Importance of Pouch Size in Laparoscopic Roux-en-Y gastric bypass -a prospective cohort study

David Edholm, MD, PhD1, Johan Ottosson, MD, PhD2, Magnus Sundbom, MD, PhD1. 1Uppsala University, Uppsala, Sweden, 2Orebro Unviersity, Orebro, Sweden

Background: Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is the most common bariatric procedure worldwide. The size of the gastric pouch and its implications on formation of marginal ulcers and weight loss is still under debate.

Methods: In December 2013, the Scandinavian Obesity Surgery Registry (Soreg) included 12 860 LRYGB-patients with complete pre- and post-operative data (6 weeks and one year) concerning incidence of marginal ulcers, weight result, and total length of stapling needed to complete the gastric pouch. LRYGB technique in Sweden is highly standardized and total length of stapling was used as a proxy for pouch size. The aim was to study how pouch size affected risk of marginal ulcer and excess weight loss.

Results: Mean length of stapler used for the pouch was 145 mm. The relative risk of marginal ulcer increased with 14% (95% CI 9-20%) for each extra centimeter of stapling used for the pouch. Body mass index (BMI) was reduced from 42.5 ± 5.2 kg/m2 at surgery to 36.3 kg/m2 at 6 weeks and 29.0 kg/m2 at one year. The total length of stapling predicted excess body mass index loss (EBMIL%) at 6 weeks but not at one year. This implies that other factors than pouch size mediates weight loss in the long run after LRYGB. Female gender, low BMI, young age and absence of diabetes predicted better EBMIL% at one year.

Conclusion: A smaller pouch reduces the risk of marginal ulcers, but does not predict better weight loss at one year. Care should be taken to avoid extra stapling as every additional centimeter increases the relative risk for marginal ulcers by 14%.

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