Application and prospect of long and narrow pouch in Roux-en-Y gastric bypass surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Xiao , HU Songhao , DONG Zhiyong ,  WANG Cunchuan , Chinese Obesity and Metabolic Surgery Collaborative

Weight Loss Center, The First Affiliated Hospital of Jinan University, Guangzhou 510630, P. R. China;

Corresponding author：

WANG Cunchuan, Email: twcc@jnu.edu.cn

Keywords：

long and narrow gastric pouch; Roux-en-Y gastric bypass; obesity; weight loss surgery

DOI：

10.7507/1007-9424.202310016

Video：

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Laparoscopic Roux-en-Y gastric bypass (RYGB) is a classic operation in the field of obesity metabolic surgery. It not only obviously reduces body weight but also exhibits notable therapeutic efficacy in treating metabolic diseases such as type 2 diabetes. However, it can result in complications such as postoperative dumping syndrome and a lack of satiety after meals. So our team has further modified the RYGB, introducing a long and narrow pouch in RYGB (LN-RYGB), its core is reserving the length of the gastric pouch, then the long and narrow pouch could make maintaining a small gastric volume for a prolonged period, make food pass through slowly, and reduce reflux and decrease the incidences of dumping syndrome and intestinal bile acid reflux relevant to RYGB. The gastric contents could be thoroughly mixed, not only leading to a stronger satiety after meals but also reducing risk of postoperative bounce back. Furthermore, ulcer complications relevant to RYGB markedly declined, the therapeutic outcome is better especially in patients with type 2 diabetes. In future, more results and data relevant to LN-RYGB can be accumulated in clinic to further confirm its safety and effectiveness. Mearnwhile, it should still be paid attended to that LN-RYGB still faccs certain difficulties and has a clear indication. At present, the indications of RYGB are served as reference, and postoperative malnutrition and element deficiency need to be prevented and a long-term follow-up is also necessary.

Citation： HUANG Xiao, HU Songhao, DONG Zhiyong, WANG Cunchuan, Chinese Obesity and Metabolic Surgery Collaborative. Application and prospect of long and narrow pouch in Roux-en-Y gastric bypass surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(4): 389-393. doi: 10.7507/1007-9424.202310016 Copy

