Is an Early Resumption of a Regular Diet After Laparoscopic Roux-en-Y Gastric Bypass Safe?

Abstract

Background: Return to a normal diet is a crucial step after bariatric surgery. Proximal anastomosis is a source of concern for early feeding as the passage of solid food through a recent anastomosis could well increase pressure and the risk of leakage. This study aims to assess the safety of an early normal diet after a laparoscopic Roux-en-Y gastric bypass (LRYGB).

Materials and methods: All consecutive patients undergoing primary LRYGB between January 2015 and December 2020 were included prospectively. Three postoperative pureed diets were compared at 4 weeks, 2 weeks, and 1 week. All-cause morbidity at 90 days was the main outcome. Overall complications, severe complications (Clavien-Dindo ≥ grade 3a), length of hospital stay, number of emergency, and unplanned consultations during the 3 postoperative months were recorded for each group.

Results: Three hundred and sixty-seven patients with a mean BMI of 42.10 kg/m² (± SD: 4.78) were included. All-cause morbidity at 90 days was 11.7% (43/367) and no significant difference was observed between the 3 groups. Adjustment for patients and operative cofounders did not demonstrate any increased risk of postoperative complications between the 3 groups, with an odds ratio of 1, 1.23(95% CI [0. 55-2.75]), and 1.14 (95% CI [0.49, 2.67]) for groups 1, 2, and 3 respectively. Severe complications (Clavien-Dindo ≥ grade 3a) and emergency or unplanned consultations were also similar in the 3 groups.

Conclusion: Return to a normal diet 1 week after LRYGB did not increase short-term morbidity and unplanned consultations. It may be safe and contribute to patient comfort.

Keywords: Bariatric surgery; Obesity; Postoperative care.

Fig. 1

Postoperative day one example of a typical pureed diet meal tray. At the top of the picture: chocolate flan. In the middle: mashed potatoes. Bottom of the picture: pureed chicken meat

Fig. 2

Rate of overall and severe complications for each group of diet recommendations (group 1: 4 weeks, group 2: 2 weeks, group 3: 1 week)

Fig. 3

Kaplan–Meier analysis for the proportion of emergency consultations for LRYGB patients according to their diet recommendations (group 1: 4 weeks, group 2: 2 weeks, group 3: 1 week)

Fig. 4

Rates for each group of diet recommendations of A emergency consultations, B unplanned consultations with a dietician or a surgeon, and C readmissions at 90 days (group 1: 4 weeks, group 2: 2 weeks, group 3: 1 week)