CHICAGO – Weight loss and comorbidity reduction from Roux-en-Y gastric bypass remain durable at 10 years, according to a reviewof 651 patients at the University of Virginia in Charlottesville.
Investigators checked up on their patients after a decade because “the long-term durability of this operation remains ill-defined in the American population.” Their study, likely the largest American series with 10-year follow-up, helps “to more clearly define long-term outcomes that may be achieved following performance of Roux-en-Y gastric bypass and establish a benchmark for future clinical investigation,” they said.
M. Alex Otto/Frontline Medical News
Dr. Hunter Mehaffey
The study included 335 open and 316 laparoscopic Roux-en-Y gastric bypass (RYGB) patients. Although gastric bypass is preformed laparoscopically at the university now, the team felt comfortable including open cases in the analysis because patients and outcomes were similar in both groups. The mean preoperative body mass index, for instance, was about 53 kg/m2 and the mean operative time about 230 minutes. Postoperative incisional hernia and anastomotic stenosis were more likely with open surgery.
As in other studies, weight loss peaked at 24 months, with patients shedding a mean of 74% of their excess weight. Although that had fallen to a mean of 52% at 10 years, “they still kept off half of their excess weight, which is outstanding,” investigator and general surgery resident Dr. Hunter Mehaffey said at the annual clinical congress of the American College of Surgeons.
Surgery also led to persistent reductions in obesity-related comorbidities. Before RYGB, for instance, 38% of patients had gastroesophageal reflux disease, versus 29% after 10 years. Similarly, the prevalence of degenerative joint disease fell from 61% to 32%, diabetes from 41% to 18%, obstructive sleep apnea from 36% to 16%, hypertension from 59% to 47%, pulmonary problems from 28% to 13%, and psychiatric issues from 39% to 29%. About a quarter of patients had cardiac comorbidities before RYGB, versus 16% at 10 years after surgery. The data came from chart reviews and patient interviews, and the findings were statistically significant.
Overall, patients seemed glad to have had the operation, reporting an average satisfaction score of 8.7 out of 10 points, he said, adding, “I would expect these findings to be generalizable to other institutions. This is a good, durable operation.”
Given the scope of the comorbidity reductions, “the savings in health care costs” from RYGB “are likely underestimated,” Dr. Mehaffey said.
There was another lesson from the study, as well. It took a while to track down patients for 10-year follow-up because they were no longer seeing their surgeons. “If we are not going to see these patients much after 2 years, we really have to make sure that their primary care physician knows” how to recognize and manage possible complications, such as nutritional deficiency or hypoglycemia, he said.
Dr. Mehaffey had no disclosures, and there was no outside funding for the work.