Date of Award

2006

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Robert L Bell

Abstract

Introduction: The identification of relevant components of successful weight reduction surgery is the most important endeavor in the latest research aiming to increase excess weight loss. Over the past twenty years there has been ongoing discussion about the importance of gastric pouch size as one of the key factors influencing weight loss after restrictive weight reduction surgery. The goal of our analysis is to determine the relationship between pouch size and weight reduction following laparoscopic Roux-Y gastric bypass (LRYGB). Methods: Between August 2002 and March 2005, 321 LRYGB procedures were performed at the same institution. Patient demographics were entered into a longitudinal, prospective database. Upper gastrointestinal series were performed in all patients on postoperative day one. Assuming that pouch depth remained constant, pouch size was calculated as area (cm²) utilizing digital imaging technology and internal standardization for measurement. Linear regression analysis was performed to determine the association between pouch size and weight loss at 6 and 12 months postoperatively. Adjustment was made for age, gender, and preoperative BMI. Results: Mean age was 41 years (range, 17-64); 262 patients were female (81.6%); mean preoperative BM I was 51.1 kg/m² (range, 36.1-89.9 kg/m²). Mean 6 month %EWL was 50.5 (range, 13.4-85.5%) and mean 12 month %EWL was 62.5 (range, 14.6-98.1). Mean pouch size was 63.9 cm2 (range, 8.6-248.0 cm² ). A statistically significant inverse correlation between pouch size and %EWL was found at 6 months (β = -0.241, p<0.01) and at 12 months (β = -0.302, p<0.02). A significant correlation was found between pouch size, male gender and preoperative BMI but not between pouch size and age. Conclusion: Our analysis demonstrates that gastric pouch size is one important component for successful weight reduction following LRYGB. The creation of a small gastric pouch should be encouraged as an initial step towards ideal weight loss.

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