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The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients.
Surgery 2006; 140(4):517-22, discussion 522-3S

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+Show Affiliations

Division of Gastroenterologic and General Surgery, Mayo Clinic College of Medicine, Rochester, Minn, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

17011898

Citation

Nelson, Wayne K., et al. "The Malabsorptive Very, Very Long Limb Roux-en-Y Gastric Bypass for Super Obesity: Results in 257 Patients." Surgery, vol. 140, no. 4, 2006, pp. 517-22, discussion 522-3.
Nelson WK, Fatima J, Houghton SG, et al. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery. 2006;140(4):517-22, discussion 522-3.
Nelson, W. K., Fatima, J., Houghton, S. G., Thompson, G. B., Kendrick, M. L., Mai, J. L., ... Sarr, M. G. (2006). The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery, 140(4), pp. 517-22, discussion 522-3.
Nelson WK, et al. The Malabsorptive Very, Very Long Limb Roux-en-Y Gastric Bypass for Super Obesity: Results in 257 Patients. Surgery. 2006;140(4):517-22, discussion 522-3. PubMed PMID: 17011898.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. AU - Nelson,Wayne K, AU - Fatima,Javairiah, AU - Houghton,Scott G, AU - Thompson,Geoffrey B, AU - Kendrick,Michael L, AU - Mai,Jane L, AU - Kennel,Kurt A, AU - Sarr,Michael G, Y1 - 2006/09/01/ PY - 2006/03/03/received PY - 2006/06/02/accepted PY - 2006/10/3/pubmed PY - 2006/11/3/medline PY - 2006/10/3/entrez SP - 517-22, discussion 522-3 JF - Surgery JO - Surgery VL - 140 IS - 4 N2 - 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. SN - 0039-6060 UR - https://www.unboundmedicine.com/medline/citation/17011898/The_malabsorptive_very_very_long_limb_Roux_en_Y_gastric_bypass_for_super_obesity:_results_in_257_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(06)00362-X DB - PRIME DP - Unbound Medicine ER -