The history of gradual loss of weight control with a progression from satisfaction with the operation to appearance of heartburn and then increasingly frequent vomiting is highly suggestive of pouch enlargement and decompensation. This sequence of events occurred in one patient whose initial pouch was only 28 ml.2 It required 12 years before the pouch was large enough to require revision. It is because of this sort of experience that we have recommended that the volume be less than 20 ml, measured at 70 cm of water pressure. Without recorded measurements of pouch volume none of this can be known. Elapsed time is an important variable and this implies a need for five and ten year, or longer, follow-up.
Pouch failure is analogous to heart failure.
Both stomach and heart are muscular pumping organs. The Law of LaPlace helps to explain how increased volume contributes to emptying failure. The Law of LaPlace remains up to date and of universal applicability. It was originally developed in relation to spherical orbits of planets in our solar system. Surgeons do not need to consider the curvature of space-time to make use of this Law, but we do need to measure, observe over time, and be thoughtful about these simple relationships.