Skip to main content
Erschienen in: Obesity Surgery 9/2011

01.09.2011 | Clinical Report

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

verfasst von: Philippe Topart, Guillaume Becouarn, Patrick Ritz

Erschienen in: Obesity Surgery | Ausgabe 9/2011

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat Fobi MAL, Lee H, Holness R, DeGaulle C. Gastric bypass operation for obesity. World J Surg. 1998;22:925–35.PubMedCrossRef Fobi MAL, Lee H, Holness R, DeGaulle C. Gastric bypass operation for obesity. World J Surg. 1998;22:925–35.PubMedCrossRef
2.
Zurück zum Zitat Campos GM, Rabl C, Mulligan K, et al. Factors associated with weight loss after gastric bypass. Arch Surg. 2008;143:877–84.PubMedCrossRef Campos GM, Rabl C, Mulligan K, et al. Factors associated with weight loss after gastric bypass. Arch Surg. 2008;143:877–84.PubMedCrossRef
3.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
4.
5.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
6.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
7.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
8.
Zurück zum Zitat Higa KD, Boone K, Nimeri A, et al. Gastric bypass: increased restriction for poor weight loss. Surg Endosc. 2007;21:1922–3.PubMedCrossRef Higa KD, Boone K, Nimeri A, et al. Gastric bypass: increased restriction for poor weight loss. Surg Endosc. 2007;21:1922–3.PubMedCrossRef
9.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
11.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
12.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
13.
Zurück zum Zitat Meguid MM, Glade MJ, Middleton FA. Weight regain after Roux-en-Y: a significant 20% complication related to PYY. Nutrition. 2008;24:832–42.PubMedCrossRef Meguid MM, Glade MJ, Middleton FA. Weight regain after Roux-en-Y: a significant 20% complication related to PYY. Nutrition. 2008;24:832–42.PubMedCrossRef
14.
15.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
16.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
17.
Zurück zum Zitat Rheinhold RB. Critical analysis of long-term weight loss following gastric bypass. Surg Gynecol Obstet. 1982;155:385–94. Rheinhold RB. Critical analysis of long-term weight loss following gastric bypass. Surg Gynecol Obstet. 1982;155:385–94.
18.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
19.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
20.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
21.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
22.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
23.
Zurück zum Zitat 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.CrossRef 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.CrossRef
24.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
25.
Zurück zum Zitat Lanyon RI, Maxwell BM, Kraft AJ. Prediction of long-term outcome after gastric bypass surgery. Obes Surg. 2009;19:439–45.PubMedCrossRef Lanyon RI, Maxwell BM, Kraft AJ. Prediction of long-term outcome after gastric bypass surgery. Obes Surg. 2009;19:439–45.PubMedCrossRef
26.
Zurück zum Zitat Kinzl JF, Schrattenecker M, Traweger C, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;161609–14. Kinzl JF, Schrattenecker M, Traweger C, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;161609–14.
27.
Zurück zum Zitat Mitchell JE, Lancaster KL, Burgard MA, et al. Long-term follow-up of patients’ status after gastric bypass. Obes Surg. 2001;11:464–8.PubMedCrossRef Mitchell JE, Lancaster KL, Burgard MA, et al. Long-term follow-up of patients’ status after gastric bypass. Obes Surg. 2001;11:464–8.PubMedCrossRef
28.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
29.
Zurück zum Zitat 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 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
30.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
31.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
Metadaten
Titel
Pouch Size After Gastric Bypass Does not Correlate with Weight Loss Outcome
verfasst von
Philippe Topart
Guillaume Becouarn
Patrick Ritz
Publikationsdatum
01.09.2011
Verlag
Springer-Verlag
Erschienen in
Obesity Surgery / Ausgabe 9/2011
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-011-0460-8

Weitere Artikel der Ausgabe 9/2011

Obesity Surgery 9/2011 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.