Food Intake in Relation to Pouch Volume, Stoma Diameter, and Pouch Emptying after Gastroplasty for Morbid Obesity

Abstract

This study investigated possible determinants of food intake change after gastroplastry. Preoperatively and 6 and 12 months postoperatively, 27 morbidly obese patients were prospectively examined with 7-day food registration and radiologic measurement of pouch volume and stoma diameter. Pouch emptying was determined as the mean transit time by a scintigraphic method. None of the measured variables was found to influence the change in food intake taking place during the first 6 months, when most of the weight loss was observed. Between 6 and 12 months, the change of stoma diameter was positively associated with the change of solid foods consumed (by weight, p = 0.01; by energy content, p = 0.02). The change of pouch volume was negatively associated with the change of energy from beverages (p = 0.005). In conclusion, it seems impossible to tailor the reduction of food intake through adjustments of the surgical dimensions, at least within the ranges of our observations. Increased food consumption and decreased energy intake with beverages may be caused by late dilations, or vice versa.

Risk of Gastric Pouch Enlargement With Adjustable Gastric Banding in Premenopausal Women

“…Gastric emptying studies performed on patients following stomach stapling procedures during the 1980s clearly demonstrated a lack of temporal relationship between the delay of food in the distal stomach and the prolonged satiety experienced after a meal with subsequent weight loss. [3][4][5][6] These findings were confirmed for VBG and the SG precursor-the Magenstrasse and Mill gastroplasty. 7,8 This finding has also been confirmed with LAGB where gastric emptying is normal, [9][10][11][12] but delay more than 2 to 3 minutes above the band is problematic.…”

Does Pouch Size Matter?

“…Some authors have described utilizing a mathematical equation, assuming that all pouches are ellipsoid. 10,11 Our pouches almost never fit such a mathematical formula. Thus, for this study, we decided to estimate pouch size by grouping the pouches into categories.…”

“…Postero-anterior and lateral projections are utilized to measure the pouch and calculate the pouch size. 10,11 Another method utilizes a balloon that is placed into the pouch and distended with dye until the patient feels satiety or discomfort. The volume of dye is measured to estimate the pouch size.…”

“…Various authors have described methods to measure pouch size in bariatric surgery. [6][7][8][9][10][11][12][13] One method utilizes radiological techniques to measure pouch size. Postero-anterior and lateral projections are utilized to measure the pouch and calculate the pouch size.…”