Recent reports suggest that the risk of death (2-3%) following gastric bypass is higher than previously estimated, primarily related to surgeon error or inexperience. These findings stimulated us to review our own operative experience with divided gastric bypass (DGB) from 1979-2005 in 1250 patients (F/M=11/1) whose age (43),weight (398+/-46), BMI (58+/-8) and risk factors (3.5+/-0.75) met the criteria for morbid obesity.All were managed with prophylactic antibiotics,leak surveillance and pulmonary embolus (PE) prophylaxis with compression devices and low-dose heparin or Lovenox. Follow-up was monthly for 24 months.
Results: (A) 95% lost at least 50% of excess weight(EW) with an average of 173=/-56 lbs. (75%of EW). (B) There were 44 anastomotic leaks (3%) with 2 deaths (0.16%) related to leak sepsis. (C) There were an additional 24 deaths (1.92%) not directly related to anastomotic leakage (10-PE; 5-sudden death syndrome (SDS); 3-intra-abdominal/wound sepsis; 2-malnutrition; 2-suicide; 1-cirrhosis and 1-respiratory failure). (D) Seven (0.56%) died in the immediate post-operative period (1-7days); 6(0.48%) from 7-30 days; 8 (0.64%) from 31-90 days and 5(0.40%) from 3 months to two years.
Conclusion: Death following gastric bypass was evenly distributed throughout the follow-up period and was not related to operator error but most often either to thrombo-embolic disease, seemingly refractive to DVT prohylaxis, or SDS, a poorly understood syndrome unique to bariatric surgery.