Pouch Size Research Articles

Gastric pouch reduction using StomaphyX™ in post Roux-en-Y gastric bypass patients does not result in sustained weight loss: a retrospective analysis

Gastric bypass is the "gold standard" procedure of bariatric surgery. However, 20.4-34.9% of these patients may fail to achieve or maintain the weight loss on long-term follow-up and may require additional procedures. StomaphyX has been promoted for weight reduction in such patients. To study whether endoluminal reduction of gastric pouch and stoma using StomaphyX results in sustained weight loss in patients who regain weight after gastric bypass. Retrospective chart review was performed on 59 postgastric bypass patients who underwent revision of gastric pouch using StomaphyX from 2007 to 2008. Postprocedure weight at 1 week, 1 month, and 6 months follow-up as well as weight at the time of the review was recorded for each patient. Average weight loss and excess body weight loss (EBWL) were 2.6 ± 2.3 kg and 7.3 ± 7.1% (n = 42) at 1 week, 3.7 ± 2.9 kg and 11.6 ± 12.1% (n = 31) at 1 month, and 3.8 ± 4.5 kg and 11.5 ± 17.9% (n = 10) at 6 months respectively. At the time of review, the average follow-up was 41 months, average weight loss was 1.7 ± 9.7 kg, and EBWL was 4.3 ± 29.8% (n = 53). Endoscopy in 12 patients at average 18 months follow-up showed no sustained reduction in pouch and stoma size. StomaphyX results in weight loss that is not sustained on long-term follow-up. Pouch and stoma tend to regain their preprocedure size on follow-up. StomaphyX cannot be recommended as a weight loss strategy in postgastric bypass patients who regain weight.

Development and Verification of a Mouse Model for Roux-en-Y Gastric Bypass Surgery with a Small Gastric Pouch

Existing mouse models of Roux-en-Y gastric bypass (RYGB) surgery are not comparable to human RYGB in gastric pouch volume for a large or absent gastric volume. The aim of this study was to develop and characterize a mouse RYGB model that closely replicates gastric pouch size of human RYGB surgery of about 5% of total gastric volume. We established this model in diet-induced obese (DIO) mice of C57BL/6J. This surgery resulted in a sustained 30% weight loss, entirely accounted for by decreased fat mass but not lean mass, compared to sham-operated mice on the high fat diet. Compared to sham-operated mice, energy expenditure corrected for total body weight was significantly increased by about 25%, and substrate utilization was shifted toward higher carbohydrate utilization at 8 weeks after RYGB when body weight had stabilized at the lower level. The energy expenditure persisted and carbohydrate utilization was even more pronounced when the mice were fed chow diet. Although significantly increased during daytime, overall locomotor activity was not significantly different. In response to cold exposure, RYGB mice exhibited an improved capacity to maintain the body temperature. In insulin tolerance test, exogenous insulin-induced suppression of plasma glucose levels was significantly greater in RYGB mice at 4 weeks after surgery. Paradoxically, food intake measured at 5 weeks after surgery was significantly increased, possibly in compensation for increased fecal energy loss and energy expenditure. In conclusion, this new model is a viable alternative to existing murine RYGB models and the model matches human RYGB surgery in anatomy. This model will be useful for studying molecular mechanisms involved in the beneficial effects of RYGB on body weight and glucose homeostasis.

Estudos endoscópico e histológico prospectivos e sequenciais da bolsa gástrica em 130 pacientes obesos mórbidos submetidos à bypass gástrico em Y-de-Roux

