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):693–701CrossRef

20.

Topart P, Becouarn G, Ritz P (2011) Pouch size after gastric bypass does not correlate with weight loss outcome. Obes Surg 21(9):1350–1354CrossRef

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):1031–1036CrossRef

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):228–233CrossRef

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):1017–1020CrossRef

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 CrossRef

25.

Näslund I (1986) The size of the gastric outlet and the outcome of surgery for obesity. Acta Chir Scand 152:205–210PubMed

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):1553–1558CrossRef

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):2164–2167CrossRef

28.

Silen W, Eiseman B, Brown WH Jr (1958) The role of stomal size in the postgastrectomy. Surg Forum 9:464–466PubMed

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):230–235CrossRef

Title: A systematic review of the effect of gastric pouch and/or gastrojejunostomy (stoma) size on weight loss outcomes with Roux-en-Y gastric bypass
Authors: Kamal Mahawar
Alistair J. Sharples
Yitka Graham
Publication date: 01-03-2020
Publisher: Springer US
Keywords: Enterostomy
Enterostomy
Published in: Surgical Endoscopy / Issue 3/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07277-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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