Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1992 Apr;215(4):387–395. doi: 10.1097/00000658-199204000-00014

Long-limb gastric bypass in the superobese. A prospective randomized study.

R E Brolin 1, H A Kenler 1, J H Gorman 1, R P Cody 1
PMCID: PMC1242457  PMID: 1558421

Abstract

This study was designed to determine whether greater diversion of bile and pancreatic secretions away from the functional gastrointestinal tract would produce greater weight loss in superobese patients (greater than or equal to 200 pounds overweight) in comparison with conventional Roux-en-Y gastric bypass (RYGB). During the past 7 years, two modifications of RYGB were prospectively compared in 45 superobese patients: RYGB-1, in which the length of defunctionalized jejunum measured 75 cm, and RYGB-2, in which the defunctionalized jejunum measured 150 cm. Respective mean preoperative weight/body mass indexes were 393 pounds/63.4 for 22 RYGB-1 patients and 404 pounds/61.6 for 23 RYGB-2 patients. Two patients (5%) had nonfatal early complications. There were six late incisional hernias. There were no cases of protein deficiency, hepatic dysfunction, or diarrhea after operation. Mean follow-up was 43 +/- 17 months. Postoperative weight loss in pounds and daily calorie intake were compared at 6-month intervals. Weight loss stabilized by 24 months at a mean 50% excess weight lost in RYGB-1 patients and 64% excess weight lost in RYGB-2 patients. Nineteen of 23 RYGB-2 patients achieved at least 50% excess weight lost versus 11 of 22 RYGB-1 patients (p less than or equal to 0.03). Weight loss was significantly greater at 24 through 36 months in RYGB-2 versus RYGB-1 patients (p less than 0.02). There was no significant difference in either calorie intake or incidence of iron and vitamin B-12 deficiency between the two groups. These data show that gastric restriction and biliopancreatic diversion without intestinal exclusion resulted in significantly greater weight loss than conventional RYGB but did not cause additional metabolic sequelae or diarrhea. This long-limb modification of Roux-en-Y gastric bypass is a safe and effective procedure in patients who are 200 pounds or more overweight.

Full text

PDF
387

Images in this article

390FIG. 3.
on p.390
391FIG. 4.
on p.391

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amaral J. F., Thompson W. R., Caldwell M. D., Martin H. F., Randall H. T. Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg. 1985 Feb;201(2):186–193. doi: 10.1097/00000658-198502000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Benotti P. N., Hollingshead J., Mascioli E. A., Bothe A., Jr, Bistrian B. R., Blackburn G. L. Gastric restrictive operations for morbid obesity. Am J Surg. 1989 Jan;157(1):150–155. doi: 10.1016/0002-9610(89)90438-8. [DOI] [PubMed] [Google Scholar]
  3. Bray G. A. Definition, measurement, and classification of the syndromes of obesity. Int J Obes. 1978;2(2):99–112. [PubMed] [Google Scholar]
  4. Brolin R. E., Gorman R. C., Milgrim L. M., Kenler H. A. Multivitamin prophylaxis in prevention of post-gastric bypass vitamin and mineral deficiencies. Int J Obes. 1991 Oct;15(10):661–667. [PubMed] [Google Scholar]
  5. Brolin R. E., Kenler H. A., Gorman R. C., Cody R. P. The dilemma of outcome assessment after operations for morbid obesity. Surgery. 1989 Mar;105(3):337–346. [PubMed] [Google Scholar]
  6. Flickinger E. G., Pories W. J., Meelheim H. D., Sinar D. R., Blose I. L., Thomas F. T. The Greenville gastric bypass. Progress report at 3 years. Ann Surg. 1984 May;199(5):555–562. doi: 10.1097/00000658-198405000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Halverson J. D., Koehler R. E. Gastric bypass: analysis of weight loss and factors determining success. Surgery. 1981 Sep;90(3):446–455. [PubMed] [Google Scholar]
  8. Halverson J. D., Zuckerman G. R., Koehler R. E., Gentry K., Michael H. E., DeSchryver-Kecskemeti K. Gastric bypass for morbid obesity: a medical--surgical assessment. Ann Surg. 1981 Aug;194(2):152–160. doi: 10.1097/00000658-198108000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Jameson M. G. Obesity and hypertensive cardiovascular disease. JAMA. 1987 Jul 17;258(3):323–324. doi: 10.1001/jama.1987.03400030039018. [DOI] [PubMed] [Google Scholar]
  10. Kenler H. A., Brolin R. E., Cody R. P. Changes in eating behavior after horizontal gastroplasty and Roux-en-Y gastric bypass. Am J Clin Nutr. 1990 Jul;52(1):87–92. doi: 10.1093/ajcn/52.1.87. [DOI] [PubMed] [Google Scholar]
  11. Kral J. G. Morbid obesity and related health risks. Ann Intern Med. 1985 Dec;103(6 ):1043–1047. doi: 10.7326/0003-4819-103-6-1043. [DOI] [PubMed] [Google Scholar]
  12. MacLean L. D., Rhode B. M., Forse R. A. Late results of vertical banded gastroplasty for morbid and super obesity. Surgery. 1990 Jan;107(1):20–27. [PubMed] [Google Scholar]
  13. Mason E. E., Doherty C., Maher J. W., Scott D. H., Rodriguez E. M., Blommers T. J. Super obesity and gastric reduction procedures. Gastroenterol Clin North Am. 1987 Sep;16(3):495–502. [PubMed] [Google Scholar]
  14. Payne J. H., DeWind L. T. Surgical treatment of obesity. Am J Surg. 1969 Aug;118(2):141–147. doi: 10.1016/0002-9610(69)90113-5. [DOI] [PubMed] [Google Scholar]
  15. Scopinaro N., Gianetta E., Civalleri D., Bonalumi U., Bachi V. Bilio-pancreatic bypass for obesity: 1. An experimental study in dogs. Br J Surg. 1979 Sep;66(9):613–617. doi: 10.1002/bjs.1800660905. [DOI] [PubMed] [Google Scholar]
  16. Scopinaro N., Gianetta E., Civalleri D., Bonalumi U., Bachi V. Two years of clinical experience with biliopancreatic bypass for obesity. Am J Clin Nutr. 1980 Feb;33(2 Suppl):506–514. doi: 10.1093/ajcn/33.2.506. [DOI] [PubMed] [Google Scholar]
  17. Sugerman H. J., Londrey G. L., Kellum J. M., Wolf L., Liszka T., Engle K. M., Birkenhauer R., Starkey J. V. Weight loss with vertical banded gastroplasty and Roux-Y gastric bypass for morbid obesity with selective versus random assignment. Am J Surg. 1989 Jan;157(1):93–102. doi: 10.1016/0002-9610(89)90427-3. [DOI] [PubMed] [Google Scholar]
  18. Yale C. E. Gastric surgery for morbid obesity. Complications and long-term weight control. Arch Surg. 1989 Aug;124(8):941–946. doi: 10.1001/archsurg.1989.01410080077012. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES