Tags

Type your tag names separated by a space and hit enter

Long-term results of malabsorptive distal Roux-en-Y gastric bypass in superobese patients.
Surg Obes Relat Dis 2011 Mar-Apr; 7(2):189-93SO

Abstract

BACKGROUND

The purpose of the present study was to evaluate the safety, efficacy, and nutritional outcomes of malabsorptive distal Roux-en-Y gastric bypass (D-RYGB) 20-25 years later at a university hospital.

METHODS

From 1985 to 1989, 49 mostly superobese (body mass index >50 kg/m(2)) patients had undergone D-RYGB. D-RYGB consisted of open laparotomy with a 50-mL proximal gastric pouch and gastroenterostomy performed 250 cm proximal to the ileocecal junction, with common channels of 50-150 cm. These 49 patients were compared with a similar group of 92 consecutive patients who had undergone long-limb RYGB, with a 75-cm biliopancreatic limb and 150-cm alimentary limb.

RESULTS

The mean ± SD preoperative body mass index was 58.9 ± 9.3 kg/m(2). After 1 perioperative death secondary to pulmonary embolism, limb-lengthening revisions were required in 21 (43.7%) of the 48 remaining patients for protein-calorie malnutrition. Of the 23 with a 50-cm common channel, 13 required revision compared with 8 of 25 with ≥100-cm common channel (P <.05, chi-square). Of the 48 patients who had undergone D-RYGB, 8 had died 6-19 years after D-RYGB. Of the nonrevised patients, 19 (70.4%) of 27 had >5 years of follow-up. In these, the latest body mass index was 34.2 kg/m(2) at 10 ± 6.1 years. The percentage of excess weight loss was 66.8% ± 14%. The lowest late serum albumin level was 3.4 ± .5 g/dL (range 2.3-4.4). The mean 25-hydroxy vitamin D level was 14.6 ± 11.3 ng/mL. Compared with patients who had undergone long-limb RYGB, the D-RYGB patients had a significantly greater percentage of excess weight loss after 5 years but significantly lower albumin, hemoglobin, iron, and calcium levels.

CONCLUSION

Although D-RYGB afforded superior long-term weight loss, it caused protein-calorie malnutrition requiring frequent revision. The nonrevised patients had frequent severe metabolic derangements. Thus, D-RYGB should not be the primary operation for morbid or superobese patients.

Authors+Show Affiliations

Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA. debbie.winegar@surgicalreview.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21145293

Citation

Kellum, John M., et al. "Long-term Results of Malabsorptive Distal Roux-en-Y Gastric Bypass in Superobese Patients." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 7, no. 2, 2011, pp. 189-93.
Kellum JM, Chikunguwo SM, Maher JW, et al. Long-term results of malabsorptive distal Roux-en-Y gastric bypass in superobese patients. Surg Obes Relat Dis. 2011;7(2):189-93.
Kellum, J. M., Chikunguwo, S. M., Maher, J. W., Wolfe, L. G., & Sugerman, H. J. (2011). Long-term results of malabsorptive distal Roux-en-Y gastric bypass in superobese patients. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 7(2), pp. 189-93. doi:10.1016/j.soard.2010.08.018.
Kellum JM, et al. Long-term Results of Malabsorptive Distal Roux-en-Y Gastric Bypass in Superobese Patients. Surg Obes Relat Dis. 2011;7(2):189-93. PubMed PMID: 21145293.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term results of malabsorptive distal Roux-en-Y gastric bypass in superobese patients. AU - Kellum,John M, AU - Chikunguwo,Silas M, AU - Maher,James W, AU - Wolfe,Luke G, AU - Sugerman,Harvey J, Y1 - 2010/10/11/ PY - 2010/05/09/received PY - 2010/07/15/revised PY - 2010/08/21/accepted PY - 2010/12/15/entrez PY - 2010/12/15/pubmed PY - 2011/8/17/medline SP - 189 EP - 93 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 7 IS - 2 N2 - BACKGROUND: The purpose of the present study was to evaluate the safety, efficacy, and nutritional outcomes of malabsorptive distal Roux-en-Y gastric bypass (D-RYGB) 20-25 years later at a university hospital. METHODS: From 1985 to 1989, 49 mostly superobese (body mass index >50 kg/m(2)) patients had undergone D-RYGB. D-RYGB consisted of open laparotomy with a 50-mL proximal gastric pouch and gastroenterostomy performed 250 cm proximal to the ileocecal junction, with common channels of 50-150 cm. These 49 patients were compared with a similar group of 92 consecutive patients who had undergone long-limb RYGB, with a 75-cm biliopancreatic limb and 150-cm alimentary limb. RESULTS: The mean ± SD preoperative body mass index was 58.9 ± 9.3 kg/m(2). After 1 perioperative death secondary to pulmonary embolism, limb-lengthening revisions were required in 21 (43.7%) of the 48 remaining patients for protein-calorie malnutrition. Of the 23 with a 50-cm common channel, 13 required revision compared with 8 of 25 with ≥100-cm common channel (P <.05, chi-square). Of the 48 patients who had undergone D-RYGB, 8 had died 6-19 years after D-RYGB. Of the nonrevised patients, 19 (70.4%) of 27 had >5 years of follow-up. In these, the latest body mass index was 34.2 kg/m(2) at 10 ± 6.1 years. The percentage of excess weight loss was 66.8% ± 14%. The lowest late serum albumin level was 3.4 ± .5 g/dL (range 2.3-4.4). The mean 25-hydroxy vitamin D level was 14.6 ± 11.3 ng/mL. Compared with patients who had undergone long-limb RYGB, the D-RYGB patients had a significantly greater percentage of excess weight loss after 5 years but significantly lower albumin, hemoglobin, iron, and calcium levels. CONCLUSION: Although D-RYGB afforded superior long-term weight loss, it caused protein-calorie malnutrition requiring frequent revision. The nonrevised patients had frequent severe metabolic derangements. Thus, D-RYGB should not be the primary operation for morbid or superobese patients. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/21145293/Long_term_results_of_malabsorptive_distal_Roux_en_Y_gastric_bypass_in_superobese_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(10)00701-X DB - PRIME DP - Unbound Medicine ER -