Laparoscopic Roux-en-Y gastric bypass ‘acceptable long term’

By MedWire Reporters

Obese patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) retain a fair quality of life 9 years later, research suggests.

The majority (76%) of a sample of patients who underwent LRYCB between 2001 and 2002 showed good satisfaction with the results in August 2011, Jacques Himpens and colleagues, from St Blasius General Hospital in Dendermonde, Belgium, report in Obesity Surgery.

The team notes: "Due to the obesity epidemic, the search for an adequate surgical option for weight reduction is a priority."

They continue: "In 1999, we decided to surgically treat morbid obesity by laparoscopic Roux-en-Y gastric bypass in selected cases based on the unsatisfactory long-term results of laparoscopic adjustable band gastroplasty and because laparoscopic gastric bypass was emerging at the time as a valuable bariatric option."

By August 2011 - an average of 9.4 years after LRYGB surgery - complete data were available for 77 patients, two of whom had died.

The patients' average body mass index (BMI) at the time of surgery was 40.3 kg/m2, significantly higher than the 30 kg/m2 obesity cutoff. There were no cases of postoperative mortality.

At follow up, patient BMI had reached a plateau of an average of 30.0 kg/m2, while individual BMIs ranged from 19.7 kg/m2 to 50.5 kg/m2. This followed a nadir of 25.1 kg/m2 (range 19.0-50.5 kg/m2) a median of 2.0 years postsurgery.

The maximum percentage of excess BMI lost was 88.0%, and by the time of the current evaluation the overall average loss was 56.2% of excess BMI.

Despite increases in BMI over time, Himpens et al note that patient quality of life remained fair. The average score on the Bariatric Analysis and Reporting Outcomes System was 2.03; 57 (76%) patients reported they were happy or very happy with the procedure. The fact that patients had previously lost a significant amount of weight appeared, even after this trend weakened, to have left them with significant satisfaction.

At the time of the LRYGB operation, eight (10.4%) patients had Type 2 diabetes. Six (85.7%) of seven surviving patients were in remission at the time of evaluation. However, new-onset diabetes emerged during follow up in about a quarter (27.9%) of the 68 surviving patients who did not have diabetes preoperatively. This emergence of new-onset diabetes was unrelated to the level of weight regain, Himpens et al say. Weight regain was statistically similar in patients with new-onset diabetes and the nondiabetic patients who underwent LRYGB, they explain.

Other diabetes-related complications included rehospitalization for hypoglycemic syndrome, which occurred in four patients, and problems linked to glucose metabolism, which led to two patients undergoing LRYGB reversal.

Despite these negative findings, Himpens et al say their results suggest that LRYGB, "performed as a primary or as a revisional procedure, induces an acceptable long-term weight loss."

They conclude: "Overall, the quality of life is acceptable and the satisfaction of the patients remains quite high."

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