1.	Mason EE. History of obesity surgery. Surg Obes Relat Dis, 2005, 1(2): 123-125.
2.	Griffen WO, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. 1977. Surg Obes Relat Dis, 2005, 1(2): 163-172.
3.	Torres JC, Oca CF, Garrison RN. Gastric bypass: Roux-en-Y gastrojejunostomy from the lesser curvature. South Med J, 1983, 76(10): 1217-1221.
4.	Torres JC. Why I prefer gastric bypass distal Roux-en-Y gastroileostomy. Obes Surg, 1991, 1(2): 189-194.
5.	Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg, 1994, 4(4): 353-357.
6.	Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg, 2017, 27(9): 2279-2289.
7.	王存川, 陈鋆, 胡友主, 等. 腹腔镜Roux-en-y分流胃旁路减肥术1例报告. 中国内镜杂志, 2004, 10(12): 110-111.
8.	杨华, 陈缘, 董志勇, 等. 中国肥胖代谢外科数据库: 2020年度报告. 中华肥胖与代谢病电子杂志, 2021, 7(1): 1-7.
9.	Iannelli A, Schneck AS, Hébuterne X, et al. Gastric pouch resizing for Roux-en-Y gastric bypass failure in patients with a dilated pouch. Surg Obes Relat Dis, 2013, 9(2): 260-267.
10.	Topart P, Becouarn G, Ritz P. Pouch size after gastric bypass does not correlate with weight loss outcome. Obes Surg, 2011, 21(9): 1350-1354.
11.	Riccioppo D, Santo MA, Rocha M, et al. Small-volume, fast-emptying gastric pouch leads to better long-term weight loss and food tolerance after Roux-en-Y gastric bypass. Obes Surg, 2018, 28(3): 693-701.
12.	Furnes MW, Tømmerås K, Arum CJ, et al. Gastric bypass surgery causes body weight loss without reducing food intake in rats. Obes Surg, 2008, 18(4): 415-422.
13.	Zheng H, Shin AC, Lenard NR, et al. Meal patterns, satiety, and food choice in a rat model of Roux-en-Y gastric bypass surgery. Am J Physiol Regul Integr Comp Physiol, 2009, 297(5): R1273-R1282. doi: 10.1152/ajpregu.00343.2009.
14.	Gao X, Dai S, Wang G, et al. Large versus small gastric pouch for Roux-en-Y gastric bypass in individuals with type 2 diabetes and a body mass index < 35 kg/m²: six-year outcomes. Front Endocrinol (Lausanne), 2022, 13: 913062. doi: 10.3389/fendo.2022.913062.
15.	Zhang X, Huang W, Zhang Y, et al. Effects of Roux-en-Y operations on glucose homeostasis in obese GK rats. Surg Endosc, 2011, 25(11): 3493-3498.
16.	何家赓, 牛建华, 木拉提, 等. 不同Roux-en-Y胃旁路术对GK大鼠血糖水平影响的研究. 临床和实验医学杂志, 2013, 12(11): 827-829.
17.	Azagury DE, Abu Dayyeh BK, Greenwalt IT, et al. Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy, 2011, 43(11): 950-954.
18.	Rawlins L, Rawlins MP, Brown CC, et al. Effect of Helicobacter pylori on marginal ulcer and stomal stenosis after Roux-en-Y gastric bypass. Surg Obes Relat Dis, 2013, 9(5): 760-764.
19.	Ribeiro R, Pouwels S, Parmar C, et al. Outcomes of long pouch gastric bypass (LPGB): 4-year experience in primary and revision cases. Obes Surg, 2019, 29(11): 3665-3671.
20.	Boerboom A, Cooiman M, Aarts E, et al. An extended pouch in a Roux-en-Y gastric bypass reduces weight regain: 3-year results of a randomized controlled trial. Obes Surg, 2020, 30(1): 3-10.
21.	Capella RF, Iannace VA, Capella JF. An analysis of gastric pouch anatomy in bariatric surgery. Obes Surg, 2008, 18(7): 782-790.
22.	Nudotor RD, Prokopowicz G, Abbey EJ, et al. Comparative effectiveness of Roux-en Y gastric bypass versus vertical sleeve gastrectomy for sustained remission of type 2 diabetes mellitus. J Surg Res, 2021, 407-416.
23.	Castellana M, Procino F, Biacchi E, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for remission of type 2 diabetes. J Clin Endocrinol Metab, 2021, 106(3): 922-933.
24.	Toolabi K, Golzarand M, Farid R. Laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in terms of efficacy and safety: a comparative study during 11-year experience. Obes Surg, 2021, 31(6): 2489-2496.
25.	Pajecki D, Dantas ACB, Tustumi F, et al. Sleeve gastrectomy versus Roux-en-Y gastric bypass in the elderly: 1-year preliminary outcomes in a randomized trial (BASE Trial). Obes Surg, 2021, 31(6): 2359-2363.
26.	Rodrigues B, Cordeiro A, Cruz S, et al. Vertical sleeve gastrectomy has better weight evolution and serum concentrations of vitamin D when compared with Roux-Y gastric bypass. Obes Surg, 2020, 30(12): 4794-4801.
27.	Zhao H, Jiao L. Comparative analysis for the effect of Roux-en-Y gastric bypass vs sleeve gastrectomy in patients with morbid obesity: evidence from 11 randomized clinical trials (meta-analysis). Int J Surg, 2019, 72: 216-223.
28.	赵稳, 高文星, 李丁昌, 等. 腹腔镜Roux-en-Y胃旁路术术后出血的预防及处理. 中华肥胖与代谢病电子杂志, 2022, 8(2): 73-78.
29.	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会, 中国成人教育协会医学继续教育专业委员会肥胖代谢委员会. 腹腔镜Roux-en-Y胃旁路术规范化手术操作指南(2019版). 中华肥胖与代谢病电子杂志, 2019, 5(2): 63-69.
30.	刘明学, 刘昶. 保留幽门的胃旁路手术在减重代谢外科的临床应用. 中国普外基础与临床杂志, 2022, 29(2): 270-273.

