Long-term results of laparoscopic Roux-en-Y gastric bypass for morbid obesity: 105 patients with minimum follow-up of 15 years

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the second most frequently performed bariatric procedure worldwide; however, long-term results are not frequently reported. Objectives: To evaluate the outcomes of LRYGB on weight loss and co-morbidities in a single center 15 years after the operation. Setting: Tertiary-care referral hospital. Methods: From February 2000 to December 2003, 105 patients (86 women; mean age 39.9 +/- 17.4; mean body mass index [BMI] 47.2 +/- 6.4 kg/m(2); 78 with BMI, 50 kg/m(2) and 27 with BMI >= 50 kg/m(2)) underwent LRYGB. Retrospective analyses of a prospectively maintained database were carried out to evaluate weight loss; resolution of co-morbidities, including type 2 diabetes mellitus (T2D), hypertension (HTN), and dyslipidemia; complications; and nutritional status. Results: The follow-up rate at 15 years was 87.6%. Mean excess weight loss was 58.6 +/- 27%, with 74.1% of patients achieving a total weight loss >= 20%. According to the Biron et al. criteria, an inadequate outcome was found in 11/21 (52.4%) of patients with an initial BMI >= 50 kg/m(2) versus 21/64 (32.8%) of patients with a preoperative BMI < 50 kg/m(2) (P = .001). Both groups experienced gradual weight regain (WR); specifically, 34.1% of patients regained more than 15% of their lowest postoperative weight. The rates of reoperations due to early and late surgical complications were 3.8% and 9.5%, respectively. T2D was resolved in 50% of patients, HTN in 61.1%, and dyslipidemia in 58.3%. Iron deficiency anemia (53%) was the most common postoperative nutritional finding. Conclusion: LRYGB provides satisfactory weight loss and resolution of co-morbidities up to 15 years. WR was a common finding. A significant proportion of patients with a preoperative BMI >= 50 kg/m(2) did not achieve a favorable weight loss outcome. Indications to perform LRYGB in this group of patients should be definitively reconsidered. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.