NEW YORK (Reuters Health) – Results of a single-center case series of 188 consecutive severely obese patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) corroborate the efficacy of the procedure for weight reduction, but also highlight predictors of complications and suboptimal outcome, according to a new study.
Dr. Richard A. Perugini and colleagues from the University of Massachusetts in Worcester followed the cohort for an average of 351 days (range 89-1019 days).
One-year follow-up data on 93 patients demonstrate a “good amount of total weight loss (114 lbs.) and reduction in [body-mass index] BMI from an average of 53 to 35 kgm2,” Dr. Perugini told Reuters Health.
The surgery is not without risk for complication or death, however. “Approximately one quarter of our patients required some form of invasive therapeutic intervention following surgery,” Dr. Perugini said, adding that he was “somewhat surprised” by the initial high rate of gastrojejunal stricture, occurring in 27 patients (14.4%).Surgeon experience, sleep apnea, and hypertension were predictors of complications of RYGB on multivariate analysis, with odds ratios of 3.0 for the first two and 2.0 for the third. The study is published in the May issue of The Archives of Surgery.
“The learning curve for laparoscopic gastric bypass is long,” Dr. Perugini said, noting that the “complication rate did not decrease significantly until after 120 cases.” He also said the association of hypertension and sleep apnea with postoperative RYGB complications has not been explicitly identified before. “I am interested in seeing whether any other group finds a similar association,” he said.
In this series, a preoperative diagnosis of diabetes mellitus predicted less weight loss, as measured by percentage of excess body weight lost at one year. “However, the health benefits of performing gastric bypass on patients who are diabetic are enormous,” Dr. Perugini emphasized. “Eighty percent will be cured of their diabetes postoperatively. In addition, there is a significant reduction in mortality in severely obese diabetic patients who undergo gastric bypass.”
“We should not view weight loss as the ultimate measure of success for this surgery,” Dr. Perugini concluded. “Instead, we should focus on reduction in morbidities and mortality and improvement in quality of life.”