Societe de Chirurgie Viscerale, Clinique de l'Anjou, Angers, France.
Obes Surg. 2011 Sep;21(9):1350-4. doi: 10.1007/s11695-011-0460-8.
A large gastric pouch is a classic explanation for weight loss problems after gastric bypass. However, several reports have emphasized the role of others, essentially behavorial, factors. We reviewed the outcomes of 151 patients who were operated on over a period of nearly 2 years. 132 patients who had not been reoperated on were assessed between June and September 2009. A barium swallow was available to assess the gastric pouch volume which was determined by the radiologist. %EWL was compared to the pouch volume using ANOVA test. Pouch volumes were compared using t test. The gastric pouch was dilated when >50 ml and failure to lose enough weight was defined by a %EWL<50%. 107 patients (81%) had a complete follow up of 35.7 ± 5.8 months. Mean pouch volume was 68 ± 4.5 ml with a %EWL of 68 ± 26.1%. 59 patients had a large pouch with a weight loss similar to those with a normally sized pouch (68 ± 3.6 vs 66 ± 3.6%EWL). 25 patients (23.3%) had weight loss failure with a similar pouch volume. No correlation was found between the %EWL and the pouch volume. Pouch size probably plays a role in the weight loss process of RYGB. However, 3 years later, pouch volume does not appear to be the most important factor. Behavorial factors such as recurrent eating disorders and failure to adapt to the changes induced by the surgery may explain at least in part weight loss failure.
大胃囊是胃旁路术后体重减轻的一个经典解释。然而，有几项报告强调了其他因素，尤其是行为因素的作用。我们回顾了近 2 年内接受手术的 151 例患者的结果。在 2009 年 6 月至 9 月期间评估了未再次手术的 132 例患者。通过钡餐评估胃囊体积，由放射科医生确定。使用 ANOVA 检验比较%EWL 与胃囊体积。使用 t 检验比较胃囊体积。当胃囊大于 50ml 时，胃囊扩张，当%EWL<50%时，定义为未能减轻足够的体重。107 例患者（81%）完成了 35.7±5.8 个月的随访。平均胃囊体积为 68±4.5ml，%EWL 为 68±26.1%。59 例患者胃囊较大，但体重减轻与正常大小的胃囊相似（68±3.6%EWL）。25 例患者（23.3%）体重减轻失败，胃囊体积相似。%EWL 与胃囊体积之间无相关性。胃囊大小可能在 RYGB 的体重减轻过程中起作用。然而，3 年后，胃囊体积似乎不是最重要的因素。行为因素，如反复发作的饮食失调和未能适应手术引起的变化，可能至少部分解释了体重减轻失败。
