The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: Results in 257 patients

• Published in: Surgery 2006-10, Vol.140 (4), p.517-523
• Main Authors: Nelson, Wayne K., Fatima, Javairiah, Houghton, Scott G., Thompson, Geoffrey B., Kendrick, Michael L., Mai, Jane L., Kennel, Kurt A., Sarr, Michael G.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Body Mass Index; Comorbidity; Female; Follow-Up Studies; Gastric Bypass - adverse effects; Gastric Bypass - methods; Gastric Bypass - mortality; Humans; Male; Middle Aged; Obesity, Morbid - mortality; Obesity, Morbid - surgery; Patient Satisfaction; Postoperative Complications - mortality; Prospective Studies; Treatment Outcome; Weight Loss
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2006.06.020

For the past 11 years, we have used a malabsorptive form of Roux-en-Y gastric bypass (RYGB), the “very, very long limb” RYGB, for selected patients with BMIs >50 kg/m 2 and in highly selected patients with BMI 50% of excess body weight; BMI at follow-up was 37 ± 9 kg/m 2. Resolution of comorbidities included diabetes mellitus (94%), hypertension (65%), sleep apnea (48%), and asthma (30%). Side effects included mild food intolerance (82%), occasional loose or watery stools (71%), nephrolithiasis (16%), and symptomatic steatorrhea (5%). Nine patients (4%) who developed or were developing impending protein/calorie malnutrition required proximal relocation of the enteroenterostomy with symptom resolution. Overall, 90% were satisfied with the operation, and 93% would recommend it to a friend. The very, very long limb RYGB is relatively safe and effective and has acceptable side effects in the treatment of selected patients with super obesity (BMI >50). Because of the possibility of malabsorptive sequelae, patients should be selected based on degree of medical sophistication, insight, and compliance.