Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity.
OBJECTIVE
To determine prospectively the results of Roux-en-Y gastric bypass (RYGB) used as the primary weight-reducing operation in patients with medically complicated ("morbid") obesity. The RYGB procedure combines the advantages of a restrictive physiology (pouch of 10 mL) and a "dumping physiology" for high-energy liquids without requiring an externally reinforced (banded) stoma.


METHODS
Between April 1987 and December 1998, a total of 191 consecutive patients with morbid obesity (median weight, 138 kg [range, 91-240 kg]; median body mass index, 49 kg/m2 [range, 36-74 kg/m2]), all of whom had directly weight-related morbidity, underwent RYGB and prospective follow-up.


RESULTS
Hospital mortality was 0.5% (1/191), and hospital morbidity occurred in 10.5% (20/191). Good long-term weight loss was achieved, and patients adapted well to the required new eating habits. The mean +/- SD weight loss at 1 year after operation (113 patients) was 52 +/- 1 kg or 68% +/- 2% of initial excess body weight. By 3 years postoperatively (74 patients), weight loss was still 66% +/- 2% of excess body weight. Overall, 53 (72%) of 74 patients had achieved and maintained a weight loss of 50% or more of their preoperative excess body weight 3 years after the operation. In addition, only 1 (1%) of 98 patients had persistent postoperative vomiting 1 or more times per week.


CONCLUSIONS
We believe that RYGB is a safe, effective procedure for most patients with morbid obesity and thus may be the current procedure of choice in patients requiring bariatrics++ surgery for morbid obesity.
Balsiger
B M
BM
Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minn. 55905, USA.
Kennedy
F P
FP
Abu-Lebdeh
H S
HS
Collazo-Clavell
M
M
Jensen
M D
MD
O'Brien
T
T
Hensrud
D D
DD
Dinneen
S F
SF
Thompson
G B
GB
Que
F G
FG
Williams
D E
DE
Clark
M M
MM
Grant
J E
JE
Frick
M S
MS
Mueller
R A
RA
Mai
J L
JL
Sarr
M G
MG
D000222:Adaptation, Physiological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D015992:Body Mass Index; D001835:Body Weight; D005069:Evaluation Studies as Topic; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D011446:Prospective Studies; D012449:Safety; D015996:Survival Rate; D016896:Treatment Outcome; D015431:Weight Loss