There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
Surgical treatment is the procedure of choice for morbidly obese patients. Gastric
bypass with a long limb Roux-en-Y anastomosis is the "gold standard" technique for
these patients. We sought to determine the early and late results of open gastric
bypass with resection of the distal excluded stomach in patients with morbid obesity.
We included in this prospective study 400 patients who were seen from September 1999
through August 2003 (311 women and 89 men; mean age, 38.5 years). The mean body mass
index of the patients was 46 kg/m2. All underwent 95% distal gastrectomy, with resection
of the bypassed stomach, leaving a small gastric pouch of 15 to 20 ml. An end-to-side
gastrojejunostomy was performed with circular stapler No. 25. The length of the Roux-en-Y
loop was 125 to 150 cm. In all patients, a biopsy was taken from the liver and routine
cholecystectomy was performed. Follow-up was as long as 36 months. A barium study
was performed in all patients at 5 days after surgery. Mortality and postoperative
morbidity rates were 0.5% and 4.75%, respectively, mainly due to anastomotic leak
in 10 patients (2.5%). Hospital length of stay was 7 days for 95% of the patients.
Follow-up data for longer than 12 months were available in 184 patients. There was
excess body weight loss of 70% at 24 and 36 months, and there was an inverse correlation
among preoperative body mass index and the loss of weight. Anemia was present in 10%,
and incisional hernia was present in 10.2%. At 1 year after surgery, the BAROS index
demonstrated very good or excellent index in 96.6% of the patients. Gastric bypass
with resection of the distal excluded segment has results very similar to those of
gastric bypass alone but eliminates the potential risks of gastric bypass such as
anastomotic ulcer, gastrogastric fistula, postoperative bleeding due to peptic ulcer
and gastritis, and the eventual future development of gastric cancer. It is also possible
to perform via laparoscopy, as we started to do recently.