Correlation Between the Gastrojejunostomosis Area, Documented Endoscopically, and the Loss of Weight in Laparoscopic Gastric Bypass Postoperative Patients

Abstract

Laparoscopic Y Roux gastric bypass (YRGB) is the most performed bariatric surgery. There are 3 main techniques in the construction of the gastrojejunostomosis (GJA). The size of the GJA and its relation to the reduction of excess weight has been previously debated. The aim of our study was to determine whether the GJA area in YRGB correlates with the loss of excess weight at 1 year postoperatively. Patients who complied 1 year after YRGB underwent an upper gastrointestinal endoscopy. Images of the GJA were obtained and the area of the GJA was calculated. A statistical analysis, adjusting for age and body mass index preoperatively obtained an r of -0474 and P=0.032, demonstrating a significant negative correlation between the GJA area and the percentage of excess weight loss. A statistically significant negative correlation between the GJA area and the percentage of the excess weight loss was shown. The number of patients evaluated should be increased for a higher statistical significance to corroborate whether the stoma size influences the loss of weight in YRGB patients.

Transoral outlet reduction: a comparison of purse-string with interrupted stitch technique

“…Although diet and lifestyle factors play a role in weight regain after RYGB, anatomic changes also play a role 6–10 . Dilated GJA aperture is an independent predictor of weight regain with a linear association 11,12 .…”

Endoscopic Management of Weight Regain

“…Previous studies have demonstrated that a dilated GJA aperture is an independent predictor of weight regain with a linear association ( Fig. 1) [9,10]. Surgical revision for weight recidivism, however, carries significant morbidity [11,12].…”

Endoscopic Evaluation and Treatment of Postoperative Bariatric Surgery Complications

“…Evaluation of the gastrojejunal stoma size has become particularly important considering the documented relationship between a dilated gastrojejunal stoma and post-Roux-en-Y bypass weight regain. 10 An instrument with a known size, such as a biopsy snare, may be used to accurately measure the stoma size. A stoma size greater than 20 mm in the setting of weight regain may be amenable to endoscopic stoma revision.…”

“…38 Literature has demonstrated a larger gastrojejunal anastomosis aperture is one significant and independent predictor of weight regain after RYGB in a linear fashion. 39,40 A 2011 Cleveland Clinic study examined 205 RYGB patients with postoperative weight gain who underwent endoscopy. Abnormal endoscopic findings (n = 146, 71.2%) included large gastrojejunum (n = 86, 58.9%), large pouch (n = 42, 28.8%), or both (n = 18, 12.3%).…”

“…38 Literature has demonstrated a larger gastrojejunal anastomosis aperture is one significant and independent predictor of weight regain after RYGB in a linear fashion. 39,40…”