Five-Year Follow-up after Laparoscopic Roux-en-Y Gastric and Partial Ileal Bypass for Treatment of Morbid Obesity and Uncontrolled Hyperlipidemia
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Morbid obesity is associated with significant co-morbid illnesses and mortality. Hyperlipidemia is strongly associated with atherosclerosis and cardiovascular disease. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a proven and effective procedure for the treatment of morbid obesity and its related co-morbid illnesses. In a randomized prospective clinical trial, partial ileal bypass showed sustained control of hyperlipidemia and reduced comorbidities. Given risks of surgery, pharmacologic agents are the current primary therapy for hyperlipidemia. However, a morbidly obese patient with medically refractory hyperlipidemia may benefit from a combined laparoscopic Roux-en-Y gastric bypass and partial ileal bypass. We are describing the first case of a totally laparoscopic approach.
A 56-year-old female patient with morbid obesity (BMI 45.2 kg/m2) and medically refractive hyperlipidemia underwent a combined LRYGB and partial ileal bypass in 2002. She was continuously followed for 5 years for weight profile, hyperlipidemia, post-operative complications, and morbidity.
Five-year follow-up of the patient showed sustained excess body weight loss. Her lipid profile has approached normal ranges with less medication. She experienced no comorbidities related to surgery or hyperlipidemia.
Laparoscopic Roux-en-Y gastric bypass and partial ileal bypass may be the best option for the patient who has morbid obesity and medically refractory hyperlipidemia and should be considered for select patients.
KeywordsRoux-en-Y Laparoscopic gastric bypass Laparoscopic partial ileal bypass Hyperlipidemia POSCH Bariatrics Metabolic surgery
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