10-year Outcomes After Roux-en-Y Gastric Bypass

J. Hunter Mehaffey, MD; Damien J. LaPar, MD; Kathleen C. Clement; Florence E. Turrentine, PhD, RN; Michael S. Miller, MS; Peter T. Hallowell, MD; Bruce D. Schirmer, MD

Disclosures

Annals of Surgery. 2016;264(1):121-126. 

In This Article

Abstract and Introduction

Abstract

Objective(s): The aim of the study was to evaluate the clinical effectiveness and long-term durability of Roux-en-Y Gastric Bypass (RYGB) at an accredited center.

Background: Short-term data have established the effectiveness of RYGB for weight loss and comorbidity amelioration. The long-term durability of this operation remains infrequently described in the American population.

Methods: All patients (N = 1087) undergoing RYGB at a single institution over a 20-year study period (1985–2004) were evaluated. Univariate differences in preoperative comorbidities, operative characteristics (laparoscopic vs. open), postoperative complications, annual weight loss, and current comorbidities were analyzed to establish trends and outcomes 10 years after surgery.

Results: Among 1087 RYGB patients, 651 (60%) had complete 10-year follow-up, including 335 open RYGB and 316 laparoscopic RYGB. Patients undergoing open RYGB had a higher preoperative body mass index. Otherwise, preoperative characteristics were similar. Postoperative incisional hernia rates were expectedly higher in open (vs laparoscopic) RYGB (16.9% vs 4.7%; P = 0.02). Annual % reduction in excess body mass index significantly improved over time, peaking at 74% by 24 months, with a slow trend down to 52% at 10 years (all P < 0.001). Importantly, a highly significant decrease in obesity-related comorbid disease persisted at 10 years of follow-up after RYGB.

Conclusions: Roux-en-Y Gastric Bypass remains an excellent and durable operation for long-term weight loss and treatment of obesity-related comorbid disease. Laparoscopic RYGB results in highly favorable outcomes with reduced incisional hernia rates. These 10-year data help to more clearly define long-term outcomes and demonstrate outstanding reduction in comorbid disease following RYGB.

Introduction

The obesity epidemic in this country continues to grow at an alarming rate, with over half of the population being overweight [body mass index (BMI) 25–30 kg/m2) or obese (BMI > 30 kg/m2).[1] The healthcare-related cost of obesity has been estimated to reach 60 billion dollars by 2030.[2,3] Evidenced by more than 124,000 patients who underwent weight loss surgery in 2008, bariatric surgery is becoming more popular, and there is a greater need to study the long-term outcomes of these surgeries.[4] Numerous studies have shown the benefits of bariatric surgery in terms of weight loss and comorbidity reduction in the short term (<2 y).[1,2] In 2011, the American College of Surgeons Bariatric Surgery Center Network found that among 28,616 patients in the study, 83% in the Roux-en-Y gastric bypass (RYGB) group, 55% in the sleeve gastrectomy group, and 44% in the gastric banding group had improvement or remission of their diabetes at 12 months.[7] Three randomized control studies also showed that bariatric surgery plus medical therapy was superior to intensive medical therapy alone in treating diabetes.[3–5,12–16] Other smaller studies have demonstrated that RYGB can treat dyslipidemia, obstructive sleep apnea, and gastroesophageal reflux disease in the short term.[9–11]

For RYGB, few studies have evaluated weight loss, comorbidity reduction, and surgical complications beyond 10 years. The Swedish Obese Subjects (SOS) trial is the largest study published to date, with 2011 bariatric surgery patients followed for 10 to 20 years, depending on the outcome measure studied.[6–9] In this study, 89% of the bariatric operations were open cases, and only 265 patients underwent RYGB. Given the increasing prevalence of laparoscopic RYGB surgery and the unique challenges of successfully medically treating an unhealthy American obese population, we studied long-term RYGB outcomes, complications, and comorbidity reduction in a large prospectively collected database at an academic teaching hospital with a significant proportion of laparoscopic cases.[18,19] The purpose of this study is to assess long-term outcomes beyond 10 years for RYGB in the American population. We hypothesize there will be no difference in long-term outcomes for patients undergoing open versus laparoscopic RYGB, and we believe patients will maintain a statistically significant reduction in excess BMI at 10 years. As a secondary outcome, we hypothesize patients undergoing RYGB will have equivalent or improved comorbidity profile at 10 years compared with preoperatively, indicating losing weight is not the only benefit of surgery.

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