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. 2006 Nov;244(5):734-40.
doi: 10.1097/01.sla.0000217592.04061.d5.

Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years

Nicolas V Christou  1 , Didier Look, Lloyd D Maclean
Affiliations

Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years

Nicolas V Christou et al. Ann Surg. 2006 Nov.

Abstract

Objective: To complete a long-term (>10 years) follow-up of patients undergoing isolated roux-en-Y gastric bypass for severe obesity.

Background: Long-term results of gastric bypass in patients followed for longer than 10 years is not reported in the literature.

Methods: Accurate weights were recorded on 228 of 272 (83.8%) of patients at a mean of 11.4 years (range, 4.7-14.9 years) after surgery. Results were documented on an individual basis for both long- and short-limb gastric bypass and compared with results at the nadir BMI and % excess weight loss (%EWL) at 5 years and >10 years post surgery.

Results: There was a significant (P < 0.0001) increase in BMI in both morbidly obese (BMI < 50 kg/m) and super obese patients (BMI > 50 kg/m) from the nadir to 5 years and from 5 to 10 years. The super obese lost more rapidly from time zero and gained more rapidly after reaching the lowest weight at approximately 2 years than the morbidly obese patients. There was no difference in results between the long- and short-limb operations. There was a significant increase in failures and decrease in excellent results at 10 years when compared with 5 years. The failure rate when all patients are followed for at least 10 years was 20.4% for morbidly obese patients and 34.9% for super obese patients.

Conclusions: The gastric bypass limb length does not impact long-term weight loss. Significant weight gain occurs continuously in patients after reaching the nadir weight following gastric bypass. Despite this weight gain, the long-term mortality remains low at 3.1%.

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Figures

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FIGURE 1. A, Standard short-limbed gastric bypass with 10-cm afferent limb and 40-cm Roux-en-Y limb and a 15- to 20-mL gastric pouch. B, Long-limb gastric bypass with 100-cm afferent limb and 100-cm Roux-en-Y limb and a 15- to 20-mL gastric pouch. (Reprinted with permission from MacLean LD, Rhode BM, Nohr CW. Long- or short-limb gastric bypass. J Gatrointest Surg. 2001;5:525–530.)
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FIGURE 2. Plot of raw BMI values of 228 patients post RY gastric bypass at the last follow-up period (11.4 ± 2.8 years, mean ± SD) stratified by BMI into morbid obesity (BMI < 50) and superobesity (BMI ≥ 50).
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FIGURE 3. Plot of decrease of BMI against time for the 161 patients followed for more then 10 years (up to 15). The points represent the mean ± SD. Point 0 is the preoperative BMI. The nadir or lowest BMI occurred at 2.2 ± 1.9 years. The 5-year point represents a mean follow-up of 6.4 ± 3.2 years and the >10-year time point represents a follow-up of 12.3 ± 1.2 years. The superobese patients lost more quickly and gained more rapidly than the morbid obese (P < 0.0001). All increases in BMI from lowest to 5 and 10 year periods are significant (P < 0.0001).
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FIGURE 4. Plot of % excess weight loss against time for the 161 patients followed for more then 10 years (up to 15). A significant weight regain occurs following the best weight loss at about 2.5 ± 2.1 years compared with longer follow-up periods (P < 0.0001).
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FIGURE 5. The effect of limb length on long-term weight loss in morbidly obese (MO) and super (MO) obese patients.
See this image and copyright information in PMC

Comment in

References

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