Influence of the gastric stump’s volume on the long-term results of laparoscopic Roux-en-Y gastric bypass surgery

Abstract

The objective was to retrospectively analyze the dependence of long-term results of laparoscopic Roux-en-Y gastric bypass surgery according to the size of the formed gastric stumpMethods and materials. We retrospectively analyzed the long-term results of 207 morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass surgery by two different techniques. The median follow-up was 36 months. Two groups of patients were identified according to the method of formation of the gastric stump: using 2 (1st group) or 3 (2nd group) stapler cassettes and performing of computed tomography volumetry to determine thevolume of the created gastric stump.Results. Statistically significant differences in the volume of the formed gastric stump, depending on the method of operation, were as follows: 23.8 ml (8.9–37.3 ml) in the 1st group and 47.7 ml (31.9–72.8 ml) in the 2nd group (p<0.0001). Significant differences were observed in the following indicators: relapse of weight gain or insufficient weight loss (loss of < 70 % overweight) at median follow-up of 36 months were observed in 2 (2.3 %) and 12 (9.9 %) cases in the 1st and 2nd groups, respectively (p<0.05).Conclusion. We revealed that the formation of the gastric stump of a very small volume by 2 stapler cassettes compared to using 3 stapler cassettes contributes to improving the results in the long-term postoperative period and minimizing the frequency of relapse of weight gain and insufficient weight loss. The restrictive component of the surgery with equal malabsorptive is fundamental for the clinical parameters of its effectiveness, that leads to increasing the frequency of relapses of weight gain and insufficient weight loss in the 2nd group in comparison with the 1st and group of patients (p<0.05). Based on computed tomography volumetry, the volume of a small-sized stomach stump can be reliably measured and, accordingly, weight loss is predicted in the long term after the surgery, as well as the absence of relapses of weight gain or insufficient weight loss.