Does pouch size matter?

被引:36
作者
Madan, Atul K.
Tichansky, David S.
Phillips, Jerry C.
机构
[1] Univ Tennessee, Ctr Hlth Sci, Sect Minimally Invas Surg, Dept Surg, Memphis, TN 38163 USA
[2] Univ Tennessee, Ctr Hlth Sci, Dept Radiol Gastrointestinal & Diagnost, Memphis, TN 38163 USA
关键词
morbid obesity; Roux-en-Y gastric bypass; laparoscopy; pouch size measurement;
D O I
10.1007/s11695-007-9058-6
中图分类号
R61 [外科手术学];
学科分类号
摘要
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 LRYGBR.
引用
收藏
页码:317 / 320
页数:4
相关论文
共 13 条
[1]   POUCH VOLUME, STOMA DIAMETER, AND CLINICAL OUTCOME AFTER GASTROPLASTY FOR MORBID-OBESITY - A PROSPECTIVE-STUDY [J].
ANDERSEN, T ;
PEDERSEN, BH .
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 1984, 19 (05) :643-649
[2]  
ANDERSON T, 1988, SCAN J GASTROENTEROL, V223, P1057
[3]  
BACKMAN L, 1984, ACTA CHIR SCAND, V150, P549
[4]  
BECHTOLD DL, 1988, POUCH SIZE FAILED VE
[5]   Bariatric surgery worldwide 2003 [J].
Buchwald, H ;
Williams, SE .
OBESITY SURGERY, 2004, 14 (09) :1157-1164
[6]   Recommendations for reporting weight loss [J].
Deitel, M ;
Greenstein, RJ .
OBESITY SURGERY, 2003, 13 (02) :159-160
[7]   Measurement of functional pouch volume following the gastric bypass procedure [J].
Flanagan, L .
OBESITY SURGERY, 1996, 6 (01) :38-43
[8]  
LUNDELL L, 1987, INT J OBESITY, V11, P169
[9]   Triple-stapling technique for jejunojejunostomy in laparoscopic gastric bypass [J].
Madan, AK ;
Frantzides, CT .
ARCHIVES OF SURGERY, 2003, 138 (09) :1029-1032
[10]   Meta-analysis: Surgical treatment of obesity [J].
Maggard, MA ;
Shugarman, LR ;
Suttorp, M ;
Maglione, M ;
Sugarman, HJ ;
Livingston, EH ;
Nguyen, NT ;
Li, ZP ;
Mojica, WA ;
Hilton, L ;
Rhodes, S ;
Morton, SC ;
Shekelle, PG .
ANNALS OF INTERNAL MEDICINE, 2005, 142 (07) :547-559