Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients.
OBJECTIVE
An analysis of patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) may identify factors predictive of complication and of suboptimal weight loss.


METHODS
Inception cohort.


METHODS
Metropolitan university hospital.


METHODS
One hundred eighty-eight consecutive patients with severe obesity who met National Institutes of Health consensus guidelines for bariatric surgery.


METHODS
Laparoscopic RYGB.


METHODS
Complications requiring therapeutic intervention and percentage of excess body weight lost at 1 year after surgery.


RESULTS
Of the 188 patients who underwent laparoscopic RYGB, 50 (26.6%) developed complications that required an invasive therapeutic intervention, including 2 deaths. The average follow-up was 351 days (range, 89-1019 days). Multivariate analysis by stepwise logistic regression identified surgeon experience, sleep apnea (P =.003; odds ratio, 3.0; 95% confidence interval, 1.3-7.1), and hypertension (P =.07; odds ratio, 2.0; 95% confidence interval, 1.0-4.0) as predictors of complications. The most common complication requiring therapeutic intervention was stricture at the gastrojejunal anastomosis, occurring in 27 patients (14.4%). Of the 115 patients who underwent surgery more than 1 year previously, 1-year follow-up data were available for 93 (81%). The body mass index (weight in kilograms divided by the square of height in meters) decreased from 53 +/- 8 preoperatively to 35 +/- 6 at 1 year. The mean +/- SD percentage of excess body weight lost at 1 year was 61% +/- 14%. Diabetes mellitus was negatively correlated with percentage of excess body weight lost at 1 year (P =.06).


CONCLUSIONS
Surgeon experience, sleep apnea, and hypertension are associated with complications after laparoscopic RYGB. Diabetes mellitus may be associated with poorer postoperative weight loss.
Department of Surgery and the Informatics Unit, University of Massachusetts Medical School, Worcester 01655, USA. peruginr@ummhc.org
Richard A
RA
Perugini
Robin
R
Mason
Donald R
DR
Czerniach
Yuri W
YW
Novitsky
Stephen
S
Baker
Demetrius E M
DE
Litwin
John J
JJ
Kelly
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D002983:Clinical Competence; D003251:Constriction, Pathologic; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D015431:Weight Loss