1. Mason EE. History of obesity surgery. Surg Obes Relat Dis, 2005, 1(2): 123-125.
2. Griffen WO, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. 1977. Surg Obes Relat Dis, 2005, 1(2): 163-172.
3. Torres JC, Oca CF, Garrison RN. Gastric bypass: Roux-en-Y gastrojejunostomy from the lesser curvature. South Med J, 1983, 76(10): 1217-1221.
4. Torres JC. Why I prefer gastric bypass distal Roux-en-Y gastroileostomy. Obes Surg, 1991, 1(2): 189-194.
5. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg, 1994, 4(4): 353-357.
6. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg, 2017, 27(9): 2279-2289.
7. 王存川, 陈鋆, 胡友主, 等. 腹腔镜Roux-en-y分流胃旁路减肥术1例报告. 中国内镜杂志, 2004, 10(12): 110-111.
8. 杨华, 陈缘, 董志勇, 等. 中国肥胖代谢外科数据库: 2020年度报告. 中华肥胖与代谢病电子杂志, 2021, 7(1): 1-7.
9. Iannelli A, Schneck AS, Hébuterne X, et al. Gastric pouch resizing for Roux-en-Y gastric bypass failure in patients with a dilated pouch. Surg Obes Relat Dis, 2013, 9(2): 260-267.
10. Topart P, Becouarn G, Ritz P. Pouch size after gastric bypass does not correlate with weight loss outcome. Obes Surg, 2011, 21(9): 1350-1354.
11. Riccioppo D, Santo MA, Rocha M, et al. Small-volume, fast-emptying gastric pouch leads to better long-term weight loss and food tolerance after Roux-en-Y gastric bypass. Obes Surg, 2018, 28(3): 693-701.
12. Furnes MW, Tømmerås K, Arum CJ, et al. Gastric bypass surgery causes body weight loss without reducing food intake in rats. Obes Surg, 2008, 18(4): 415-422.
13. Zheng H, Shin AC, Lenard NR, et al. Meal patterns, satiety, and food choice in a rat model of Roux-en-Y gastric bypass surgery. Am J Physiol Regul Integr Comp Physiol, 2009, 297(5): R1273-R1282. doi: 10.1152/ajpregu.00343.2009.
14. Gao X, Dai S, Wang G, et al. Large versus small gastric pouch for Roux-en-Y gastric bypass in individuals with type 2 diabetes and a body mass index < 35 kg/m²: six-year outcomes. Front Endocrinol (Lausanne), 2022, 13: 913062. doi: 10.3389/fendo.2022.913062.
15. Zhang X, Huang W, Zhang Y, et al. Effects of Roux-en-Y operations on glucose homeostasis in obese GK rats. Surg Endosc, 2011, 25(11): 3493-3498.
16. 何家赓, 牛建华, 木拉提, 等. 不同Roux-en-Y胃旁路术对GK大鼠血糖水平影响的研究. 临床和实验医学杂志, 2013, 12(11): 827-829.
17. Azagury DE, Abu Dayyeh BK, Greenwalt IT, et al. Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy, 2011, 43(11): 950-954.
18. Rawlins L, Rawlins MP, Brown CC, et al. Effect of Helicobacter pylori on marginal ulcer and stomal stenosis after Roux-en-Y gastric bypass. Surg Obes Relat Dis, 2013, 9(5): 760-764.
19. Ribeiro R, Pouwels S, Parmar C, et al. Outcomes of long pouch gastric bypass (LPGB): 4-year experience in primary and revision cases. Obes Surg, 2019, 29(11): 3665-3671.
20. Boerboom A, Cooiman M, Aarts E, et al. An extended pouch in a Roux-en-Y gastric bypass reduces weight regain: 3-year results of a randomized controlled trial. Obes Surg, 2020, 30(1): 3-10.
21. Capella RF, Iannace VA, Capella JF. An analysis of gastric pouch anatomy in bariatric surgery. Obes Surg, 2008, 18(7): 782-790.
22. Nudotor RD, Prokopowicz G, Abbey EJ, et al. Comparative effectiveness of Roux-en Y gastric bypass versus vertical sleeve gastrectomy for sustained remission of type 2 diabetes mellitus. J Surg Res, 2021, 407-416.
23. Castellana M, Procino F, Biacchi E, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for remission of type 2 diabetes. J Clin Endocrinol Metab, 2021, 106(3): 922-933.
24. Toolabi K, Golzarand M, Farid R. Laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in terms of efficacy and safety: a comparative study during 11-year experience. Obes Surg, 2021, 31(6): 2489-2496.
25. Pajecki D, Dantas ACB, Tustumi F, et al. Sleeve gastrectomy versus Roux-en-Y gastric bypass in the elderly: 1-year preliminary outcomes in a randomized trial (BASE Trial). Obes Surg, 2021, 31(6): 2359-2363.
26. Rodrigues B, Cordeiro A, Cruz S, et al. Vertical sleeve gastrectomy has better weight evolution and serum concentrations of vitamin D when compared with Roux-Y gastric bypass. Obes Surg, 2020, 30(12): 4794-4801.
27. Zhao H, Jiao L. Comparative analysis for the effect of Roux-en-Y gastric bypass vs sleeve gastrectomy in patients with morbid obesity: evidence from 11 randomized clinical trials (meta-analysis). Int J Surg, 2019, 72: 216-223.
28. 赵稳, 高文星, 李丁昌, 等. 腹腔镜Roux-en-Y胃旁路术术后出血的预防及处理. 中华肥胖与代谢病电子杂志, 2022, 8(2): 73-78.
29. 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会, 中国成人教育协会医学继续教育专业委员会肥胖代谢委员会. 腹腔镜Roux-en-Y胃旁路术规范化手术操作指南(2019版). 中华肥胖与代谢病电子杂志, 2019, 5(2): 63-69.
30. 刘明学, 刘昶. 保留幽门的胃旁路手术在减重代谢外科的临床应用. 中国普外基础与临床杂志, 2022, 29(2): 270-273.

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Application and prospect of long and narrow pouch in Roux-en-Y gastric bypass surgery

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