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Twelve-year results for revisional gastric bypass after failed restrictive surgery in 131 patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
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2014 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, Vol. 10, no 1, 44-48 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Gastric banding (GB) and vertical banded gastroplasty (VBG) may result in unsatisfactory weight loss or intolerable side effects. Such outcomes are potential indications for additional bariatric surgery, and Roux-en-Y gastric bypass is frequently used at such revisions (rRYGB). The present study examined long-term results of rRYGB.

METHODS: In total, 175 patients who had undergone rRYGB between 1993 and 2003 at 2 university hospitals received a questionnaire regarding their current status. The questionnaire was returned by 131 patients (75% follow-up rate, 66 VBG and 65 GB patients). Blood samples were obtained and medical charts studied. The reason for conversion was mainly unsatisfactory weight loss among the VBG patients and intolerable side effects among GB patients.

RESULTS: The 131 patients (112 women), mean age 41.8 years at rRYGB, were evaluated at mean 11.9 years (range 7-17) after rRYGB. Mean body mass index of those with prior unsatisfactory weight loss was reduced from 40.1 kg/m(2) (range 28.7-52.2) to 32.6 kg/m(2) (range 19.1-50.2) (P<.01). Only 2 patients (2%) underwent additional bariatric surgery after rRYGB. The overall result was satisfactory for 74% of the patients. Only 21% of the patients adhered to the recommendation of lifelong multivitamin supplements while 76% took vitamin B12. Anemia was present in 18%.

CONCLUSIONS: rRYGB results in sustained weight loss and satisfied patients when VBG or GB have failed. Subsequent bariatric surgery was rare but micronutrient deficiencies were frequent.

Place, publisher, year, edition, pages
2014. Vol. 10, no 1, 44-48 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-213784DOI: 10.1016/j.soard.2013.05.011ISI: 000331773800007PubMedID: 24094870OAI: oai:DiVA.org:uu-213784DiVA: diva2:683478
Available from: 2014-01-03 Created: 2014-01-03 Last updated: 2014-04-04Bibliographically approved
In thesis
1. Gastric Bypass: Facilitating the Procedure and Long-term Results
Open this publication in new window or tab >>Gastric Bypass: Facilitating the Procedure and Long-term Results
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Gastric bypass achieves weight loss in the morbidly obese. Preoperative weight loss is used to reduce the enlarged fatty liver that otherwise reduces visibility during surgery. The purpose of gastric bypass is to provide patients with long-term weight loss. The aim of this thesis was to investigate the result of preoperative low calorie diet on liver volume and to evaluate the long-term result of gastric bypass.

Paper I showed that four weeks of low calorie diet reduces intrahepatic fat by 40% and facilitates surgery mainly through improved visualisation. Paper II demonstrated that all of the reduction of liver volume occurs during the first two weeks of treatment with low calorie diet.  In paper I liver volume was reduced by 12% and in paper II by 18%. Paper III focused on long-term results and showed that gastric bypass achieves a mean 63% excess body mass index loss in obese patients after 11 years. However, of these 40% undergo abdominoplasty and 2% require additional bariatric surgery. Only 24% adhere to the lifelong recommendation on multivitamins and 72% to Vitamin B12 recommendations. Paper IV evaluated gastric bypass as a revisional procedure after earlier restrictive surgery had failed. Similar weight results as after primary gastric bypass are attained. No patient taking vitamin B12 supplementation was deficient at follow-up, regardless of whether the vitamin was taken as a pill or as intramuscular injections.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 66 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 967
Morbid obesity, Gastric bypass, Laparoscopy, Low-calorie diet, Magnetic resonance imaging, Magnetic resonance spectroscopy
National Category
Surgery Gastroenterology and Hepatology Radiology, Nuclear Medicine and Medical Imaging
Research subject
urn:nbn:se:uu:diva-213785 (URN)978-91-554-8851-2 (ISBN)
Public defence
2014-02-28, Grönwallsalen, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Available from: 2014-02-06 Created: 2014-01-03 Last updated: 2014-02-10

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Edholm, DavidKarlsson, Anders FSundbom, Magnus
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