Roux-en-Y gastric bypass is the most common performed bariatric surgery. A small gastric pouch is created, leaving a narrow gastrojejunal anastomosis, with a long jejunal limb. Very little is known regarding the behavior of this pouch years after surgery. To determine through prospective sequential endoscopic studies the size of the gastric pouch, the diameter of the anastomosis, and the behavior of H. pylori infection after surgery. In 130 patients subjected to resectional gastric bypass, several routine sequential endoscopic (until 120 months) and histological evaluations of the gastric pouch were performed. After surgery, a mean of 3.6 endoscopies/patient were performed. Macroscopically nearly 95% of the small gastric pouches were normal, and the main pathological finding was a marginal ulcer. Erosive esophagitis disappeared in 93% of the patients. There was no increase in the orocaudal size of the pouch during this period of observation. There was no dilatation of the diameter of gastrojejunal anastomosis. Near 54% of all patients had normal fundic mucosa, while 18% had chronic active gastritis, coincident with H. pylori infection. Five patients had intestinal metaplasia. Based on this sequential endoscopic evaluation, there was no increase in the orocaudal size of the gastric pouch nor increase in the diameter of the gastrojejunal anastomosis. H. pylori behavior was inconsistent and difficult to interpret.

Study of Caryophyllidean (Capingentidae: Pseudobatrachus) tapeworms of fresh water fishes of Bundelkhand region of Madhya Pradesh, India: Part-III

Presently eight species are reported from the World in the genus, Pseudobatrachus, Pathak and Srivastav, 2005 i.e. P. chandrai Pathak and Srivastav, 2005; P. moolchandrai Srivastav et al, 2006; P. chandlaensis Sahu, 2007; P. madhyapradeshensis, Khare, 2008; P. chhatrasali Sahu et al, 2009; P. Sengarii Singh, 2009; P. kenensis Srivastav et al, 2010 and P. ramchandrai, Srivastav and Aditya, 2010. The present form is the ninth one from the Indian subcontinent as well as from the whole world and differs on the basis of various morphometric character viz. size of worm, size and shape of scolex, presence of bothridea and grooved rostellum, size of neck, size and number of testes, size of cirrus pouch, presence of internal seminal vesicle, size of ovary and shape of ovarian lobes, size of vitellaria and their distribution, presence of receptaculum seminis, size of uterus, size and type of eggs and their hosts. The caryophyllidean is unique among cestoidea in having monopleuroide body plane, i.e. without internal or external proglottidization and with a single set of reproductive organ. Thus it is provisionally accommodated as P. ramsagarensis n. sp.

Endoscopic or external approach revision surgery for pharyngeal pouch following primary endoscopic stapling: which is the favoured approach?

This study aimed to assess outcomes of revision endoscopic stapling and external excision of pharyngeal pouch. A 5-year prospective study was performed on all patients requiring revision pouch surgery following primary endoscopic stapling. Data were collected retrospectively. Eighteen patients underwent revision pouch surgery. In seven patients, pouch size was down-graded from 3 to 2, and these were stapled endoscopically. Two leaks resulted. Eleven patients with grade 1 or 3 pouches underwent external excision of pouch, with no post-operative complications. As per results external excision of pouch is safe for grade 1 and 3 pouches. It avoids risking redundant mucosa and recurrence of symptoms which can complicate stapling and enables a myotomy to be performed to reduce cricopharyngeal hypertonicity. The highest predictable success is with grade 2 pouches, whose size is amenable to adequate endoscopic stapling. However, the "staple over staple" effect of revision stapling leads to unpredictable fibrosis, which can contribute to risk of perforation.

A new species of Asthenocotyle Robinson, 1961 (Monogenea: Microbothriidae), a skin parasite of the great lanternshark Etmopterus princeps Collett from the Azores, with a redescription of A. kaikourensis Robinson, 1961 and observations on A. taranakiensis Beverley-Burton, Klassen & Lester, 1987

