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Introduction:Bariatric surgery decreases weight and its associated comorbidities, but it is unclear whether health care resources are over-utilized in the post-gastric bypass state. There are few, long-term studies documenting the utilization of health care resources after gastric bypass in a mixed American population. Our aim was to review all interventions related to gastrointestinal complications after gastric bypass surgery. Methods and Procedures:We retrospectively reviewed the medical records of 261 subjects in Olmsted County (thus captured by the Rochester Epidemiology Project) who underwent a Roux-en-Y gastric bypass (RYGB) from Jan. 1997 through Dec. 2004. Patients were predominantly female (84%), with a mean age of 45 years +/- 10, and a mean preoperative BMI of 49 +/- 9; 72 patients (28%) underwent laparoscopic operation. Retrocolic technique was used in 188 patients (72%). All subsequent gastrointestinal surgical and endoscopic interventions and abdominal imaging studies were reviewed. Imaging studies were categorized as Abdominal CT (CTAP) and non-CT imaging (including ultrasonography and fluoroscopy). Resource utilization rates for 2006 for Americans aged 55-64 years, as published by the CDC, and published Medicare beneficiary utilization rates for 2001 were used as a reference. Results:Median patient follow-up was 7 years (range 6-13) after RYGB, for a total number of 2039 patient-years (pt-yrs). A total of 162 abdominal operations were performed in 95 patients (36%); 58 operations in 48 patients were repairs of abdominal wall hernias and 34 were re-operations for wound complications in 21 patients. Sixty-nine gastrointestinal operations, 46 in 32 patients (12%) were directly attributed to the post-RYGB state. There were 132 upper endoscopies performed in 78 patients (30%), a rate of 65 per 1000 pt-yrs, compared to 28 upper endoscopies per 1000 pt-yrs for Americans aged 55-64. Eighteen study patients had 32 therapeutic endoscopies for complications of RYGB. One-hundred and two patients underwent a total of 348 CTAP; a rate of 171 per 1000 pt-yrs, which were evenly distributed throughout patient-years of follow-up. For non-CT imaging, 119 patients underwent 432 studies, a rate of 212 per 1000 pt-yrs; half were in the first three years postop. Medicare national average for CT imaging was 391 per 1000 patients, and for non-CT imaging, 3556 per 1000 patients. Surgical technique was not associated with any pattern of re-intervention or complication, except for incisional hernias which were greater after open RYGB.Conclusions:Even though the benefits of RYGB are well established in the literature, patients after RYGB appear to have a greater requirement for gastrointestinal procedures than the average American population. This would not be unexpected in patients having undergone a major gastrointestinal operation.