Obesity Surgery

, Volume 22, Issue 10, pp 1586–1593 | Cite as

Long-Term Results of Laparoscopic Roux-en-Y Gastric Bypass: Evaluation After 9 Years

  • Jacques Himpens
  • Anneleen Verbrugghe
  • Guy-Bernard Cadière
  • Wouter Everaerts
  • Jan-Willem Greve


This retrospective study aimed to evaluate the long-term results of the laparoscopic Roux-en-Y gastric bypass (LRYGB) procedure performed at our department of bariatric surgery. The 126 consecutive patients treated by LRYGB between January 1, 2001 and December 31, 2002 were analyzed in August 2011. Seventy-seven patients (61.1 %), including 18 who had had previous bariatric surgery, were available for evaluation after 9.4 ± 0.6 years (range, 8.7–10.9 years). Eight patients (10.4 %) suffered from type 2 diabetes mellitus (DMII) at the time of surgery. Initial body mass index (BMI) was 40.3 ± 7.5 kg/m2 (range, 24.5–66.1 kg/m2). There was no postoperative mortality, but two patients died of causes unrelated to the surgery. Some 9 % of the patients suffered from internal herniation, despite the closure of potential hernia sites. With time, the patients had the tendency to experience weight regain: percentage of excess BMI lost was 56.2 ± 29.3 % (range, −78.8 to 117.9 %), down from a maximum of 88.0 ± 29.6 % (range, −19.7 to 197.1 %), that had been obtained after a median of 2.0 years (range, 1–8 years). LRYGB was effective for diabetes control in 85.7 % of the affected patients, but, surprisingly, 27.9 % developed new-onset diabetes. The weight regain in this latter patient group was statistically not different from the nondiabetic group. Conversely, four patients required hospitalization for hypoglycemic syndrome. Two patients underwent reversal of their bypass for problems linked to glucose metabolism (one hypoglycemia, one DMII). Patient quality of life was fair. The patient satisfaction remained good in 76 % of the cases.


Laparoscopic Roux-en-Y gastric bypass Long-term results Reoperations Type 2 diabetes New-onset diabetes Hypoglycemia 


Conflict of Interest

The authors have no conflict of interest with the materials presented here. Jacques Himpens is a consultant for Ethicon Endosurgery (receives money personally) and receives money personally from Gore for lectures. Anneleen Verbrugghe has no potential conflicts of interest. Wouter Everaerts has no potential conflicts of interest. Guy-Bernard Cadière is a consultant for Covidien, Endogastric Solutions, and Ethicon Endosurgery (receives money personally and for the unit of obesity surgery at Saint-Pierre University Hospital); he personally receives royalties from Intuitive and has stock options of Endogastric Solutions. Jan Willlem Greve is a consultant with Allergan and Johnson and Johnson Endosurgery (receives money personally from both companies); he is a consultant with GI Dynamics and his institution receives money for that; his institution benefits from an open research grant from GI Dynamics.


