It is this law that explains why the cecum is the site of rupture in obstruction of the colon. The rate of dilatation increases over time because of the increasing radius. This law is also of help in understanding why it is important to measure the volume of the pouch in vertical banded gastroplasty. If the initial volume is less than 20 ml, excessive volume requiring revision will be unlikely. When a pouch reaches too large a volume it does not empty properly due to kinking of the outlet or poor contraction.
Retention also causes formation of bezoars and staple line disruption.
An enlarged pouch may cause increased capacity for a meal. Some patients with large pouches complain of the seemingly inexplicable combination of vomiting and weight gain. More detailed questioning of such a patient suggests an inability to detect fullness of the pouch. As a consequence the patient is able to eat considerable food without vomiting when the pouch is empty. When the pouch is nearly full, vomiting occurs after the first few bites.