title: Influence of pouch and stoma size on weight loss after gastric bypass.
abstract: BACKGROUND
  Enlargement of the gastric pouch and/or gastrojejunostomy after Roux-en-Y gastric bypass (RYGB) is postulated to be the antecedent to suboptimal weight loss or weight regain. The present study evaluated the gastric pouch and stoma dimensions in RYGB patients and correlated them with the weight loss outcomes.
  
  
  METHODS
  Patients who underwent upper endoscopy for investigation of gastrointestinal symptoms or weight regain after RYGB were identified. The stoma was considered enlarged if >2 cm in diameter and the pouch was considered enlarged if >6 cm long or >5 cm wide. Successful weight loss was defined as excess weight loss >50% or a body mass index decrease to ≤ 30 kg/m(2).
  
  
  RESULTS
  A total of 380 patients had nondiagnostic upper endoscopy findings at a mean post-RYGB interval of 5.9 ± 4.0 years. Among these were 175 patients (group A; 87% women) who had successful weight loss and 205 patients (group B; 86% women) who were referred for investigation of weight regain. The pouch and stoma size were normal in most of the patients in group A (63.4%) compared with 28.8% of the patients in group B (P <.001). The most common abnormality was an enlarged stoma. The pouch length, pouch volume, and stoma diameter correlated inversely with excess weight loss. Multivariate analysis identified that the stoma diameter was independently associated with weight regain after RYGB.
  
  
  CONCLUSIONS
  The current definition of a "normal" size pouch/stoma is associated with optimal weight loss after RYGB, although this might need to be reviewed. Patients who regain weight are likely to have abnormal anatomy, in particular, stoma enlargement. The surgical RYGB technique and methods of evaluating the gastric anatomy in RYGB patients need to be standardized, intraoperatively and postoperatively.
authors: Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors: Helen M
authors: HM
authors: Heneghan
authors: Panot
authors: P
authors: Yimcharoen
authors: Stacy A
authors: SA
authors: Brethauer
authors: Matthew
authors: M
authors: Kroh
authors: Bipan
authors: B
authors: Chand
mesh_terms: D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D054047:Surgical Stomas; D016896:Treatment Outcome; D015430:Weight Gain / Q000502:physiology; D015431:Weight Loss / Q000502:physiology*