Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity

Objective: To determine prospectively the results of Roux-en-Y gastric bypa ss (RYGB) used as the primary weight-reducing operation in patients with me dically complicated ("morbid") obesity. The RYGB procedure combines the adv antages of a restrictive physiology (pouch of 10 mL) and a "dumping physiol ogy" for high-energy liquids without requiring an externally reinforced (ba nded) stoma, Patients and Methods: Between April 1987 and December 1998, a total of 191 consecutive patients with morbid obesity (median weight, 138 kg [range, 91- 240 kg]; median body mass index, 49 kg/m(2) [range, 36-74 kg/m(2)]), all of whom had directly weight-related morbidity, underwent RYGB and prospective follow-up. Results: Hospital mortality was 0.5% (1/191), and hospital morbidity occurr ed in 10.5% (20/191), Good longterm weight loss was achieved, and patients adapted well to the required new eating habits. The mean +/- SD weight loss at 1 year after operation (113 patients) was 52+/-1 kg or 68%+/-2% of init ial excess body weight. By 3 years postoperatively (74 patients), weight lo ss was still 66%+/-2% of excess body weight. Overall, 53 (72%) of 74 patien ts had achieved and maintained a weight loss of 50% or more of their preope rative excess body weight 3 years after the operation. In addition, only 1 (1%) of 98 patients had persistent postoperative vomiting 1 or more times p er week. Conclusion: We believe that RYGB is a safe, effective procedure for most pa tients with morbid obesity and thus may be the current procedure of choice in patients requiring bariatric surgery for morbid obesity.