A systematic review of the effect of gastric pouch and/or gastrojejunostomy (stoma) size on weight loss outcomes with Roux-en-Y gastric bypass

Mahawar, Kamal; Sharples, Alistair; Graham, Yitka

doi:10.1007/s00464-019-07277-w

Cited by 23 publications

(13 citation statements)

References 25 publications

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“…The increased prevalence of obesity led to the evolution of metabolic surgery, which is currently the only effective way of improving medical comorbidities and achieving long-term weight loss [3][4][5]. Gastric bypass as a bariatric procedure was introduced by Mason et al in 1967 [6] and remains the gold standard bariatric procedure now performed via laparoscopic approach (LRYGB) [7,8].The evolution of this procedure aimed at improving weight loss and co-morbidities with the least complications led to multiple variations including different lengths of bilio-pancreatic, alimentary limb and common channel [9,10], difference in gastric pouch size and shape [11], or a variety of anastomotic techniques.…”

Section: Purposementioning

confidence: 99%

“…There are pros and cons for each technique, but currently, they are all considered safe and are accepted to form gastrojejunostomy. Less evidence is available on how different anastomotic techniques can influence weight loss and weight re-gain, particularly in the longer term [11]. As safety features have been now thoroughly investigated the next important step is to focus on weight loss, weight regain and other health benefits that may be associated with some of these techniques.…”

Section: Purposementioning

confidence: 99%

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Gastrojejunal Anastomotic Technique. Does It Matter? Weight Loss and Weight Regain 5 Years After Laparoscopic Roux-en-Y Gastric Bypass

et al. 2020

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Purpose The gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass (LRYGB) can be constructed by hand sewn (HSA), linear (LSA) and circular (CSA) stapler technique. They are all considered safe; however, it is not known which the best technique is. Short-term follow-up suggest no difference in weight loss or weight regain between them. However, there is no information on these parameters in the long term. Theatre time and cost are other important factors defining the best way to form gastrojejunostomy. Materials and Methods In a prospective longitudinal cohort study consecutive patients following primary LRYGB were recruited to a bariatric database in a tertiary care centre. Anastomotic technique, diameter, the length of operations and associated costs, weight loss and weight regain were recorded. Patients were followed up for 5 years. Results A total of 385 patients with an initial body mass index of 47.1 kg/m 2 (35-68) were enrolled to this study. This decreased to 33.3 kg/m 2 (21-54 kg/m 2) after 5 years. There was no difference in %TWL after 3 years, P = 0.296, or 5 years, P = 0.187, between the techniques. The number of patients with weight regain was not different after 3 years, P = 0.224, or 5 years, P = 0.795. All techniques had similar operative time. CSA has a higher material cost. Early anastomotic stricture was more common following HSA; however, the difference was not significant. Conclusion Mid-term weight loss and weight regain are not related to anastomotic technique, and there is no difference in operative time associated to them. Circular stapler technique has a higher material cost due to the additional stapler.

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Section: Purposementioning

confidence: 99%

Section: Purposementioning

confidence: 99%

Gastrojejunal Anastomotic Technique. Does It Matter? Weight Loss and Weight Regain 5 Years After Laparoscopic Roux-en-Y Gastric Bypass

et al. 2020

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“…Основными «инструментами» анализа послеоперационного состояния культи желудка по-прежнему остаются такие традиционные методы, как эндоскопическое и рентгенологическое исследование. Однако для объективной оценки рестриктивного компонента гастрошунтирования по Ру, особенно в случае недостаточной потери веса или рецидива ожирения, требуются более точные методы исследования и функциональные пробы [16,17]. Так, сравнительно «молодым» инструментальным методом в бариатрической хирургии является спиральная компьютерная томография (КТ) с трехмерной реконструкцией (3D-КТ-волюмометрия) [18].…”

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

Хитарьян¹,

Мельников²,

Орехов³

et al. 2021

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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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.

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“…A recent metanalysis found that the data concerning this relationship was of low quality. 15 This is partly because several of studies that have examined the impact of stapler size explored the difference between similar sized staplers. For instance, when comparing the use of 21 versus 25 mm diameter circular staplers to form the gastrojejunostomy, weight loss outcomes do not vary.…”

mentioning

confidence: 99%

“…12,14 Such an approach is supported by evidence that suggests that by reducing the size of this stoma, patients who have suffered from postoperative weight gain can benefit from renewed weight loss. 15,16 Despite the link between stoma size and weight loss, the impact of varying the stapler diameter or length when initially forming gastrojejunostomy is less clear. A recent metanalysis found that the data concerning this relationship was of low quality.…”

mentioning

confidence: 99%

Gastrojejunostomy in Roux-En-Y Gastric Bypass for Morbid Obesity: Linear Stapler Length Does Not Affect Mid-term Outcomes

Tankel¹,

Ahmed²

2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: The purpose of this study was to compare whether different linear stapler lengths used to form the gastrojejunostomy during laparoscopic Roux-En-Y gastric bypass affects mid-term weight loss outcomes.Materials and Methods: A retrospective single center analysis was performed. Surgical technique was identical other than either a 35 or 45 mm linear stapler being used to form the gastrojejunostomy. Multivariate regression was used to assess the relationship between the different stapler lengths and weight loss outcomes 2 years following surgery.Results: Of the 97 patients identified, 67 (69.1%) were included in the study. There were 30 patients in the 35 mm group and 37 in the 45 mm group. The groups were comparable in terms of basic demographic data and preoperative weight characteristics. There was no significant difference in weight loss outcomes 2 years following surgery when comparing between the different linear stapler lengths. Conclusion:Thirty-five versus 45 mm linear stapler lengths does not affect mid-term weight loss outcomes.

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A systematic review of the effect of gastric pouch and/or gastrojejunostomy (stoma) size on weight loss outcomes with Roux-en-Y gastric bypass

Cited by 23 publications

References 25 publications

Gastrojejunal Anastomotic Technique. Does It Matter? Weight Loss and Weight Regain 5 Years After Laparoscopic Roux-en-Y Gastric Bypass

Gastrojejunal Anastomotic Technique. Does It Matter? Weight Loss and Weight Regain 5 Years After Laparoscopic Roux-en-Y Gastric Bypass

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

Gastrojejunostomy in Roux-En-Y Gastric Bypass for Morbid Obesity: Linear Stapler Length Does Not Affect Mid-term Outcomes

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