Weight Regain Following Roux-En-Y Gastric Bypass Surgery

Luis C Zurita MV, MD, Radu Pescarus, MD, Izabela Apriasz, MD, Lukas Wasserman, MD, Dennis Hong, MD, FRCSC, FACS, Mehran Anvari, MB, BS, PhD, FRCSC, FACS, Scott Gmora, MD, FRCSC

Department of Surgery, Centre of Minimal Access Surgery, St. Joseph’s Healthcare, Hamilton, ON, Canada.

INTRODUCTION
The Roux-en-y gastric bypass (RYGB) remains the gold standard bariatric operation for patients with morbid obesity. However, even with an ideally constructed RYGB, it is well known that not all patients achieve permanent weight loss. The aim of this paper is to systematically review the extant literature regarding definitions and incidence of weight regain (WR) following modern RYGB surgery.

METHODS AND PROCEDURES
We conducted a systematic review at Medline, Embase and Cochrane libraries from 1960 to 2011 for weight regain following RYGB with a vertically transected pouch. Studies were limited to those with ≥ 5 years follow up and patient retention rate ≥ 70%.

RESULTS
Ten published studies that address weight loss outcomes using modern gastric bypass techniques were identified with a ≥ 5-year follow-up and patient retention rate ≥ 70%. One study achieved a 100% follow-up after 5 years with 66.6% EWL and 0.7% incidence of WR, although the study is limited by a small sample size (n=24 patients).

Excess weight loss observed at 5-year ranges from 60.2% to 92.9%, with a WR from 5% to 13.5%. Only one study reported an adequate patient retention rate (83.8% in 272 patients) for longer than 10 years (mean 11.4 years), observing an adequate EWL of 67.6% and a WR of 21.9% EWL from the second to the eleventh year after surgery.

CONCLUSIONS
Weight regain after a modern RYGB has long been neglected in the extant literature. To date, the overwhelming majority of studies examining this phenomenon suffer from fundamental methodological limitations, including short duration of follow-up and poor patient retention. There is also a lack of uniformity across studies in defining weight regain and bariatric surgery failure, which further limits our ability to draw meaningful conclusions from the data. It is important to understand these limitations and to unify criteria in order to decrease bias, better interpret outcomes and improve results.

Session: Poster Presentation

Program Number: P442