Obesity Surgery

, Volume 19, Issue 1, pp 13–17 | Cite as

The Effect of Stoma Size on Weight Loss After Laparoscopic Gastric Bypass Surgery: Results of a Blinded Randomized Controlled Trial

  • Daniel R. CottamEmail author
  • Barry Fisher
  • Varun Sridhar
  • James Atkinson
  • Ramsey Dallal
Research Article



To determine the effect of different stoma sizes on the percent excess weight loss (%EWL) following laparoscopic Roux-en-Y gastric bypass surgery (LRYGBP).


Blinded randomized prospective controlled study in two American Society for Bariatric Surgeons-designated Centers of Excellence hospitals. Two hundred gastric bypass patients between January 2005 and September 2005 were prospectively randomized into two groups of 100 patients each in the operating room, after the induction of anesthesia. Patients underwent LRYGBP with different stapler sizes of 21 and 25 mm for gastrojejunal (GJ) anastomosis from January 2005 to September 2005. Postoperative %EWL following LRYGBP in both patient groups were calculated using a multivariable linear mixed-effects model with an unstructured covariance matrix and a logistic regression was used to measure clinical comorbidities.


Applying multivariable mixed models and logistical regression, circular stapler size of 21 and 25 mm, which predicted the need for dilations (odds ratio = 0.489), did not predict weight loss. The only predictors of weight loss were male gender and higher initial weight (p < 0.001). Follow-up at 2 years in the 21- and 25-mm groups was 68% and 66%, respectively. Both groups had > 80% EWL at 2 years.


The level of restriction or the presence of stenosis achieved by different circular stapler sizes does not have a significant causative role in weight loss.


Stoma Weight loss Gastrojejunal anastomosis Stricture Roux-en-Y gastric bypass Stenosis 



There was no funding source for the study.

Conflict of interest

There are no conflict of interest to report.


  1. 1.
    Talieh J, Kirgan D, Fisher BL. Gastric bypass for morbid obesity; a standard surgical technique by consensus. Obes Surg. 1997;7:198–201.CrossRefGoogle Scholar
  2. 2.
    Madan AK, Hraper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing members. Surg Obes Relat Dis. 2008;4:166–72.CrossRefGoogle Scholar
  3. 3.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.CrossRefGoogle Scholar
  4. 4.
    Cottam DR, Atkinson J, Anderson A, et al. A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up. Obes Surg. 2006;16:534–40.CrossRefGoogle Scholar
  5. 5.
    Fisher BL, Atkinson JD, Cottam D. Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study. Surg Obes Relat Dis. 2007;3:176–9.CrossRefGoogle Scholar
  6. 6.
    Twisk JWR. Applied longitudinal data analysis for epidemiology. A practical guide. New York: Cambridge University Press; 2003.Google Scholar
  7. 7.
    Standards Committee ASMBS. Guidelines for reporting results in bariatric surgery. Obes Surg. 1997;7:521–2.CrossRefGoogle Scholar
  8. 8.
    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.CrossRefGoogle Scholar
  9. 9.
    Gould JC, Garren M, Boll V, Starling J. The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2006;20:1017–20.CrossRefGoogle Scholar
  10. 10.
    Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–91.CrossRefGoogle Scholar
  11. 11.
    Orth WS, Madan AK, Taddeuci RJ, et al. Support group meeting attendance is associated with better weight loss. Obes Surg. 2008;18:391–4.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Daniel R. Cottam
    • 1
    Email author
  • Barry Fisher
    • 2
  • Varun Sridhar
    • 1
  • James Atkinson
    • 3
  • Ramsey Dallal
    • 4
  1. 1.Surgical Weight Loss Center of UtahSalt Lake CityUSA
  2. 2.IASIS CorporationFranklinUSA
  3. 3.Surgical Weight Control Center of NevadaLas VegasUSA
  4. 4.Einstein Bariatrics Laparoscopic Weight Loss Surgery CenterPhiladelphiaUSA

Personalised recommendations