Introduction The Roux-en-Y gastric bypass (RYGB) has been employed for more than 3 decades. However, there are no normative data to aid the bariatric surgeon in assessing the adequacy of weight loss at each postoperative visit. Objective To construct nomograms to aid in assessment of weight loss. Setting University Hospital, United States Methods We used data prospectively collected from 1216 patients who underwent RYGB at Duke University between April 2000 and September 2007. Percent excess weight loss (EWL) was determined for each follow-up visit (1, 3, 6, 12, and 36 months). EWL velocity was also determined using postoperative data collected at 1 and 3 month visits. Multivariate analysis was used to determine predictive factors that influence long term results. Results At 12 months follow up, the majority of patients, especially those in the 1st and 4th quartiles (p=0.01) continue to be in the same weight loss quartile where they were initially classified at 1 month postoperatively. The positive and negative predictive values for 1st quartile EWL at 1 month resulting in 1st quartile EWL at 12 months was 39% and 81%, respectively. The multivariate analysis indicated that sex, preoperative body mass index (BMI), EWL at 1 month, and EWL velocity were statistically significant predictors of EWL at 12 months. Conclusions We are the first group to determine that weight loss performance in the early period is a significant predictor of long term outcome. The clinical utility of the weight loss chart is to identify underperformers early postoperatively and potentially improve outcomes.

Revisional LRYGB is characterized by lower EWL and higher morbidity than primary LRYGB. However, our data suggest that revisional LRYGB is still capable of providing significant weight loss in these high-risk patients.

In selected patients, TOGa®, was associated with good results after two years in terms of weight loss, even in comparison with LRYGBP and BPD. Minimal trauma, absence of complications, and short hospital stay justify this procedure for patients with low BMI.

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A significant improvement in the 10 year estimated cardiovascular risk is observed in patients undergoing RYGB, but not in those who were offered usual medical therapy plus DSE. However, the effects of RYGB on FRS are independent of weight loss.