Asthenocotyle azorensis n. sp. (Monogenea: Microbothriidae) is described from the dermal denticles of the great lanternshark Etmopterus princeps Collett off the Azores. The type-species of the genus, A. kaikourensis Robinson, 1961, is redescribed and additional observations are made on A. taranakiensis Beverley-Burton, Klassen & Lester, 1987. The generic diagnosis is revised. The new species is distinguished from its two congeners by the large size of the pharynx and fewer testes. The ejaculatory bulb of A. kaikourensis is much larger than those of A. taranakiensis and A. azorensis and is supplied with many ducts from an extensive field of male accessory gland-cells located outside the genital pouch and extending posteriorly to the region of the germarium and external seminal vesicle. Asthenocotyle taranakiensis is distinguished from the other two species by its copulatory sclerite, which forms a double loop, although this may not be the case when the copulatory organ is extended. The bodies of A. azorensis and A. kaikourensis are similar in shape, with the maximum width approximately 37% and 25%, respectively, of the total length from the anterior end. In addition to the relatively small size of the genital pouch and ejaculatory bulb in A. azorensis and A. taranakiensis, the vaginal opening is adjacent to the common genital opening. In A. kaikourensis, the vaginal opening is distant from and posterior to the common genital opening. The functional morphology of the copulatory organ of A. azorensis is considered. The relative importance, for the taxonomy of microbothriids, of the number of testes versus the anatomy of the copulatory complex is discussed.

Roux-en-Y Gastric Bypass Operation in Rats

Currently, the most effective therapy for the treatment of morbid obesity to induce significant and maintained body weight loss with a proven mortality benefit is bariatric surgery. Consequently, there has been a steady rise in the number of bariatric operations done worldwide in recent years with the Roux-en-Y gastric bypass (gastric bypass) being the most commonly performed operation. Against this background, it is important to understand the physiological mechanisms by which gastric bypass induces and maintains body weight loss. These mechanisms are yet not fully understood, but may include reduced hunger and increased satiation, increased energy expenditure, altered preference for food high in fat and sugar, altered salt and water handling of the kidney as well as alterations in gut microbiota. Such changes seen after gastric bypass may at least partly stem from how the surgery alters the hormonal milieu because gastric bypass increases the postprandial release of peptide-YY (PYY) and glucagon-like-peptide-1 (GLP-1), hormones that are released by the gut in the presence of nutrients and that reduce eating. During the last two decades numerous studies using rats have been carried out to further investigate physiological changes after gastric bypass. The gastric bypass rat model has proven to be a valuable experimental tool not least as it closely mimics the time profile and magnitude of human weight loss, but also allows researchers to control and manipulate critical anatomic and physiologic factors including the use of appropriate controls. Consequently, there is a wide array of rat gastric bypass models available in the literature reviewed elsewhere in more detail. The description of the exact surgical technique of these models varies widely and differs e.g. in terms of pouch size, limb lengths, and the preservation of the vagal nerve. If reported, mortality rates seem to range from 0 to 35%. Furthermore, surgery has been carried out almost exclusively in male rats of different strains and ages. Pre- and postoperative diets also varied significantly. Technical and experimental variations in published gastric bypass rat models complicate the comparison and identification of potential physiological mechanisms involved in gastric bypass. There is no clear evidence that any of these models is superior, but there is an emerging need for standardization of the procedure to achieve consistent and comparable data. This article therefore aims to summarize and discuss technical and experimental details of our previously validated and published gastric bypass rat model.

Arthroscopic Inferior Capsular Shift

Background: Neer and Foster’s open inferior capsular shift to treat acquired cases of anteroinferior shoulder instability due to an overstretched and redundant capsule is described with good results. Recently, new arthroscopic techniques were described to manage this problem. Purpose: To assess the results of a new arthroscopic reinforced inferior capsular shift technique based on Neer and Foster’s open inferior capsular shift. Study Design: Case series; Level of evidence, 4. Methods: This new technique of arthroscopic inferior capsular shift was used to treat 108 patients with anteroinferior shoulder instability due to capsular redundancy as confirmed clinically and during arthroscopy. It reduces the size of the redundant capsular pouch and reinforces the thinned-out capsule. Intraoperatively, patients with associated labral tears (n = 25) and patients with open rotator intervals (n = 8) were excluded, and only 75 patients with pure capsular redundancy were included in this study. Results: Patients were followed for a minimum of 7 years. All 75 patients had patulous and redundant capsules. Three patients (4.0%) had a redislocation after a significant trauma. The range of motion preoperatively was 168.1° ± 7.5° in forward elevation, 64.7° ± 7.9° in external rotation, and T5.0 ± T0.8 in internal rotation. Postoperatively, it was 167.2° ± 5.8° in forward elevation, 59.95° ± 4.9° in external rotation, and T7.1 ± T1.0 in internal rotation. The American Shoulder and Elbow Surgeons (ASES) (70.76 to 97.53; P < .001), Constant (90.02 to 99.24; P < .001), and University of California, Los Angeles (UCLA) (21.97 to 33.84; P < .001) scores demonstrated significant improvement postoperatively. Conclusion: This novel technique of arthroscopic capsular shift addresses the problem of capsular redundancy present in many cases of anteroinferior shoulder instability. It tries to achieve a capsular shift based on the principles of Neer. The long-term results are very good.

