Original articleFive-year outcome with gastric bypass: Roux limb length makes a difference
Section snippets
Methods
The weight loss outcomes of 344 MO/SO patients in 3 clinical and sequential groups were retrospectively collated for this report. All procedures had been done under the direct supervision of 1 surgeon, and all patients had undergone open Roux-en-Y gastric bypass. Those patients who had undergone revisional surgery or laparoscopic surgery were excluded. All patients had undergone gastric bypass >5 years previously and thus were potentially evaluable through 5 years. The patients who had died
Results
A total of 344 patients were followed up through 5 years by clinic visits or telephone interviews with the patient, the patient's relatives, or the patient's primary care physician. The overall follow-up through 4 years was 71%; however, it had decreased to 49% by 5 years. Follow-up for the earliest group 1 patients (81% and 51% at 4 and 5 years, respectively) was better than for the latest group 3 patients (57% and 42% at 4 and 5 years, respectively). Follow-up for the patients with a BMI <50
Discussion
The patients included in this retrospective and sequential analysis underwent gastric bypass from 1980 onward as the surgical concepts of the Roux length issues evolved. The patients in the early group (1980–1992) had a Roux limb length of 45 cm (range 41–61), with occasional minor variations. The technical discussions generated in the published reports (and at bariatric surgery meetings) in that early era addressed the effectiveness of the gastric operations for weight loss as issues of
Conclusion
The results of this study have shown that longer Roux limbs improved weight loss or BMI reduction early and through 5 years in SO patients and started later in MO patients. The reason for this in MO patients appeared to be the desirable reduced BMI achieved even with a short Roux limb, such that an additional reduction had no clinical appeal. The long Roux limbs used in group 2 patients, 25-cm longer in SO than in MO patients, were close enough to one third of the total small bowel length used
Disclosures
The author claims no commercial associations that might be a conflict of interest in relation to this article.
Acknowledgments
The author acknowledges the instructive and exacting assistance in all statistical analyses of these data by Naomi S. Fineberg, Ph.D., Research Professor, Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama.
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