Is Roux-en-Y gastric bypass effective in the treatment of obesity?

Updated: Jun 09, 2021
  • Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Flickinger and associates, in an examination of 210 patients who received a Roux-en-Y gastric bypass, recorded a mean weight loss of 51 kg in 18 months, which was then maintained over 36 months of follow-up. [188] Only 4% of the patients required a repeat operation. Sugerman and colleagues reported that, among patients undergoing gastric bypass, two thirds of their excess body weight was lost over 2 years, 60% of the excess body-weight loss was maintained at 5 years, and more than 50% of excess body-weight loss was maintained at 8-9 years’ follow-up. [24]

Roux-en-Y and other gastric-bypass procedures generally result in more weight loss than do gastric-restriction procedures. When 329 patients receiving vertical gastroplasty procedures were compared with 623 persons undergoing Roux-en-Y gastric bypass, weight loss was maintained in 47% and 62% of patients, respectively, over 5-9 years of follow-up. [24]

According to a study by Plecka et al, in patients who are morbidly obese, gastric bypass (but not restrictive surgery) apparently reduces the risk levels for the development of type 2 diabetes and myocardial infarction to those for the general population. However, the mortality risk in these patients nonetheless remains higher than that in the general population. [189]

Mingrone et al reported regression of diabetes (defined as fasting glucose < 100 mg/dL and hemoglobin A1c [HbA1c] < 6.5% in the absence of pharmacologic therapy) at 2 years in 75% of Roux-en-Y gastric bypass patients and 95% of biliopancreatic-diversion patients. [190] This randomized, controlled trial included 60 patients with a BMI of more than 35, a history of at least 5 years of type 2 diabetes, and HbA1c of 7% or greater. Improvement in glucose control was unrelated to baseline BMI or overall weight loss.

A Norwegian study compared gastric bypass with duodenal switch and determined that duodenal switch surgery was associated with greater weight loss and greater reductions in total and LDL-C levels. However, duodenal switch surgery was also associated with reductions in concentrations of vitamin A and 25-hydroxyvitamin D, as well as with increased adverse effects. [191]

Similarly, a randomized trial from Sweden found greater postoperative weight loss in patients who had duodenal switch surgery than in those who had gastric bypass. Fasting glucose and HgA1c were also lower at 3 years in the duodenal switch group. [192]

A study by Schiavon et al indicated that bariatric surgery can lead to a reduction in the number of antihypertensive drugs required by persons with obesity taking multiple blood pressure agents and in some cases can eliminate the need for any such medications. The study involved 96 patients with a BMI of 30 to just under 40 kg/m2, including 49 who underwent laparoscopic Roux-en-Y gastric bypass and a control group of 47 treated only with medical and lifestyle therapy. The investigators found that 83.7% of the surgery group, but just 12.8% of the control patients, were able to reduce the total number of antihypertensive medications they were taking by at least 30%. Moreover, at 12 months, 51% of the surgery patients were able to maintain an office-measured blood pressure of under 140/90 mm Hg without any blood pressure drugs, a milestone that none of the control patients reached. [193, 194]


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