Quality of life following laparoscopic distal gastrectomy with modified billroth II reconstruction.

140 Background: Laparoscopic gastrectomy has been proposed as a procedure to reduce the morbidity of gastric cancer surgery. Modified Billroth II (BII) reconstruction with a side to side loop gastrojejunostomy is technically straightforward to accomplish laparoscopically. To determine the long term morbidity of this reconstruction technique, we performed a quality of life (QOL) analysis of patients undergoing laparoscopic distal gastrectomy with modified BII reconstruction. Methods: Between June 2005 and May 2011, 64 patients underwent laparoscopic distal gastrectomy with modified BII reconstruction at City of Hope Medical Center (COH). Patients alive with no evidence of disease were recruited to participate in the QOL study. The study was approved by the Institutional Research Board of COH. Research subjects completed the EORTC QOL-STO22 instrument which queried patients for post gastrectomy symptoms. Comparison between groups was done using the Student-t test. Results: 33 of 64 patients met the criteria for participation in our QOL study. Of these, 23 patients consented to participate and completed the EORTC QOL-STO22 instrument. Overall, 81% categorized symptoms as occurring “not-at-all” or “a-little” while 19% reported symptoms occurring “quite-a-bit” or “very-much”. Since symptoms could be worse in patients with small gastric pouches, we divided our cohort into two groups, one having at least 70% of the stomach resected (12 patients) and the other having less than 70% of the stomach resected (11 patients). The two groups were compared with respect to symptoms. There was no difference between the groups with respect to dysphasia (p=0.80), pain (p=0.98), reflux (p=0.93), and eating restriction (p=0.33). Overall 78% of patients with a small gastric pouch and 83% of patients with a larger gastric pouch reported these symptoms as occurring “not-at-all” or “a-little”. Conclusions: Laparoscopic distal gastrectomy with modified BII reconstruction resulted in an acceptable morbidity rate with few patients experiencing severe symptoms. Gastric pouch size did not predict symptoms and most patients with a small gastric pouch report excellent QOL.

Evaluation of the Different Transcervical Approaches for Zenker Diverticulum

The aim of this study was to evaluate the results of open surgical techniques in the treatment of Zenker diverticulum. Case series with chart review. Academic tertiary referral center. Fifty-four patients with Zenker diverticulum were treated using a transcervical approach. Three with a Brombart I diverticulum underwent a simple myotomy of the cricopharyngeal muscle. Myotomy was combined with a diverticulum inversion in 14 patients and myotomy with diverticulectomy was performed in 37 patients. The surgical procedures were compared with regard to mean anesthesia time, duration of hospitalization, overall complication rate and rate of serious complications, recurrence rate, and follow-up results. Hospitalization times were significantly shorter in the inversion group (P = .024). No statistically significant differences were observed between the transcervical modalities for any of the other variables investigated. Inversion is an effective modality and is by definition less traumatic than traditional diverticulectomy. Although the size of the diverticulum appeared to be a helpful criterion, careful intraoperative evaluation is the key element in deciding which transcervical procedure should be used. In the authors' view, inversion always should be considered if the individual anatomy of the diverticulum sac (in terms of pharyngeal pouch size and intactness of the mucosa) allows it.

