OBES SURG (2014) 24:1744–1745 DOI 10.1007/s11695-014-1378-8
LETTER TO THE EDITOR
The Long and Narrow Gastric Pouch for Laparoscopic Roux-en-Y Gastric Bypass Antonio Iannelli & Radwan Kassir & Jean Gugenheim
Published online: 24 July 2014 # Springer Science+Business Media New York 2014
Introduction The shape and volume of the gastric pouch and the diameter of the gastrojejunostomy of the Roux-en-Y gastric bypass (RYGBP) are responsible for the restrictive effect of this procedure. Although these are the key factors influencing long-term weight loss, no consensus exists on how to construct the optimal gastric pouch and gastrojejunostomy (GJ). Herein, we show that the long and narrow gastric pouch with a hand-sewn gastrojejunostomy undergoes only moderate dilation overtime, keeping the restrictive effect of the procedure.
Images in Obesity Surgery: Long and Narrow Gastric Pouch and Hand-Sewn Gastrojejunostomy The patient had a LRYGBP for morbid obesity (Body Mass Index (BMI); 41 kg/m 2). A long and narrow
Iannelli Antonio and Radwan Kassir equally contributed to the paper. A. Iannelli : R. Kassir : J. Gugenheim Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202 Nice, France A. Iannelli : J. Gugenheim Inserm, U1065, Team 8 “Hepatic complications of obesity”, 06204 Nice, France
gastric pouch was shaped laparoscopically over a 36 Fr endoluminal orogastric tube, a Roux-en-Y loop was then constructed with a biliopancreatic limb of 50 cm and an alimentary limb of 150 cm. A handsewn 12 mm long gastrojejunostomy (GJ) was fashioned (Fig. 1a). At 1 year, the weight loss was 40 % of the body weight. The CT scan with three-dimensional reconstruction of the gastric pouch 8 years after surgery showed a 60-ml gastric pouch and a 15 cm gastrojejunostomy with moderate pouch dilatation (Fig. 1b). Currently, the patient weight loss is stable (35 % of the body weight). Controversy exists regarding the influence of gastric pouch shape and volume on its dilatation overtime and the loss of weight. Capella et al. demonstrated that long and narrow pouches have less tendency to enlarge and should delay the transit of food to a greater degree than wider pouches according to the LaPlace's and Poiseuille's Laws, respectively, [1]. The diameter of the GJ also showed only moderate dilation. Optimal gastric pouch and GJ are not the only significant component for successful weight loss after LRYGB [2]. Several factors are thought to be associated with poor weight loss including advanced age, black race, being married, male sex, physical inactivity after surgery and poor follow-up after surgery [3]. However, insome studies, the size of the gastric pouch did not correlate with the percentage of excess weight loss 1 year after LRYGBP [4, 5].
A. Iannelli : J. Gugenheim University of Nice Sophia-Antipolis, 06107 Nice, France A. Iannelli (*) Service de Chirurgie Digestive et Centre de Transplantation Hépatique, Hôpital Archet 2, 151 Route Saint Antoine de Ginestière, BP 3079, Nice Cedex3, France e-mail: [email protected]
Conclusion Controversy exists regarding the optimal gastric pouch shape and volume and GJ diameter. Long and narrow
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Fig. 1 Upper gastrointestinal contrast study view of Roux-en-Y gastric bypass pouch immediately after surgery (a). CT scan with three-dimensional reconstruction of the gastric pouch and gastrojejunostomy showing a 60ml gastric pouch and a 15 cm gastrojejunostomy (b) 8 years after surgery
gastric pouch and small hand-sewn GJ seem important for long-term weight loss
Conflict of Interest The authors (Antonio Iannelli, Radwan Kassir and Jean Gugenheim) have no conflicts of interests to declare in relation to this article. Statement of Informed Consent Informed consent was obtained from all individual participants included in the study. Statement of Human and Animal Rights Informed consent was obtained from all individual participants included in the study.
References 1. Capella RF, Iannace VA, Capella JF. An analysis of gastric pouch anatomy in bariatric surgery. Obes Surg. 2008;18:782–90. 2. Roberts K, Duffy A, Kaufman J, et al. Size matters: Gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:1397–402. 3. Campos GM, Rabl C, Mulligan K, et al. Factors associated with weight loss after gastric bypass. Arch Surg. 2008;143:877–84. 4. O'Connor EA, Carlin AM. Lack of correlation between variation in small-volume gastric pouch size and weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:399–403. 5. Nishie A, Brown B, Barloon T, et al. Comparison of size of proximal gastric pouch and short-term weight loss following routine upper gastrointestinal contrast study after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17:1183–8.
