Laparoscopic Roux-en-Y Gastric Bypass: Evolution of Weight Loss and Metabolic Obesity-Related Complications After 15–20 Years

Abstract

Background: Roux-en-Y gastric bypass (RYGB) is one of the prevailing metabolic/bariatric surgical (MBS) procedures. It has been used for > 50 years, yet few long-term results (> 10 years) have been published. The aim of this study is to report 15-year results and beyond in a large patient group regarding weight loss, metabolic outcomes and long-term morbidity. Methods: Our prospective bariatric database was reviewed and analyzed retrospectively. All patients who underwent primary laparoscopic RYGB between 1999 and 2008 were included. Data was gathered during in-person visits for most patients, but also using electronic medical records, phone calls to patients and/or general practitioners. Results: Nine hundred forty-four patients underwent RYGB during the study period. All were eligible for follow-up after 15 years, and 340 were eligible after 20 years. 39 (4.1%) patients died during the first 15 postoperative years. Follow-up rates were 91.7%, 74.5% and 52.3% after 10, 15 and 20 years respectively. Weight loss peaked after 2 years when total weight loss (TWL) reached 35.1%. TWL was 28.6%, 28.4% and 26.7% after 10, 15 and 20 years. Mean body mass index decreased from 45.7 kg/m2 to 29.5, 32.5, 32.7 and 34.6 after 2, 10, 15 and 20 years respectively. Metabolic status remained improved after 20 years (reduced fasting glycemia, better lipid profile and lowered serum urates). Conclusions: RYGB is an efficient MBS procedure, associated with sustained weight loss and improvement of metabolic complications; a slight worsening occurs over time, partly attributed to aging and the chronic course of obesity and related metabolic disorders.