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Obesity Surgery

, Volume 19, Issue 10, pp 1384–1392 | Cite as

Different Criteria for Assessment of Roux-en-Y Gastric Bypass Success: Does Only Weight Matter?

  • Maria de Fátima Haueisen Sander DinizEmail author
  • Valéria Maria de Azeredo Passos
  • Sandhi Maria Barreto
  • Daniela Barreto Linares
  • Soraya Rodrigues de Almeida
  • Alexandre Lages Savassi Rocha
  • Marco Túlio Costa Diniz
Research Article

Abstract

Background

Medium and long-term efficacy of Roux-en-Y gastric bypass (RYGBP) has previously been demonstrated. However, weight-loss success criteria could be influenced by super-obesity prevalence at baseline. Here, we describe a 5-year follow-up concerning weight loss results, comorbidities, and mortality of a RYGBP Brazilian population with a high prevalence (60.6%) of super-obesity.

Methods

One hundred ninety-three patients (142 female, 51 male) submitted to RYGBP were studied. Preoperative and follow-up body mass index (BMI), percent excess weight loss (%EWL), percent BMI loss (%EBL), and comorbidities were analyzed. Analysis of success was based on %EWL, Reinhold modified by Christou, and Biron criteria.

Results

Five-year follow-up rates were 91.9%, 82.0%, 71.1%, 71.2%, 72.5%, respectively. By 2 years of follow-up, the rates of success based on %EWL, Reinhold modified by Christou, and Biron criteria were 90.4%, 63.4%, and 87.0%, respectively. By 5 years, these rates were 78.0%, 50.0%, and 74.0%, respectively. There was significant and persistent reduction of hypertension, diabetes mellitus, and dyslipidemia. Super-obesity was associated with the worst weight-loss results by modified Reinhold criteria, despite a significant reduction of comorbidities.

Conclusions

In the super-obese population, RYGBP was very efficient, contributing to significant weight loss and reduction in comorbidities. Mortality was more frequent than international rates, but this was most likely due to the severity of the cohort baseline. Success rates were different according to each criterion, but reaching BMI < 35 kg/m2 was not necessary for improvement in comorbidities.

