Lack of correlation between variation in small-volume gastric pouch size and weight loss after laparoscopic Roux-en-Y gastric bypass

Abstract

Controversy exists in published reports regarding the influence of gastric pouch size on weight loss after gastric bypass (GB). The purpose of this study was to determine whether variations in the anatomic size of small-volume (</=20 cm(3)) gastric pouches correlate with weight loss 1 year after laparoscopic GB. We prospectively collected intraoperative data on gastric pouch size during laparoscopic GB in 231 morbidly obese patients. A divided, vertical, lesser curve-based gastric pouch was created using an orogastric tube for size and diameter determination. The height of the cylindrical pouch was measured by the number of staple fires. The mean age was 45 +/- 10 years, 90% were women, and 68% were white. The mean preoperative body mass index was 48 +/- 6 kg/m(2). The percentage of excess weight loss (%EWL) 1 year after GB was 66%. The calculated gastric pouch volume was 10-20 cm(3). No significant difference was found in the %EWL at 1 year when stratified by gastric pouch size. The pouch size was not dependent on age, gender, preoperative weight, or body mass index. A significant inverse correlation was found between the %EWL and both preoperative weight and body mass index (P <.001). Blacks had significantly smaller gastric pouches than whites (P = .004); however, whites had a significantly greater %EWL at 1 year compared with blacks (67% versus 61%; P = .016). With construction of divided, vertical, lesser curve-based small-volume (< or =20 cm(3)) gastric pouches, the actual size of the gastric pouch did not correlate with the %EWL at 1 year after laparoscopic GB.