  1. 1.
    Himpens J, Cadière GB, Bazi M, et al. Long term outcomes of laparoscopic adjustable gastric banding. Arch Surg. 2011;146(7):802–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Jonson W, DeMaria E. Surgical treatment of obesity. Curr Treat Options Gastroenterol. 2006;9(2):167–74.CrossRefGoogle Scholar
  3. 3.
    Oomen MW, Hoekstra LT, Bakx R, et al. Learning curves for pediatric laparoscopy: how many operations are enough? The Amsterdam experience with laparoscopic pyloromyotomy. Surg Endosc. 2010;24(8):1829–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Cadière GB, Himpens J, Dapri G. Atlas of laparoscopic obesity surgery. Brussels: COELIO ASBL; 2007.Google Scholar
  5. 5.
    Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.PubMedCrossRefGoogle Scholar
  6. 6.
    Shukla AP, Ahn SM, Patel RT et al. Surgical treatment of type 2 diabetes: the surgeon perspective. Endocrine. 2011 Aug 13.Google Scholar
  7. 7.
    Pories WJ, Mehaffey JH, Staton KM. The surgical treatment of type two diabetes mellitus. Surg Clin North Am. 2011;91(4):821–36.PubMedCrossRefGoogle Scholar
  8. 8.
    Himpens J. The gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Semin Laparosc Surg. 2004;11(3):171–7.PubMedGoogle Scholar
  9. 9.
    Oria HE, Moorehead MK. Bariatric analysis and outcome reporting system (BAROS). Obes Surg. 1998;8:487–99.PubMedCrossRefGoogle Scholar
  10. 10.
    Plecka Östlund M, Marsk R, Rasmussen F, et al. Morbidity and mortality before and after bariatric surgery for morbid obesity compared with the general population. Br J Surg. 2011;98(6):811–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Haal JC, Watts JM, O’Brien PE, et al. Gastric surgery for morbid obesity. Ann Surg. 1990;211(4):419–27.CrossRefGoogle Scholar
  12. 12.
    Higa K, Ho T, Tercero F, et al. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–25.PubMedCrossRefGoogle Scholar
  13. 13.
    te Riele WW, Boerma D, Wiezer MJ, et al. Long-term results of laparoscopic adjustable band in patients lost to follow-up. Br J Surg. 2010;97(10):1535–40.CrossRefGoogle Scholar
  14. 14.
    Kruseman M, Leimgruber A, Zumbach F, et al. Dietary, weight, and psychological changes among patients with obesity, 8 years after gastric bypass. J Am Diet Assoc. 2010;110(4):527–34.PubMedCrossRefGoogle Scholar
  15. 15.
    Busetto L, Segato G, De Marchi F. Postoperative management of laparoscopic gastric banding. Obes Surg. 2003;13(1):121–7.PubMedCrossRefGoogle Scholar
  16. 16.
    El Chaar M, McDeavitt K, Richardson S, et al. Does patient compliance with preoperative bariatric office visits affect postoperative excess weight loss? Surg Obes Relat Dis. 2011;7(6):743–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.PubMedCrossRefGoogle Scholar
  18. 18.
    Narchet FM, Meissner CA, Russano MB. Modeling the influence of investigator bias on the elicitation of true and false confessions. Law Hum Behav. 2011;35(6):452–65.PubMedCrossRefGoogle Scholar
  19. 19.
    Buchwald H, Vidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMedCrossRefGoogle Scholar
  20. 20.
    Fried M, Ribaric G, Buchwald JN, et al. Metabolic surgery for the treatment of type 2 diabetes in patients with BMI <35 kg/m2: an integrative review of early studies. Obes Surg. 2010;20(6):776–90.PubMedCrossRefGoogle Scholar
  21. 21.
    Radtka 3rd JF, Puleo FJ, Wang I, et al. Revisional bariatric surgery: who, what, where, and when? Surg Obes Relat Dis. 2010;6(6):635–42.PubMedCrossRefGoogle Scholar
  22. 22.
    Cadière GB, Himpens J, Bazi M, et al. Are laparoscopic gastric bypass after gastroplasty and primary laparoscopic bypass similar in terms of results? Obes Surg. 2011;21(6):692–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Topart P, Becouarn G, Ritz P. One-year weight loss after primary or revisional Roux-en-Y gastric bypass for filed adjustable gastric banding. Surg Obes Relat Dis. 2009;5(4):459–62.PubMedCrossRefGoogle Scholar