LETTER TO THE EDITOR
The Long and Narrow Gastric Pouch for Laparoscopic Roux-en-Y Gastric Bypass Antonio Iannelli & Radwan Kassir & Jean Gugenheim
Published online: 24 July 2014 # Springer Science+Business Media New York 2014
Introduction The shape and volume of the gastric pouch and the diameter of the gastrojejunostomy of the Roux-en-Y gastric bypass (RYGBP) are responsible for the restrictive effect of this procedure. Although these are the key factors influencing long-term weight loss, no consensus exists on how to construct the optimal gastric pouch and gastrojejunostomy (GJ). Herein, we show that the long and narrow gastric pouch with a hand-sewn gastrojejunostomy undergoes only moderate dilation overtime, keeping the restrictive effect of the procedure.
Images in Obesity Surgery: Long and Narrow Gastric Pouch and Hand-Sewn Gastrojejunostomy The patient had a LRYGBP for morbid obesity (Body Mass Index (BMI); 41 kg/m 2). A long and narrow
Iannelli Antonio and Radwan Kassir equally contributed to the paper. A. Iannelli : R. Kassir : J. Gugenheim Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202 Nice, France A. Iannelli : J. Gugenheim Inserm, U1065, Team 8 “Hepatic complications of obesity”, 06204 Nice, France
gastric pouch was shaped laparoscopically over a 36 Fr endoluminal orogastric tube, a Roux-en-Y loop was then constructed with a biliopancreatic limb of 50 cm and an alimentary limb of 150 cm. A handsewn 12 mm long gastrojejunostomy (GJ) was fashioned (Fig. 1a). At 1 year, the weight loss was 40 % of the body weight. The CT scan with three-dimensional reconstruction of the gastric pouch 8 years after surgery showed a 60-ml gastric pouch and a 15 cm gastrojejunostomy with moderate pouch dilatation (Fig. 1b). Currently, the patient weight loss is stable (35 % of the body weight). Controversy exists regarding the influence of gastric pouch shape and volume on its dilatation overtime and the loss of weight. Capella et al. demonstrated that long and narrow pouches have less tendency to enlarge and should delay the transit of food to a greater degree than wider pouches according to the LaPlace's and Poiseuille's Laws, respectively, [1]. The diameter of the GJ also showed only moderate dilation. Optimal gastric pouch and GJ are not the only significant component for successful weight loss after LRYGB [2]. Several factors are thought to be associated with poor weight loss including advanced age, black race, being married, male sex, physical inactivity after surgery and poor follow-up after surgery [3]. However, insome studies, the size of the gastric pouch did not correlate with the percentage of excess weight loss 1 year after LRYGBP [4, 5].
A. Iannelli : J. Gugenheim University of Nice Sophia-Antipolis, 06107 Nice, France A. Iannelli (*) Service de Chirurgie Digestive et Centre de Transplantation Hépatique, Hôpital Archet 2, 151 Route Saint Antoine de Ginestière, BP 3079, Nice Cedex3, France e-mail: [email protected]
Conclusion Controversy exists regarding the optimal gastric pouch shape and volume and GJ diameter. Long and narrow
OBES SURG (2014) 24:1744–1745
1745
Fig. 1 Upper gastrointestinal contrast study view of Roux-en-Y gastric bypass pouch immediately after surgery (a). CT scan with three-dimensional reconstruction of the gastric pouch and gastrojejunostomy showing a 60ml gastric pouch and a 15 cm gastrojejunostomy (b) 8 years after surgery
gastric pouch and small hand-sewn GJ seem important for long-term weight loss
Conflict of Interest The authors (Antonio Iannelli, Radwan Kassir and Jean Gugenheim) have no conflicts of interests to declare in relation to this article. Statement of Informed Consent Informed consent was obtained from all individual participants included in the study. Statement of Human and Animal Rights Informed consent was obtained from all individual participants included in the study.
References 1. Capella RF, Iannace VA, Capella JF. An analysis of gastric pouch anatomy in bariatric surgery. Obes Surg. 2008;18:782–90. 2. Roberts K, Duffy A, Kaufman J, et al. Size matters: Gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:1397–402. 3. Campos GM, Rabl C, Mulligan K, et al. Factors associated with weight loss after gastric bypass. Arch Surg. 2008;143:877–84. 4. O'Connor EA, Carlin AM. Lack of correlation between variation in small-volume gastric pouch size and weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:399–403. 5. Nishie A, Brown B, Barloon T, et al. Comparison of size of proximal gastric pouch and short-term weight loss following routine upper gastrointestinal contrast study after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17:1183–8.
