Critical determinants of a successful gastric bypass: reservoir versus stoma.

Most investigators have emphasized that both a small reservoir and a narrow stoma are critical to the success of a gastric bypass. This prospective study was performed to test this clinical hypothesis. All patients had a similar 30-45 ml proximal gastric reservoir created; however, stoma size was determined by the lumen of the jejunum, averaging 3.2 cm in cross-sectional diameter. We found that stoma size had little effect on the success of the gastric bypass if a tiny (less than 45 ml) reservoir was consistently created and a Roux-en-Y anastomosis was used for reestablishing intestinal continuity. The avoidance of a small stoma virtually eliminates postbypass emesis as a major complication.