Long-term results of malabsorptive distal Roux-en-Y gastric bypass in superobese patients.

Abstract

BACKGROUND:

The purpose of the present study was to evaluate the safety, efficacy, and nutritional outcomes of malabsorptive distal Roux-en-Y gastric bypass (D-RYGB) 20-25 years later at a university hospital.

METHODS:

From 1985 to 1989, 49 mostly superobese (body mass index >50 kg/m(2)) patients had undergone D-RYGB. D-RYGB consisted of open laparotomy with a 50-mL proximal gastric pouch and gastroenterostomy performed 250 cm proximal to the ileocecal junction, with common channels of 50-150 cm. These 49 patients were compared with a similar group of 92 consecutive patients who had undergone long-limb RYGB, with a 75-cm biliopancreatic limb and 150-cm alimentary limb.

RESULTS:

The mean ± SD preoperative body mass index was 58.9 ± 9.3 kg/m(2). After 1 perioperative death secondary to pulmonary embolism, limb-lengthening revisions were required in 21 (43.7%) of the 48 remaining patients for protein-calorie malnutrition. Of the 23 with a 50-cm common channel, 13 required revision compared with 8 of 25 with ≥100-cm common channel (P <.05, chi-square). Of the 48 patients who had undergone D-RYGB, 8 had died 6-19 years after D-RYGB. Of the nonrevised patients, 19 (70.4%) of 27 had >5 years of follow-up. In these, the latest body mass index was 34.2 kg/m(2) at 10 ± 6.1 years. The percentage of excess weight loss was 66.8% ± 14%. The lowest late serum albumin level was 3.4 ± .5 g/dL (range 2.3-4.4). The mean 25-hydroxy vitamin D level was 14.6 ± 11.3 ng/mL. Compared with patients who had undergone long-limb RYGB, the D-RYGB patients had a significantly greater percentage of excess weight loss after 5 years but significantly lower albumin, hemoglobin, iron, and calcium levels.

CONCLUSION:

Although D-RYGB afforded superior long-term weight loss, it caused protein-calorie malnutrition requiring frequent revision. The nonrevised patients had frequent severe metabolic derangements. Thus, D-RYGB should not be the primary operation for morbid or superobese patients.

• Authors: John M Kellum, Silas M Chikunguwo, James W Maher, Luke G Wolfe, Harvey J Sugerman
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) 2011 Mar-Apr Vol. 7 Issue 2 Pg. 189-93 ISSN: 1878-7533 [Electronic] United States
• PMID: 21145293 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Anastomosis, Roux-en-Y (adverse effects)
• Body Mass Index
• Female
• Follow-Up Studies
• Gastric Bypass (adverse effects, methods)
• Humans
• Incidence
• Male
• Obesity, Morbid (metabolism, surgery)
• Postoperative Complications
• Protein-Energy Malnutrition (epidemiology, etiology)
• Risk Factors
• Severity of Illness Index
• Time Factors
• Virginia (epidemiology)
• Weight Loss