Keywords

Morbid obesity Bariatric surgery Gastric bypass Success criteria Comorbidities 

Notes

Conflict of interest statement

Federal University of Minas Gerais

References

  1. 1.
    Shekelle PG, Morton SC, Maglione MA, et al. Pharmacological and surgical treatment of obesity. Evidence report/ Technology assessment No.103 (Prepared by the Southern California- RAND Evidence-Based Practice Center, Santa Monica, CA, under contract Number 290-02-0003). AHRQ Publication No. 04-E028–2. Rockville, MD. Agency for Healthcare Research and Quality. July 2004.Google Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA 2004;292:1724–37.CrossRefGoogle Scholar
  3. 3.
    Sjoström L, Lindroos A, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351:2683–93.CrossRefGoogle Scholar
  4. 4.
    Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbibidly obese patients. Ann Surg 2004;240:416–24.CrossRefGoogle Scholar
  5. 5.
    Sowemimo OA, Yood SM, Courtney J, et al. Natural history of morbid obesity without surgical intervention. Surg Obes Rel Dis 2007;3:73–7.CrossRefGoogle Scholar
  6. 6.
    Sjostrom L, Narbro K, Sjostrom C, et al. Effects of bariatric surgery on mortality in Swedish Obese Subjects. N Engl J Med 2007;357:741–52.CrossRefGoogle Scholar
  7. 7.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357:753–61.CrossRefGoogle Scholar
  8. 8.
    Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg 2004;14:1157–64.CrossRefGoogle Scholar
  9. 9.
    Souto KE, Meinhardt NG, Stein AT. Evaluation of quality of life and metabolic improvement after jejunoileal bypass in a community of low socioeconomic status. Obes Surg 2004;14:823–8.CrossRefGoogle Scholar
  10. 10.
    Oliveira NRR , Faintuch J, Beani A Jr, et al. Weight loss and comorbidities after gastroplasty for morbid obesity. ABCD Arq Bras Cir Dig 2005;18:8–12.Google Scholar
  11. 11.
    Pajecki D, Dalcanalle L, Souza de Oliveira CP, et al. Follow-up of Roux-en-Y gastric bypass patients at 5 or more years postoperatively. Obes Surg 2007;17:601–7.CrossRefGoogle Scholar
  12. 12.
    Shah M, Simha V, Garg A. Long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab 2006;91:4223–31.CrossRefGoogle Scholar
  13. 13.
    Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg 2006;244:734–40.CrossRefGoogle Scholar
  14. 14.
    O’Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric surgery. Obes Surg 2006;16:1032–40.CrossRefGoogle Scholar
  15. 15.
    Bloomstom M, Zervos EE, Camps MA, et al. Outcome following bariatric surgery in super versus morbidly obese patients: does weight matter? Obes Surg 1997;7:414–9.CrossRefGoogle Scholar
  16. 16.
    Brolin RE, Kenler HA, Gorman RC, et al. The dilemma of outcome assessment after operations for morbid obesity. Surgery 1989;105:337–46.PubMedGoogle Scholar
  17. 17.
    Reinhold RB. Critical analysis of long-term weight loss following gastric bypass. Surg Gynecol Obstet 1982;155:385–94.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Biron S, Hould FS, Lebel S, et al. Twenty years of biliopancreatic diversion: what is the goal of the surgery? Obes Surg 2004;14:160–4.CrossRefGoogle Scholar
  19. 19.
    Deitel MD, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg 2007;17:565–8.CrossRefGoogle Scholar
  20. 20.
    Dixon JB, McPhail T, O’Brien PE. Minimal reporting requirements for weight loss: current methods not ideal. Obes Sirg 2005;15:1034–9.CrossRefGoogle Scholar
  21. 21.
    Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 2003;289:2560–72.CrossRefGoogle Scholar
  22. 22.
    The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183–97.CrossRefGoogle Scholar
  23. 23.
    National Cholesterol Education Program. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486–97.CrossRefGoogle Scholar
  24. 24.
    DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Sur Obes Rel Dis 2007;3:134–40.CrossRefGoogle Scholar
  25. 25.
    Madan AK, Whitfield JD, Fain JN, et al. Are african-americans as successful as caucasians after laparoscopic gastric bypass? Obes Surg 2007;17:460–4.CrossRefGoogle Scholar
  26. 26.
    Mathus-Vliegen EMH, Dutch Bariatric Surgery Group. Long-term weight loss after bariatric surgery in patients visited at home outside the study environment. Obes Surg 2006;16:1508–19.CrossRefGoogle Scholar
  27. 27.
    Frigg A, Peterli R, Peters T, et al. Reduction in comorbidities 4 years after laparoscopic adjustable gastric banding. Obes Surg 2004;14:216–23.CrossRefGoogle Scholar
  28. 28.
    Lara MD, Kothari SN, Sugerman HJ. Surgical management of obesity. A review of the evidence relating to the health benefits and risks. Treat Endocrinol 2005;4:55–64.CrossRefGoogle Scholar
  29. 29.
    Lamounier RN, Pareja JC, Tambascia MA, et al. Incretins: clinical physiology and bariatric surgery—correlating the entero-endocrine system and a potentially anti-dysmetabolic procedure. Obes Surg 2006;17:569–76.CrossRefGoogle Scholar
  30. 30.
    Poobalan A, Aucott L, Smith WCS, et al. Effects of weight loss in overweight/obese individuals and long-term lipid outcomes—a systematic review. Obes Rev 2004;5:43–50.CrossRefGoogle Scholar
  31. 31.
    Ware JH. Interpreting incomplete data in studies of diet and weight loss. New Engl J Med 2003;348:2136–7.CrossRefGoogle Scholar
  32. 32.
    Harper J, Madan AK, Ternovits CA, et al. What happens to patients who do not follow-up after bariatric surgery? Am Surg 2007;73:181–4.PubMedGoogle Scholar
  33. 33.
    Samaha FF, Nayyar I, Seshadri P, et al. A low carbohydrate as compared with a low-fat diet in severe obesity. New Engl J Med 2003;348:2074–81.CrossRefGoogle Scholar
  34. 34.
    Wardé-Kamar J, Rogers M, Flancnaum L, et al. Calorie intake and meal patterns up to 4 years after Roux-en-Y gastric bypass surgery. Obes Surg 2004;14:1070–9.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Maria de Fátima Haueisen Sander Diniz
    • 1
    • 2
    • 8
    Email author
  • Valéria Maria de Azeredo Passos
    • 1
    • 4
  • Sandhi Maria Barreto
    • 3
    • 4
  • Daniela Barreto Linares
    • 7
  • Soraya Rodrigues de Almeida
    • 5
    • 6
  • Alexandre Lages Savassi Rocha
    • 6
  • Marco Túlio Costa Diniz
    • 5
    • 6
  1. 1.Departamento de Clínica Médica, Faculdade de Medicina e Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  2. 2.Serviço de Endocrinologia e Metabologia, Faculdade de Medicina e Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  3. 3.Departamento de Medicina Social e Preventiva, Faculdade de Medicina e Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  4. 4.CNPq, Conselho Nacional de Desenvolvimento Científico e Tecnológico e membro do Centro Colaborador de Doenças Crônicas do Ministério da Saúde do Brasil, Faculdade de Medicina e Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  5. 5.Departamento de Cirurgia, Faculdade de Medicina e Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  6. 6.Instituto Alfa de Gastroenterologia, Faculdade de Medicina e Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  7. 7.Departamento de Medicina, Faculdade de Medicina e Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  8. 8.Minas GeraisBrazil

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