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Arch Surg. 2003 May;138(5):541-5; discussion 545-6.

Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients.

Author information

1
Department of Surgery and the Informatics Unit, University of Massachusetts Medical School, Worcester 01655, USA. peruginr@ummhc.org

Abstract

HYPOTHESIS:

An analysis of patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) may identify factors predictive of complication and of suboptimal weight loss.

DESIGN:

Inception cohort.

SETTING:

Metropolitan university hospital.

PATIENTS:

One hundred eighty-eight consecutive patients with severe obesity who met National Institutes of Health consensus guidelines for bariatric surgery.

INTERVENTIONS:

Laparoscopic RYGB.

MAIN OUTCOME MEASURES:

Complications requiring therapeutic intervention and percentage of excess body weight lost at 1 year after surgery.

RESULTS:

Of the 188 patients who underwent laparoscopic RYGB, 50 (26.6%) developed complications that required an invasive therapeutic intervention, including 2 deaths. The average follow-up was 351 days (range, 89-1019 days). Multivariate analysis by stepwise logistic regression identified surgeon experience, sleep apnea (P =.003; odds ratio, 3.0; 95% confidence interval, 1.3-7.1), and hypertension (P =.07; odds ratio, 2.0; 95% confidence interval, 1.0-4.0) as predictors of complications. The most common complication requiring therapeutic intervention was stricture at the gastrojejunal anastomosis, occurring in 27 patients (14.4%). Of the 115 patients who underwent surgery more than 1 year previously, 1-year follow-up data were available for 93 (81%). The body mass index (weight in kilograms divided by the square of height in meters) decreased from 53 +/- 8 preoperatively to 35 +/- 6 at 1 year. The mean +/- SD percentage of excess body weight lost at 1 year was 61% +/- 14%. Diabetes mellitus was negatively correlated with percentage of excess body weight lost at 1 year (P =.06).

CONCLUSIONS:

Surgeon experience, sleep apnea, and hypertension are associated with complications after laparoscopic RYGB. Diabetes mellitus may be associated with poorer postoperative weight loss.

PMID:
12742960
DOI:
10.1001/archsurg.138.5.541
[Indexed for MEDLINE]

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