Prospective Evaluation of Roux-en-Y Gastric Bypass as Primary Operation for Medically Complicated Obesity

To determine prospectively the results of Roux-en-Y gastric bypass (RYGB) used as the primary weight-reducing operation in patients with medically complicated (“morbid”) obesity. The RYGB procedure combines the advantages of a restrictive physiology (pouch of 10 mL) and a “dumping physiology” for high-energy liquids without requiring an externally reinforced (banded) stoma. Between April 1987 and December 1998, a total of 191 consecutive patients with morbid obesity (median weight, 138 kg [range, 91–240 kg]; median body mass index, 49 kg/m 2 [range, 36–74 kg/m 2]), all of whom had directly weight-related morbidity, underwent RYGB and prospective follow-up. Hospital mortality was 0.5% (1/191), and hospital morbidity occurred in 10.5% (20/191). Good longterm weight loss was achieved, and patients adapted well to the required new eating habits. The mean ± SD weight loss at 1 year after operation (113 patients) was 52±1 kg or 68% ±2% of initial excess body weight. By 3 years postoperatively (74 patients), weight loss was still 66% ±2% of excess body weight. Overall, 53 (72%) of 74 patients had achieved and maintained a weight loss of 50% or more of their preoperative excess body weight 3 years after the operation. In addition, only 1 (1%) of 98 patients had persistent postoperative vomiting 1 or more times per week. We believe that RYGB is a safe, effective procedure for most patients with morbid obesity and thus may be the current procedure of choice in patients requiring bariatric surgery for morbid obesity.