title: Five-year follow-up after laparoscopic Roux-en-Y gastric and partial ileal bypass for treatment of morbid obesity and uncontrolled hyperlipidemia.
abstract: BACKGROUND
  Morbid obesity is associated with significant co-morbid illnesses and mortality. Hyperlipidemia is strongly associated with atherosclerosis and cardiovascular disease. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a proven and effective procedure for the treatment of morbid obesity and its related co-morbid illnesses. In a randomized prospective clinical trial, partial ileal bypass showed sustained control of hyperlipidemia and reduced comorbidities. Given risks of surgery, pharmacologic agents are the current primary therapy for hyperlipidemia. However, a morbidly obese patient with medically refractory hyperlipidemia may benefit from a combined laparoscopic Roux-en-Y gastric bypass and partial ileal bypass. We are describing the first case of a totally laparoscopic approach.
  
  
  METHODS
  A 56-year-old female patient with morbid obesity (BMI 45.2 kg/m(2)) and medically refractive hyperlipidemia underwent a combined LRYGB and partial ileal bypass in 2002. She was continuously followed for 5 years for weight profile, hyperlipidemia, post-operative complications, and morbidity.
  
  
  RESULTS
  Five-year follow-up of the patient showed sustained excess body weight loss. Her lipid profile has approached normal ranges with less medication. She experienced no comorbidities related to surgery or hyperlipidemia.
  
  
  CONCLUSIONS
  Laparoscopic Roux-en-Y gastric bypass and partial ileal bypass may be the best option for the patient who has morbid obesity and medically refractory hyperlipidemia and should be considered for select patients.
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, 675 N. St. Clair St., Galter 10-250, Chicago, IL, 60611, USA.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Auyang
authors.forename: Kenric M
authors.initials: KM
authors.lastname: Murayama
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Nagle
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000517:prevention & control*; D010535:Laparoscopy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D013997:Time Factors