Increased pouch sizes and resulting changes in the amounts of nicotine and tobacco-specific N-nitrosamines in single pouches of Camel Snus and Marlboro Snus.

Initial analyses of the novel smokeless tobacco products Camel Snus and Marlboro Snus demonstrated that these products contain relatively low amounts of nicotine and the carcinogenic tobacco-specific nitrosamines N'-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), as compared with traditional smokeless products. It is unknown whether the modifications in packaging, flavors, and pouch sizes that occurred for both Camel Snus and Marlboro Snus since their first introduction to the market were accompanied by any changes in nicotine or nitrosamine levels. We examined the available data on nicotine and NNN and NNK levels in 60 samples of Camel Snus and 87 samples of Marlboro Snus that were analyzed in our laboratory between 2006 and 2010. Due to the increase in pouch size, the amounts of total nicotine, unprotonated nicotine, and the sum of NNN and NNK present in the large Camel Snus pouches released in 2010 are 1.9-fold, 2.4-fold, and 3.3-fold higher, respectively, than in the original smaller pouches that entered the market in 2006. Total and unprotonated nicotine content in the current version of Marlboro Snus pouches are 2.1-fold and 1.9-fold higher, respectively, and the sum of NNN and NNK is 1.5-fold lower than in the original version. We observed an increase in nicotine content in single portions of Camel Snus and Marlboro Snus, and an increase in tobacco-specific N-nitrosamine content in single portions of Camel Snus, due to the increases in pouch size that occurred between 2006 and 2010. This finding stresses the importance of tobacco product regulation and ingredient disclosures.

Influence of pouch and stoma size on weight loss after gastric bypass

BackgroundEnlargement of the gastric pouch and/or gastrojejunostomy after Roux-en-Y gastric bypass (RYGB) is postulated to be the antecedent to suboptimal weight loss or weight regain. The present study evaluated the gastric pouch and stoma dimensions in RYGB patients and correlated them with the weight loss outcomes. MethodsPatients who underwent upper endoscopy for investigation of gastrointestinal symptoms or weight regain after RYGB were identified. The stoma was considered enlarged if >2 cm in diameter and the pouch was considered enlarged if >6 cm long or >5 cm wide. Successful weight loss was defined as excess weight loss >50% or a body mass index decrease to ≤30 kg/m2. ResultsA total of 380 patients had nondiagnostic upper endoscopy findings at a mean post-RYGB interval of 5.9 ± 4.0 years. Among these were 175 patients (group A; 87% women) who had successful weight loss and 205 patients (group B; 86% women) who were referred for investigation of weight regain. The pouch and stoma size were normal in most of the patients in group A (63.4%) compared with 28.8% of the patients in group B (P <.001). The most common abnormality was an enlarged stoma. The pouch length, pouch volume, and stoma diameter correlated inversely with excess weight loss. Multivariate analysis identified that the stoma diameter was independently associated with weight regain after RYGB. ConclusionThe current definition of a “normal” size pouch/stoma is associated with optimal weight loss after RYGB, although this might need to be reviewed. Patients who regain weight are likely to have abnormal anatomy, in particular, stoma enlargement. The surgical RYGB technique and methods of evaluating the gastric anatomy in RYGB patients need to be standardized, intraoperatively and postoperatively.

