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A Novel Distal Very Long Roux-en Y Gastric Bypass (DVLRYGB) as a Primary Bariatric Procedure—Complication Rates, Weight Loss, and Nutritional/Metabolic Changes in the First 355 Patients

Thurnheer, Martin ; Bisang, Philipp ; Ernst, Barbara ; Schultes, Bernd

In: Obesity Surgery, 2012, vol. 22, no. 9, p. 1427-1436

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    Titre
    • A Novel Distal Very Long Roux-en Y Gastric Bypass (DVLRYGB) as a Primary Bariatric Procedure—Complication Rates, Weight Loss, and Nutritional/Metabolic Changes in the First 355 Patients
    Auteur
    • Thurnheer, Martin. Interdisciplinary Obesity Center, Department of Surgery, Cantonal Hospital St. Gallen, 9400, Rorschach, Switzerland
    • Bisang, Philipp. Interdisciplinary Obesity Center, Department of Surgery, Cantonal Hospital St. Gallen, 9400, Rorschach, Switzerland
    • Ernst, Barbara. Interdisciplinary Obesity Center, Department of Surgery, Cantonal Hospital St. Gallen, 9400, Rorschach, Switzerland
    • Schultes, Bernd. Interdisciplinary Obesity Center, Department of Surgery, Cantonal Hospital St. Gallen, 9400, Rorschach, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:314907
    Summary
    Proximal Roux-en Y gastric bypass (RYGB) representing the most frequently performed bariatric procedure yields a weight loss failure rate of around 20%. In order to reduce failure rates, we established a novel distal RYGB variant characterized by a very long alimentary (Roux) limb and a short common channel. Up to 5years, follow-up data (complication rates, weight loss, nutritional/metabolic changes) of the first 355 patients (mean ± SD preoperative age, 41.4 ± 10.8years; BMI, 48.5 ± 11.5kg/m2) who underwent the novel Distal Very Long Roux-en Y Gastric Bypass (DVLRYGB) were analysed. Overall follow-up rate was 98.9%, mean follow-up time 1.6 ± 1.4years. Limb lengths were as follows: common channel 76 ± 7cm, biliopancreatic limb 79 ± 14cm, and alimentary (Roux) limb 604 ± 99cm. The operation was performed laparoscopically in 95.2% of the cases. Thirty-day mortality was zero; major and minor complication rate was 4.5% and 10.4%, respectively. Average excess weight loss (EWL) was >74% 3, 4, and 5years after the operation and failure rate defined by an EWL < 50% remained < 6%. Annually blood measurements revealed a relatively low incidence rate of severe nutritional deficiencies, but mild anaemia and hypoproteinemia were frequently observed. Laparoscopic revision with a proximalization of the lower anastomosis was required in 4 (1.1%) patients. Data indicate that our DVLRYGB leads to excellent weight loss results. Furthermore, within the setting of a structured multidisciplinary follow-up program, the incidence of severe malnutrition states was relatively low