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Obesity Surgery

, Volume 19, Issue 4, pp 432–438 | Cite as

Obesity Surgery Results Depending on Technique Performed: Long-Term Outcome

  • J. A. GraciaEmail author
  • M. Martínez
  • M. Elia
  • V. Aguilella
  • P. Royo
  • A. Jiménez
  • M. A. Bielsa
  • D. Arribas
Research Article

Abstract

Background

Many techniques have excellent results at 2 years of follow-up but some matters regarding their long-term efficacy have arisen. This is why bariatric surgery results must be analyzed in long-term follow-up. The aim of this study was to extend the analysis over 5 years, evaluating weight loss, morbidity, and mortality of the surgical procedures performed.

Methods

This was a retrospective cohort study of the different procedures for morbid obesity practiced in our Department of Surgery for morbid obesity. The results have been analyzed in terms of weight loss, morbidity improvement, and postoperative morbidity (Bariatric Analysis And Reporting Outcome System).

Results

One hundred twenty-five patients were operated on open vertical banded gastroplasty (VBG), 150 patients of open biliopancreatic diversion (BPD) of Scopinaro, 100 patients of open modified BPD (common limb 75 cm; alimentary limb 225 cm), and 115 patients of laparoscopic Roux-en-Y gastric bypass (LRYGBP). Mean follow-up was: VBG 12 years, BPD 7 years, and LRYGBP 4 years. An excellent initial weight loss was observed at the end of the second year of follow-up in all techniques, but from this time an important regain of weight was observed in VBG group and a discrete weight regain in LRYGBP group. Only BPD groups kept excellent weight results so far in time. Mortality was: VBG 1.6%, BPD 1.2%, and LRYGBP 0%. Early postoperative complications were: VBG 25%, BPD 20.4%, and LRYGBP 20%. Late postoperative morbidity was: protein malnutrition 11% in Scopinaro BPD, 3% in Modified BPD group, and no cases reported either in VBG group or LRYGBP group; iron deficiency 20% VBG, 62% Scopinaro BPD, 40% modified BPD, and 30.5% LRYGBP. A 14.5% of VBG group required revision surgery to gastric bypass or to BPD due to 100% weight regain or vomiting. A 3.2% of Scopinaro BPD with severe protein malnutrition required revision surgery to lengthen common limb to 100 cm. A 0.8% of LRYGBP required revision surgery to distal LRYGBP (common limb 75 cm) due to 100% weight regain.

Conclusions

The most complex bariatric procedures increase the effectiveness but unfortunately they also increase morbidity and mortality. LRYGBP is safe and effective for the treatment of morbid obesity. Modified BPD (75–225 cm) can be considered for the treatment of superobesity (body mass index > 50 kg/m2), and restrictive procedures such as VBG should only be performed in well-selected patients due to high rates of failure in long-term follow-up.

Keywords

Morbid obesity Bariatric surgery Biliopancreatic diversion Laparoscopic gastric bypass Vertical banded gastroplasty 