Vocalizations reveal body condition and are associated with visual display traits in great frigatebirds (Fregata minor)

Acoustic displays are known to advertise aspects of male quality and to affect female choice of mates in a variety of birds, including not only songbirds but some seabirds as well. Male great frigatebirds (Fregata minor) produce a rapid warble vocalization that forms a prominent part of their courtship display. We investigated the relationships between aspects of this vocalization and male quality and pairing success in 103 great frigatebirds from a population in the northwestern Hawaiian Islands. We found that across males, frequency bandwidth of the display was negatively related to repetition rate, enabling us to use deviation from the upper bound regression of bandwidth on rate (“vocal deviation”) as one measure of vocal performance. We used vocal consistency, defined as the coefficient of variation of the time interval between successive peaks in the warble, as a second measure of performance. Vocal deviation was significantly positively associated with body condition of male great frigatebirds, but vocal consistency was not. We found that peak frequency of the warble was not significantly associated with body size but was negatively associated with size of the gular pouch, the most prominent visual ornament. Male great frigatebirds showed significant individual differences in all three vocal measures—peak frequency, vocal deviation, and vocal consistency—but none of these measures was a significant predictor of pairing success in our study population. These results suggest that vocalizations provide honest information about male body condition and gular pouch size in great frigatebirds but do not influence male success in pairing with females.

Optimal Size of Jejunal Pouch as a Reservoir after Total Gastrectomy: A Single-Center Prospective Randomized Study

BackgroundIn order to improve a patient’s quality of life after total gastrectomy, jejunal pouch reconstruction has been employed. However, little information exists regarding the optimal size of the jejunal pouch after total gastrectomy. MethodsThe study was designed as a single-center randomized trial in which the results of double-tract reconstruction with pouches of two different sizes were compared, i.e., short and long pouch double tract (SPDT and LPDT, respectively). We conducted a clinical assessment with standard questionnaire after surgery. The amount of residual food in the jejunal pouch was determined by endoscopy. ResultsNo demographic differences were noted between the two groups. The eating capacity per meal was higher in the SPDT group than in the LPDT group. The postoperative weight loss 24 months after surgery was lower in SPDT group than that in the LPDT group. Although the incidence of early dumping symptoms was higher in the SPDT group, no difference was noted in the other postprandial abdominal symptoms between the two groups. ConclusionsWe conclude that the optimal pouch should be relatively short, as a short pouch improves the eating capacity per meal and the weight loss ratio to the preoperative value.

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

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.

Natural Orifice Surgery: Endoluminal Pouch Reduction Following Failed Vertical Banded Gastroplasty

Following vertical banded gastroplasty (VBG), patients may develop pouch complications such as dilation and staple-line dehiscence. This may contribute to weight regain, and if conservative measures are exhausted, traditionally, open revisional surgery of the pouch or conversion of the VBG to Roux-en-Y gastric bypass (RYGB) would be considered. StomaphyX(TM) is an endoscopic device used with a conventional gastroscope for the approximation of tissue in gastric pouches or across gastroenteric anastomoses to enhance restriction. The objective of this study is to analyze the outcomes of StomaphyX(TM) endoluminal pouch revision following failed VBG. Patients with weight gain following VBG had endoluminal pouch reduction performed using the StomaphyX(TM) device in revisional bariatric surgery clinic, tertiary care hospital, Canada. Pre- and postoperative weights were compared, and a regression model was developed to examine for predictors of weight loss following StomaphyX(TM). Fourteen patients were included in the study. Patients had a mean age of 47.3 ± 7.9years, and 13 of 14 were female. Significant reductions were appreciated between pre- and postoperative weight and BMI (119.5 ± 25.9kg vs. 109.6 ± 24.4kg; 43.4 ± 9.7kg/m(2) vs. 39.8 ± 9.1kg/m(2), respectively). There was no correlation between preoperative pouch status and weight loss. Three patients had two separate StomaphyX(TM) procedures performed. Only minor complications (headache, back pain) were identified. The StomaphyX(TM) device may be safely used for reduction of pouch size in patients following VBG. Further studies are required to determine the role of StomaphyX(TM) endoluminal pouch reduction in comparison to open or laparoscopic revisional surgery.

P-03 Influence of pouch and stoma size on weight loss after gastric bypass

Enlargement of the gastric pouch and/or gastrojejunostomy after Roux-en-Y gastric bypass (RYGB) is postulated to be the antecedent of suboptimal weight loss. This study aimed to evaluate gastric pouch and stoma dimensions in RYGB patients, and correlate with weight loss outcomes.

