Ayman Obeid, MD, Joshua W Long, MD, Manasi Kakade, MPH, Clements H Ronald, MD, Stahl Richard, MD, Jayleen Grams, MD PhD. Department of Surgery, University of Alabama at Birmingham; Department of Surgery, Vanderbilt University
INTRODUCTION: Bariatric surgery remains the most effective treatment for morbid obesity, and laparoscopic Roux-en-Y gastric bypass (LRYGB) continues to be the preferred operation. However, data on long term outcomes is lacking, especially regarding the durability of the improvement or resolution of obesity-associated comorbidities. The aim of this study was to determine the long term outcomes after LRYGB in terms of weight reduction, complications, and progress of obesity-associated comorbidities.
METHODS AND PROCEDURES: An Institutional Review Board-approved retrospective review of a prospectively maintained database was conducted of all patients who had LRYGB between 2001 and 2006. Only patients who had a postoperative clinic visit at ≤ 2 years and at ≥ 5 years were included in the study. Data collected included demographics, % excess weight loss (%EWL), complications, and improvement or resolution of comorbidities [diabetes mellitus (T2DM), hypertension (HTN), obstructive sleep apnea (OSA), and dyslipidemia (Lipids)]. Data were analyzed using SAS (version 9.2) and SPSS (version 16) statistical software.
RESULTS: There were 770 patients who underwent LRYGB at UAB from 2001-2006. Of these, 172 patients met inclusion criteria (148 females and 24 males) with a median age of 41.5 years (range, 19-34 years) and median preoperative BMI of 46 kg/m² (range, 34-71 kg/m²). Median short and long term follow up was 14 months (range, 6-27 months) and 75 months (range, 55-119 months), respectively. Short term %EWL was 71% vs a long term %EWL of 65% (p <0.005). Of the 172 patients, 77 patients experienced 103 complications [internal hernia, n=33 (19%); cholecystectomy, n=22 (18%); marginal ulcer, n=22 (13%); anastomotic stricture, n=19 (11%); and others, n=7 (4%)]. Median time to develop a complication was 29 months (range, 0.1-101 months). Clinical outcomes with regard to obesity-associated comorbidities are listed in the table below. There was no significant difference in improvement or resolution of comorbid conditions in the short vs long term follow up.
| Comorbidity (N) | Short Term | Long Term | ||||||
| N | Same | Improved | Resolved | N | Same | Improved | Resolved | |
| T2DM (77) | 65 | 2 (3%) | 2 (3%) | 61 (94%) | 77 | 4 (5%) | 12 (9%) | 63 (82%) |
| HTN (110) | 88 | 3 (3%) | 22 (25%) | 63 (72%) | 110 | 7 (6%) | 31 (28%) | 72 (66%) |
| OSA (123) | 85 | 5 (6%) | 8 (9%) | 72 (85%) | 103 | 13 (7%) | 10 (10%) | 85 (83%) |
| Lipids (65) | 51 | 2 (3%) | 12 (24%) | 37 (73%) | 65 | 6 (9%) | 19 (29%) | 40 (62%) |
CONCLUSIONS: Although there was a statistically significant difference in %EWL between short and long term follow up, both arms showed a clinically relevant %EWL and both results were statistically significant when compared to preoperative values. The improvement and resolution of comorbidities was also sustained in long-term follow up. Thus, LRYGB resulted in significant improvement in clinical outcomes that were durable in long term follow up.
Session Number: PDIST – Posters of Distinction
Program Number: P014
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