Background: We present mid-term results of a pilot study using a distal, only moderately restrictive Roux-en-Y gastric bypass in 50 consecutive patients suffering from morbid obesity (BMI>40 kg/m2).
Methods: The almost purely restrictive mechanism of classical gastric bypass was avoided by forming a proximal gastric pouch of approximately 60 ml on the lesser curvature and by using a 25mm circular stapler for the gastrojejunostomy. Malabsorption was achieved by constructing a common channel of 110 to 150 cm. The biliopancreatic limb length was 100cm.
Results: 25 open and later on 25 laparoscopic interventions have been performed in 32 females and 18 males with a median age of 41 years and a median BMI of 50.2 kg/m2. 6 patients had removal of a gastric banding at the same operation. Median postoperative hospitalisation time was 11 days. No severe intraoperative complications have been observed and no anastomotic leakage was noted in the postoperative period. 4 patients needed balloon dilation of an anastomotic stricture. Besides these 4 patients no others have been reporting vomiting or marked restriction in food intake so far. 15 patients were having intermittent diarrhea or steatorrhea, treated by pancretic enzyme supplementation. Two marginal ulcers occurred at the gastrojejunostomy. The actual median follow-up time is 18 months. All patients showed a remarkable good weight loss with an overall median BMI-reduction of 17 to an actual median BMI of 31.9 kg/m2, corresponding to a EBL of 73%. Obesity-related comorbid conditions were significantly reduced or cured.
Conclusion: dRYGB shows excellent results with marked reduction of weight and comorbid conditions. This new technique has proved to be feasible and safe. Avoiding massive restrictive measures allows a more physiological food intake and a continuous increase in quality of life in comparison to patients after a mainly restrictive intervention. Furthermore the risk of protein malabsorption is greatly reduced compared to biliopancreatic diversion.