P-04 Esophageal dilatation after laparoscopic gastric banding: incidence, management and outcomes

Stoma was considered enlarged if 2 cm diameter, and pouch enlarged if 6 cm long or 5 cm wide. Results: 275 patients underwent UE and gastric pouch and stoma measurement. Among these were 205 patients (Group 1; 86% female) who had poor weight loss ( 50% EWL) or weight regain post RYGB, and 70 patients (Group 2; 88% female) who had successful weight loss ( 50%EWL), at a mean postoperative time of 6.3 years ( 3.6). Pouch and stoma size were both normal in only 29% of group 1, compared to 43% of group 2 (p 0.03). In group 1, 42% had an enlarged stoma with normal pouch, compared to 27% of group 2 (p 0.03). An enlarged pouch and normal stoma was found in similar proportions in both groups (21% and 15% respectively, p 0.22). Conclusion: Normal sized pouch and stoma are associated with optimal weight loss after RYGB. Patients who don’t lose or regain weight are likely to have abnormal anatomy, particularly stoma enlargement. Further management strategies in these patients may focus on anatomic revision or reinforcement.

V-12 Single incision laparoscopic sleeve gastrectomy: techniques to re-establish fundamental principles of multiport laparoscopy

laparoscopic gastrojejunostomy revision, pouch reduction and truncal vagotomy. Results: No intraoperative complications occurred. She was discharged on the 6 postoperative day tolerating liquids and tube eeds. At her 7-month postoperative visit, she had gained 13 lbs nd was tolerating a regular diet. onclusion: Pouch size reduction might not be sufficient to preent recurrence of marginal ulcerations. Adequate pouch reduction nd truncal vagotomy is then necessary in recurrent refractory lcers.

Endoscopic findings and outcomes of revisional procedures for patients with weight recidivism after gastric bypass

Significant weight regain occurs for 10% to 20% of patients after Roux-en-Y gastric bypass (RYGB). Potential causative factors include anatomic abnormalities such as enlargement of the gastric pouch and gastrojejunostomy (GJ). This report describes endoscopic findings for patients referred for investigation of weight regain and presents the outcomes of revisional therapy for patients with abnormal anatomy. To evaluate gastric pouch and stoma size, RYGB patients referred for weight regain underwent upper endoscopy. A GJ was defined as enlarged if it had a diameter greater than 2 cm in any dimension, and a pouch was defined as enlarged if its length exceeded 6 cm long or its width exceeded 5 cm. Patients with abnormal anatomy who subsequently underwent revisional procedures were arbitrarily categorized into three groups based on the interval from RYGB to endoscopic evaluation: less than 5 years (group 1), 5 to 10 years (group 2), longer than 10 years (group 3). The percentage of regained weight lost (%RWL) after revision was compared between the groups. In this study, 205 RYGB patients (176 women with a mean age of 47 ± 10 years and a current body mass index [BMI] of 43.4 ± 8.4 kg/m(2)) were evaluated. The mean time from primary RYGB was 6.9 ± 3.7 years, and the increase in BMI from its nadir was 9.78 ± 5.80 kg/m(2). Abnormal endoscopic findings (n = 146, 71.2%) included large GJ (n = 86, 58.9%), large pouch (n = 42, 28.8%), or both (n = 18, 12.3%). Of the 205 patients, 51 (24.9%) underwent a revisional surgical or endoluminal procedure. At a mean follow-up assessment 13 months after revision, group 1 (n = 12) had a mean %RWL of 103% ± 89.3%, and 62% of these patients lost all their regained weight. The mean %RWL was 45% ± 12.6% in group 2 (n = 30) and 40% ± 13.6% in group 3 (n = 9). Endoscopy is a valuable tool for evaluating weight regain after bariatric surgery that can identify abnormal post-RYGB anatomy in a majority of patients. Revisional procedures to restore normal RYGB anatomy appear to be most successful if performed within 5 years after the primary procedure.