WEIGHT-LOSS AFTER EXTENDED GASTRIC BYPASS

Background: Gastric bypass (GBP) is the most effective method for cont rolling morbid obesity. Previously we showed that extending the length of the Roux limb increased weight loss. We have done over 400 obesity operations during the past 20 years. The current study consists of pa tients from the last 10 years of our experience and compares short to extended Roux-en-Y GBP. Methods: Data from all patients operated at th e Ottawa General Obesity Clinic were entered into a database on an ong oing basis, and those from the past 10 years were analyzed. All patien ts had standardized preoperative investigations and postoperative foll ow-up. Details of these and of the operative technique are provided in the manuscript. Results: The preoperative weight and BMI were 129 +/- 2 kg, and 46 +/- 2 kg/m(2), respectively. The mean weight loss prior to surgery was -2 +/- 21 kg. The results were classified, by percentag e weight loss as: 'excellent' = >35%; 'good' = 25-34%; 'poor' = 15-24% ; and 'failure' = <15%. Sixty-five patients (69%) were available for 2 -year follow-up. At this time, mean percentage weight loss was 34 +/- 2 versus 40 +/- 1 for the short Roux (45-135 cm) and long Roux (180-22 5 cm) groups, respectively (P < 0.01). There were no deaths, leaks, sp lenectomies or intraabdominal infections. The incidence of hernia and/ or reoperation for bowel obstruction was 35/121 or 29%. The overall in cidence of diarrhea was 16/121 (13%) and 6/121 (5%) at 12 and 24 month s. Quality of life is significantly impaired in at least three of thes e patients, all with extended limbs. Major vitamin deficiencies, alter ations in liver functions, or other metabolic complications did not oc cur. Conclusions: Gastric bypass is the procedure of choice for morbid obesity. Weight loss is marginally improved in proportion to the leng th of the Roux limb but at a risk of diarrhea, which occasionally may not manifest itself for 8 to 12 months. It is important that methods b e devised to correct followup, incisional hernias and diarrhea.