What Are the Long-term Outcomes of Gastric Bypass Surgery?

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A new US study published in the New England Journal of Medicine examines how patients are doing 12 years after gastric bypass surgery.

What is Gastric Bypass Surgery and How Does It Work?

The first surgical procedure performed specifically for weight loss took place in 1954.  Since then, bariatric procedures have become less invasive and safer.  Currently, there are several types of gastric bypass surgery such as adjustable gastric bands, sleeve gastrectomy, or biliopancreatic diversion.

However, the most common procedure is called Roux-en-Y. This laparoscopic operation typically involves partitioning off a portion of the stomach and reconnecting the smaller stomach “pouch”’ so that it bypasses the first portion of the small intestine.  A smaller stomach translates into feeling full after consuming small portions of food.  Bypassing part of the intestines means that the body has less of a chance to absorb calories.

Advantages and Disadvantages of Gastric Bypass Surgery

For individuals with a BMI greater than 40 and about 45 kg to lose, gastric bypass surgery may be seen as the best, or only, option for regaining their health.  Two years post-surgery, the average patient manages to lose 60% of their excess weight.  In addition to an improved quality of life, many also see improvements in their overall health such as remission of type 2 diabetes, improved cardiovascular health, and symptom relief from conditions such as sleep apnea, back, and joint pain, or depression.

  • Yet, there are risks associated with gastric bypass surgery including2: Vitamin, mineral, or nutritional deficiencies (30%)
  • The breakdown of staple lines (less than 5%)
  • Dumping syndrome – weakness, nausea, or vomiting due to food moving too quickly from the stomach to the intestine, especially after eating too many sweets or carbohydrates (50%)
  • Stomal stenosis – a narrowing of the opening where the stomach connects to the intestine (Less than 5%)
  • Gallstones from losing weight so quickly (20%)
  • Hernias (less than 5%)
  • Staple line leakage (3%)
  • Bowel obstruction (3%)
  • Pulmonary embolism (2%)

Nonetheless, when patients adhere to dietary recommendations, take daily vitamin supplements, and attend regular follow-up visits, the overall rate of serious complications immediately following surgery is under 6%.  The mortality rate 30 days post-surgery is less than 0.5%.  As such, some candidates for surgery may feel that the benefits of surgery far outweigh the risks.

Long-term Outcomes of Gastric Bypass Surgery

In a recent study published in the New England Journal of Medicine, an international team of researchers from the United States, Norway, and Qatar examine how patients are doing 12 years post-Roux-en-Y gastric bypass surgery.

A total of 1,156 severely obese patients participated in this study.  The 418 participants in the surgery group had sought and undergone Roux-en-Y gastric bypass surgery.  The 417 participants in the non-surgery group 1 had considered bariatric surgery but not undergone the procedure, primarily for insurance reasons.  The 321 participants in the non-surgery group 2 were patients who had not sought surgical treatment at all.   Clinical examinations for type 2 diabetes, hypertension, blood cholesterol, fat phospholipids, and triglyceride levels were performed for all participants at baseline and after two, six and twelve years following the surgery.

The 12-year results of this controlled, prospective study show that Roux-en-Y gastric bypass was associated with stable, long-term weight loss and fewer obesity-related coexisting conditions than among patients who did not undergo gastric bypass. At 12 years, the incidence of developing type 2 diabetes was still uncommon among patients who underwent Roux-en-Y gastric bypass and the remission rate of type 2 diabetes also remained high.  Lastly, remission and incidence rates of both hypertension and dyslipidemia (abnormal blood fat levels) were significantly more favorable in the surgery group than in either non-surgery group.

In summary, gastric bypass surgery is a well-studied and effective treatment for morbid obesity.  The long-term data provided by this study show that Roux-en-Y gastric bypass is both safe and effective for long-term weight loss and supports its consideration as the “gold standard” for bariatric surgery.

Written by Debra A. Kellen, PhD

References:

  1. Adams, T. D., Davidson, L. E., Litwin, S. E., Kim, J., Kolotkin, R. L., Nanjee, M. N., … & Hopkins, P. N. (2017). Weight and Metabolic Outcomes 12 Years after Gastric Bypass. New England Journal of Medicine377(12), 1143-1155. DOI: 10.1056/NEJMoa1700459
  2. Griffith, P. S., Birch, D. W., Sharma, A. M., & Karmali, S. (2012). Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity. Canadian Journal of Surgery55(5), 329.

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