The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: Results in 257 patients

Background. For the past I I years, we have used a malabsorptive form of Roux-en-Y gastric bypass or selected patients with BMIs > 50 kg/m(2) and in highly (RYGB), the "very, very long limb" RYGB, for selected patients with BMI < 50 kg /m(2). This modified distal gastric bypass establishes a 100-cm common channel (for digestion and absorption) and a "very, very" long Roux limb of 400 to 500 cm. Methods. To determine long-term efficacy and complications, we followed prospectively 257 consecutive patients; 188 (73%) participated in a postoperative survey. Results. Of the patients, 60% were female; overall age ((x) over bar +/- SD) was 45 +/- 11 years, and BMI was 61 +/- 11 kg/m(2). Operative mortality was 1 % with substantive postoperative morbidity occurring in 13 Eighty-two percent of patients returning the survey an average of 48 months postoperatively (range, 12 to 148 months) lost > 50% of excess body weight; BMI at follow-up was 37 9 kg/m(2). Resolution of comorbidities included diabetes mellitus (94%), hypertension (65%), sleep apnea, (48 %), and asthma (30 %). Side effects included mild food intolerance (82 %), occasional loose or watery stools (71 %), nephrolithiasis (16 %), and symptomatic steatorrhea (5 %). Nine patients (4 %) who developed or were developing impending protein/calorie malnutrition required proximal relocation of the enteroenterostomy with symptom resolution. Conclusions. Overall, 90 % were satisfied with the operation, and 93 % would recommend it to a friend. The very, very long limb RYGB is relatively safe and effective and has acceptable side effects in the treatment Of selected patients with super obesity (BMI > 50). Because of the possibility of malabsorptive sequelae, patients should be selected based on degree of medical sophistication, insight, and compliance.