Laparoscopic Roux-en-Y Gastric Bypass: Long Term Clinical Outcomes

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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