Laparoscopic Roux-en-Y Gastric Bypass: Long term results with at least 10-year follow up.

Piotr J Gorecki, MD1, Obaida Batal, MD1, Krystyna Kabata, PA1, Christine Najjar, MS2, Anthony Tortolani, MD1. 1New York Methodist Hospital, 2St. George’s University School of Medicine

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) remains the gold standard bariatric procedure. Short-term weight loss and improvement or resolution of type 2 Diabetes Mellitus (DMII) and other comorbidities are well documented. Little data is available on long-term weight loss and remission of DMII. 

METHODS: This study reports on weight loss and remission of DMII in a consecutive 251 patients operated between 2001 and 2014 who underwent primary LRYGB with at least 10 year follow up. All patients were operated in a single institution by a single surgeon utilizing the same technique. All data was collected and entered into the database prospectively. All patients signed a preoperative contract emphasizing the need for lifelong annual follow-ups. At 10 years, patients who did not report for the office visit were contacted by mail and by phone.

RESULTS: There were no conversions to open surgery and no perioperative mortalities. Average postoperative length of stay was 3.6 days. Patients mean age was 35.6 years. Females represented 91% of patients. Patients’ ethnicity was diverse and represented African Americans (41%), Caucasians (34%), Hispanics 18.9% and 5.2% from other backgrounds. There was an average of 6.5 comorbidities per patient with DMII present in 61 (24.3%) patients. Mean preoperative weight and BMI were 295Lbs and 48.4kg/m2, respectively. Fifty-nine (23%) patients were available for 10-year follow up analysis and 22 (8.2%) had an office follow up. Maximum weight loss occurred at 18 months (mean weight 181.8lbs and mean BMI 29.4kg/m2). At 10 years mean weight has been reduced to 206.5Lbs and mean BMI to 33.4 kg/m2. The average weight regain between the first and the10th postoperative year was 16.6Lbs. Among 61 (24.3%) patients with preoperative DMII, 16 (28.8%) were available for a 10-year follow up. Remission of DM occurred in 13 (81.25%) patients at one year and remained in remission in eight (50%) patients at 10 years. The detailed dynamics of annual weight loss and BMI’s will be presented.

DISSCUSSION: This study reveals that LRYGB provides durable an effective long-term weight loss and remission of DMII at 10 years. More long term follow up studies evaluating weight loss and comorbidities extending beyond the initial 10 years are needed. Such studies are essential in order to predict late outcomes of LRYGB, particularly in younger patients with life expectancy exceeding several decades.

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