Long and Narrow Gastric Pouch versus Classic Globular Pouch in Laparoscopic Proximal Gastric Bypass: Effect on Weight Loss and Dumping Syndrome

Background: Laparoscopic proximal gastric bypass Roux-en-Y (LPGBRY) has been regarded for a long time as the gold standard treatment for morbid obesity and its comorbidities. With the presence of the newer strong options, like the gastric sleeve and the mini gastric bypass, refinements in technique are taking place to avoid its current problems. Early and late gastric dumping are known problems after proximal gastric bypass. Modifications in the technique by providing the patient with a long and narrow pouch might help the problem by slowing the gastric emptying time, also should it keep the weight loss in the acceptable range. Aim: The aim of this study is to evaluate whether constructing a long and narrow pouch can decrease the incidence of early and late dumping after laparoscopic proximal gastric bypass and to evaluate the likely impact of such a long and narrow pouch on the weight loss rates. Patients and methods: The study included 79 morbidly obese patients who received primary LPGBRY for treatment of their morbid obesity. They were divided into two groups; 42 patients who received LPGBRY with a long and narrow pouch (the [LN] group), and 37 patients who received LPGBRY with a classic globular pouch (the [G] group). Their 6 and 12 months’ percentage of excess weight loss (%EWL) were recorded. Also, one year after surgery, all patients were required to fill in an Arabic translation of the Sigstad dumping score questionnaire, followed one hour later by an Arabic translation of the Arts score symptoms of late dumping, only if they scored 7 or more. Results: No significant differences were found in the %EWL between both groups. In the Sigstad questionnaire, the most commonly recorded symptoms were the need to lie down and frequent eructation, followed by dizziness, and distension. Frequent eructation was significantly higher in the [LN] group, while dizziness and palpitation were significantly more common in the [G] group (p < 0.05). Similar over all rates of dumping were observed in both groups (p > 0.05). Half the dumping patients in group [G] had late dumping symptoms. The incidence of late symptoms in the [G] group was significantly higher than in the long and narrow pouch [LN] group (p < 0.05). Conclusion: Long and narrow pouches in LPGBRY achieve similar weight loss rates as in the classic globular pouches. Constructing a long and narrow pouch produces similar overall dumping rate, but added significantly more eructation, less dizziness, less palpitation and less late dumping symptoms when compared to the classic globular pouches.