References

  1. 1.
    Adams T, Gress R, Smith S, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.CrossRefGoogle Scholar
  2. 2.
    Sjöström L, Narbro K, Sjöström D, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.CrossRefGoogle Scholar
  3. 3.
    ASBS and SAGES. Guidelines for laparoscopic and open surgical treatment of morbid obesity. Obes Surg 2000;10:378–9.CrossRefGoogle Scholar
  4. 4.
    Harvey A, Blackburn G, Apovian C, et al. Commonwealth of Massachusetts for patient safety and medical error reduction. Expert panel on weight loss surgery: executive report. Obes Res. 2005;13:205–26.CrossRefGoogle Scholar
  5. 5.
    Brolin RE, La Marca LB, Kenler HA, et al. Malabsorption gastric bypass in patients with superobesity. J Gastrointest Surg. 2002;6:195–205.CrossRefGoogle Scholar
  6. 6.
    Balsiger BM, Pogio JM, Mai J, et al. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity. J Gastrointest Surg. 2000;4:598–605.CrossRefGoogle Scholar
  7. 7.
    Oria HE, Moorehead MK. Bariatric analysis and reporting outcome system (BAROS). Obesity Surg. 1998;8(5):487–99.CrossRefGoogle Scholar
  8. 8.
    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
  9. 9.
    Fernández AZ, De María EJ, Tichansky DS, et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg. 2004;239:698–703.CrossRefGoogle Scholar
  10. 10.
    Lee C, Cartes PL, Elliott D, et al. An institutional experience with laparoscopic gastric bypass complications seen in the first year compared with open gastric bypass complications during the same period. Am J Surg. 2002;183:533–8.CrossRefGoogle Scholar
  11. 11.
    Näslund E, Backman L, Granström L, et al. Seven year results of vertical banded gastroplasty for morbid obesity. Eur J Surg. 1997;163:281–6.PubMedGoogle Scholar
  12. 12.
    Domínguez-Díez A, Olmedo-Mendicoague F, Ingelmo-Setién A, et al. Tratamiento quirúrgico de la obesidad mórbida: Bypass biliopancreático. Cir Esp. 2004;75:251–6.CrossRefGoogle Scholar
  13. 13.
    Bloomberg R, Fleishman A, Nalle J, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54.CrossRefGoogle Scholar
  14. 14.
    Guedea ME, Arribas del Amo D, Solanas JA, et al. Results of biliopancreatic diversion after five years. Obes Surg. 2004;14:766–72.CrossRefGoogle Scholar
  15. 15.
    Fox R, Fox K. Vertical banded gastroplasty and distal gastric bypass as primary procedures. A comparison. Obes Surg. 1996;6:421–5.CrossRefGoogle Scholar
  16. 16.
    Vargas-Ruiz A, Hernández-Rivera G, Herrera F. Prevalence of iron, folate and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:288–93.CrossRefGoogle Scholar
  17. 17.
    Puzziferri N, Austrheim IT, Wolfe BM, et al. Three year follow up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;243:181–8.CrossRefGoogle Scholar
  18. 18.
    Rubio MA, Moreno C. Tratamiento médico de la obesidad mórbida: alternativas actuales, límites y perspectivas. Cir Esp. 2004;75:219–24.CrossRefGoogle Scholar
  19. 19.
    Sanchez-Cabezudo C, Díaz-Guerra C, Larrad Jiménez A. Analysis of weight loss with biliopancreatic diversion of Larrad: absolute failures or relative successes. Obes Surg. 2002;12:249–52.CrossRefGoogle Scholar
  20. 20.
    Scopinaro N. Biliopancreatic diversion: mechanisms of action and long-term results. Obes Surg. 2006;16:683–9.CrossRefGoogle Scholar
  21. 21.
    Buchwald H. Evolution of operative procedures for the management of morbid obesity 1950–2000. Obes Surg. 2002;12:705–17.CrossRefGoogle Scholar
  22. 22.
    Dominguez A, Olmedo F, Ingelmo A, et al. Bypass biliopancreático. Cir Esp. 2004;75:251–8.CrossRefGoogle Scholar
  23. 23.
    McConnell DB, O’Rourke RW, Deveney CW. Common channel length predicts outcomes of biliopancreatic diversion alone and with the duodenal switch surgery. Am J Surg. 2005;189:536–40.CrossRefGoogle Scholar
  24. 24.
    Paroz A, Calmes JM, Giusti V, et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity: a continuous challenge in bariatric surgery. Obes Surg. 2006;16:1482–7.CrossRefGoogle Scholar
  25. 25.
    Pekka T, Mäkelä VM. 11-year experience with laparoscopic adjustable gastric banding for morbid obesity—what happened to the first 123 patients? Obes Surg 2008;18:251–5.CrossRefGoogle Scholar
  26. 26.
    Oria H. Standards committee statement. Obesity Surg. 2000;10:1.CrossRefGoogle Scholar
  27. 27.
    Mason EE, Doherty C, Cullen JJ, et al. Vertical gastroplasty: evolution of vertical banded gastroplasty. World J Surg. 1998;22:919–24.CrossRefGoogle Scholar
  28. 28.
    Arribas del Amo D, Elia Guedea M, Aguilella Diago V, et al. Effect of vertical banded gastroplasty on hypertension, diabetes and dyslipidemia. Obes Surg. 2002;12:319–23.CrossRefGoogle Scholar
  29. 29.
    Capella JF, Capella RF. The weight reduction operation of choice: vertical banded gastroplasty or gastric bypass. Am J Surg 1996;171:74–9.CrossRefGoogle Scholar
  30. 30.
    Pujol-Rafols J. Técnicas restrictivas en cirugía bariátrica. Cir Esp 2004;75:236–4.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • J. A. Gracia
    • 1
    Email author
  • M. Martínez
    • 1
  • M. Elia
    • 1
  • V. Aguilella
    • 1
  • P. Royo
    • 1
  • A. Jiménez
    • 1
  • M. A. Bielsa
    • 1
  • D. Arribas
    • 1
  1. 1.Department of SurgeryHospital Clínico Universitario “Lozano Blesa”ZaragozaSpain

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