title: The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients.
abstract: BACKGROUND
  For the past 11 years, we have used a malabsorptive form of Roux-en-Y gastric bypass (RYGB), the "very, very long limb" RYGB, for selected patients with BMIs >50 kg/m(2) and in highly selected patients with BMI <50 kg/m(2). This modified distal gastric bypass establishes a 100-cm common channel (for digestion and absorption) and a "very, very" long Roux limb of 400 to 500 cm.
  
  
  METHODS
  To determine long-term efficacy and complications, we followed prospectively 257 consecutive patients; 188 (73%) participated in a postoperative survey.
  
  
  RESULTS
  Of the patients, 60% were female; overall age (x +/- SD) was 45 +/- 11 years, and BMI was 61 +/- 11 kg/m(2). Operative mortality was 1% with substantive postoperative morbidity occurring in 13%. Eighty-two percent of patients returning the survey an average of 48 months postoperatively (range, 12 to 148 months) lost >50% of excess body weight; BMI at follow-up was 37 +/- 9 kg/m(2). Resolution of comorbidities included diabetes mellitus (94%), hypertension (65%), sleep apnea (48%), and asthma (30%). Side effects included mild food intolerance (82%), occasional loose or watery stools (71%), nephrolithiasis (16%), and symptomatic steatorrhea (5%). Nine patients (4%) who developed or were developing impending protein/calorie malnutrition required proximal relocation of the enteroenterostomy with symptom resolution.
  
  
  CONCLUSIONS
  Overall, 90% were satisfied with the operation, and 93% would recommend it to a friend. The very, very long limb RYGB is relatively safe and effective and has acceptable side effects in the treatment of selected patients with super obesity (BMI >50). Because of the possibility of malabsorptive sequelae, patients should be selected based on degree of medical sophistication, insight, and compliance.
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic College of Medicine, Rochester, Minn, USA.
authors.forename: Wayne K
authors.initials: WK
authors.lastname: Nelson
authors.forename: Javairiah
authors.initials: J
authors.lastname: Fatima
authors.forename: Scott G
authors.initials: SG
authors.lastname: Houghton
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.forename: Jane L
authors.initials: JL
authors.lastname: Mai
authors.forename: Kurt A
authors.initials: KA
authors.lastname: Kennel
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sarr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss