How Sustained is Roux-en-Y Gastric Bypass Long-term Efficacy?

Abstract

Purpose The rate of weight regain after Roux-en-Y Gastric Bypass (RYGB) can hamper the procedure long-term efficacy for obesity treatment and related comorbidities. To evaluate the rate of weight loss and comorbidity remission failure 10 years or more after RYGB surgery. Materials and methods Retrospective observational cohort study. Patients submitted to RYGB for obesity treatment at a single centre with 10 years or more after surgery underwent a clinical reassessment. Results Among the subjects invited for clinical revaluation (n = 585), only those who performed RYGB and attended the hospital visit were included in the study (n = 281). The pre-operative mean body mass index (BMI) was 44.4 ± 6.1 kg/m2. Mean post-operative time was 12.2 ± 1.1 years. After surgery, mean BMI was significantly lower 33.4 ± 5.8 kg/m2 (p < 0.0001), 29.5% with a BMI < 30 kg/m2. Mean Total Weight Lost (%TWL) was 24.3 ± 11.4%, reaching a %TWL ≥ 20% in 70.1% with a mean %TWL of 30.0 ± 7.0%. Co-morbidities remission rate was 54.2% for type 2 diabetes, 34.1% for hypertension, 52.4% for hyperlipidemia and 50% for obstructive sleep apnea. Early complications rate was 13.2% and revision surgery occurred in 2.8% of patients. Four patients died of RYGB complications within the first 90 days after surgery. Conclusion RYGB has a high rate of long-term successful weight loss and obesity-associated comorbidity improvement. Weight loss failure requiring revision surgery occurs in a small proportion of patients. Our data confirms the long-term effectiveness of RYGB as primary bariatric intervention. Graphical abstract

Accuracy of prediction models for long-term type 2 diabetes remission after gastric bypass

“…A percentage that tends to increase along the timespan after surgery with an estimated long-term failure rate of 20–35% [ 8 , 9 ]. This figure was corroborated by our previous study that evaluated the weight loss and comorbidities remission rate 10 or more years after RYGB, which allowed to demonstrate that less than one-third of the patients did not achieve the weight loss goal and only 54.2% of patients achieved T2D remission [ 10 ].…”

“…Data from patients with obesity (BMI ≥ 35 kg/m 2 ) submitted to RYGB, between January of 2003 and December of 2009 for obesity treatment, who completed 10 or more years of follow-up after surgery, were retrieved for analysis. From the initial cohort of 281 patients, 83 had a pre-operative diagnosis of diabetes [ 10 ]. This initial cohort was later expanded by 71 additional patients with type 2 diabetes submitted to RYGB between January of 2010 and December of 2011, who at the time of the initial cohort recruitment, had not yet completed 10 years of follow-up after RYGB.…”

Machine learning models to predict success of endoscopic sleeve gastroplasty using total and excess weight loss percent achievement: a multicentre study

“…Each model was trained to predict whether the procedure would be successful at 12-month follow-up (a binary output), including confidence estimates where applicable (SVM and LR). Success was defined with respect to TWL (≥ 10%) and EWL (≥ 25%), since both TWL and EWL were relevant clinical outcomes in ESG [ 18 , 19 ]. Consequently, each model was trained twice; first to predict TWL success, and secondly to predict EWL success.…”

Revisional Bariatric Surgery

“…Although less technically demanding procedures are available, RYGB is still considered the preferable procedure in some areas worldwide. Several reports demonstrated the efficacy of RYGB and its durability from a weight-loss standpoint over 10 years, with a total weight reduction of >25% in 61-71% of patients [70][71][72]. Despite that, weight regain can happen regardless of the type of weight-reducing surgery.…”