Abstracts
2001 Digestive Disease Week

# 403 Malabsorptive Gastric Bypass in Patients with Super Obesity: A Comparative Study of Roux Limb Length.
Robert E. Brolin, Lisa B. LaMarca, Ronald P. Cody, Piscataway, NJ, New Brunswick, NJ

Super obesity has been defined as 200 lb overweight or as a BMI 50 kg/m2Ø. Weight loss results in super obese patients have been problematic after gastric restrictive operations including conventional short limb RY gastric bypass (RYGB). An earlier report showed that a 150cm Roux limb produced significantly greater weight loss vs. a 75cm Roux limb in super obese patients. However, recidivism after 3 years was common in both groups. The goal of the present prospective study was to compare long term weight loss using a distal RYGB (D-RY) in which the RY anastomosis was performed 75cm proximal to the ileocecal junction (N=47) vs. super obese patients who had Roux limbs of 150cm (N=152) and 50-75cm (N=99). All operations incorporated the same gastric restrictive parameters and were performed by one surgeon. Minimum follow up period was 3 years and ranged to 16 years. Weight loss and reduction in BMI were significantly greater after D-RY vs. both RYGB-150, RYGB-75 and in RYGB-150 vs. RYGB-75 through 5 years. Mean percent excess weight loss peaked at 63% after DRY and RYGB-150 vs. 55% after RYGB-75. Weight loss maintenance through 5 years was correlated with Roux limb length with DRY >RYGB-150 >RYGB-75. More than 75% of obesity-related comorbidities improved or resolved with weight loss. There was no difference in early postop morbidity rate: 8.7% after D-RY; 8.5% after RYGB-150; 2.0% after RYGB-75. There was one death (0.3%) from pulmonary embolism after RYGB-150. Diarrhea was noted in 17 patients (36%) after D-RY; in one patient (0.3%) after RYGB-150 and absent after RYGB-75. All D-RY patients had at least one postop metabolic abnormality. The incidence of anemia was significantly greater after D-RY vs. RYGB-150 and RYGB-75 (p < 0.05 D-RY vs. others). There was no difference in the incidence of metabolic sequelae between RYGB-150 and RYGB-75 patients. No operations were reversed or modified for nutritional complications. Two D-RY patients required TPN for protein calorie malnutrition. These results show that Roux limb length has a significant impact on weight loss in super obese patients. However, it is unclear whether the greater weight loss and better weight loss maintenance after D-RY in comparison with RYGB-150 is sufficient justification for its routine use in superobese patients having bariatric operations. We conclude that some degree of malabsorption should be incorporated in bariatric operations performed in super obese patients in order to achieve satisfactory long term weight loss.