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May 08, 2006

Small Gastric Pouch Size Important in Weight Loss

Gastric_bypass_pouch There is an inverse relationship between gastric pouch size and weight loss after laparoscopic Roux-en-Y gastric bypass surgery, but certain cofactors affect gastric pouch size, a new study reveals. Kurt E. Roberts, MD, from Yale University School of Medicine in New Haven, Connecticut, presented these findings.

Size matters: patients with smaller pouches lost the most weight at 6- and 12-month follow-ups."

The study by Dr. Roberts and colleagues involved 320 patients who underwent laparoscopic Roux-en-Y gastric bypass surgery at Yale School of Medicine. Two surgeons performed the procedures. The mean age of participants was 41 years, and 262 were women (81.6%). Patients had a mean preoperative body mass index (BMI) of 51.1 kg/m2 with a range of 36.1 to 89.9 kg/m2.

At postoperative day 1, the researchers measured pouch size by performing an upper gastrointestinal series on 216 of the patients. From anterior-posterior radiographs, they calculated gastric pouch area by measuring length and width of the maximally distended gastric pouch. They assumed depth of the gastric pouch to be constant.

Although this method does not directly measure gastric pouch volume, they used a modification of techniques validated in previous studies and that their measurement technique is "reliable and easy to reproduce."

Patients had a mean gastric pouch size of 63.91 cm2 with a range of 8 to 248 cm2. Using a multiple linear regression analysis, the researchers found that at 6 months patients with gastric pouches smaller than 60 cm2 lost about 55% of their excess weight, as opposed to patients whose gastric pouches were greater than 120 cm2, who lost only about 40% of their excess weight (P < .001).

At 12 months, the difference was even more apparent. Patients with gastric pouches smaller than 60 cm2 had lost an average of 69.2% of their excess weight. Those with gastric pouches measuring 90 to 120 cm2 lost about 53% of excess weight, and patients with pouches greater than 120 cm2 had lost only about 48% of excess weight (P < .001).

This study demonstrates that patients with smaller pouch size lost more weight over time.

They found that patients with preoperative BMIs higher than 50 had larger pouches, averaging about 74 cm2. In addition, male sex also correlated with larger pouch size. Male patients had a mean pouch size of 79 cm2 while pouch size in women averaged about 61 cm2.

But not everybody agrees: the theory today about why gastric bypass leads to weight loss depends more on endocrine changes, such as a decrease in ghrelin, than pouch size. Gastric pouch size matters to launch the weight loss, but not to maintain it.

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