  24. 24.
    te Riele WW SZEYK, Wiezer MJ, et al. Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients. Surg Obes Relat Dis. 2008;4(6):735–9.CrossRefGoogle Scholar
  25. 25.
    de la Cruz-Munoz N, Cabrera JC, Cuesta M, et al. Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2011;7(2):176–80.PubMedCrossRefGoogle Scholar
  26. 26.
    Steele KE, Prokopowicz GP, Magnuson T, et al. Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc. 2008;22(9):2056–61.PubMedCrossRefGoogle Scholar
  27. 27.
    Abasbassi M, Pottel H, Deylgat B, et al. Small bowel obstruction after antecolic antegastric laparoscopic Roux-en-Y gastric bypass without division of small bowel mesentery: a single-centre, 7-year review. Obes Surg. 2011;21(12):1822–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Cho M, Pinto D, Carrodequas L, et al. Frequency and management of internal hernias after laparoscopic antecolic antegastric Roux-en-Y gastric bypass without division of the small bowel mesentery or closure of the mesenteric defects: review of 1400 consecutive cases. Surg Obes Relat Dis. 2006;2(2):87–91.PubMedCrossRefGoogle Scholar
  29. 29.
    Ahmed AR, Rickards G, Husain S, et al. Bioabsorbable glycolide copolymer staple-line reinforcement decreases internal hernia rate after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(7):797–802.PubMedCrossRefGoogle Scholar
  30. 30.
    Silecchia G, Boru CE, Mouiel J, et al. Clinical evaluation of fibrin glue in the prevention of anastomotic leak and internal hernia after laparoscopic gastric bypass: preliminary results of a prospective, randomized multicenter trial. Obes Surg. 2006;16(2):125–31.PubMedCrossRefGoogle Scholar
  31. 31.
    Reavis KM. Management of the obese patient with gastroesophageal reflux disease. Thorac Surg Clin. 2011;21(4):489–98.PubMedCrossRefGoogle Scholar
  32. 32.
    Flanagin BA, Mitchell MT, Thistlethwaite WA, et al. Diagnosis and treatment of atypical presentations of hiatal hernia following bariatric surgery. Obes Surg. 2010;20(3):386–92.PubMedCrossRefGoogle Scholar
  33. 33.
    Garrido Jr AB, Rossi M, Lima Jr SE, et al. Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study. Arch Gastroenterol. 2010;47(2):130–4.CrossRefGoogle Scholar
  34. 34.
    Kalaiselvan R, Exarchos G, Hamza N, et al. Incidence of perforated gastrojejunal anastomotic ulcers after laparoscopic gastric bypass for morbid obesity and role of laparoscopy in their management. Surg Obes Relat Dis 2011; in press.Google Scholar
  35. 35.
    Chin EH, Hazzan D, Sarpel U, et al. Laparoscopic repair of a perforated marginal ulcer 2 years after gastric bypass. Surg Endosc. 2007;21(11):2110.PubMedCrossRefGoogle Scholar
  36. 36.
    Fobi MA, Lee H, Holness R, et al. Gastric bypass operation for obesity. World J Surg. 1998;22(9):925–35.PubMedCrossRefGoogle Scholar
  37. 37.
    Junior WS, do Amaral JL, Nonino CB. Factors related to weight loss up to 4 years after bariatric surgery. Obes Surg. 2011;21(11):1724–30.PubMedCrossRefGoogle Scholar
  38. 38.
    Tucker ON, Szomstein S, Rosenthal R. Surgical management of gastro-gastric fistula after divided laparoscopic Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2007;11(12):1673–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.PubMedCrossRefGoogle Scholar
  40. 40.
    Shukla AP, Ahn SM, Patel RT, et al. Surgical treatment of type 2 diabetes: the surgeon perspective. Endocrine. 2011;40(2):151–61.PubMedCrossRefGoogle Scholar
  41. 41.
    Pories WJ, Mehaffey JH, Staton KM. The surgical treatment of type two diabetes mellitus. Surg Clin North Am. 2011;91(4):821–36.PubMedCrossRefGoogle Scholar
  42. 42.
    Leslie DB, Dorman RB, Serrot FJ, et al. Efficacy of the Roux-en-Y gastric bypass compared to medically managed controls in meeting the American Diabetes Association composite end point goals for management of type 2 diabetes mellitus. Obes Surg. 2011;22(3):367–74.CrossRefGoogle Scholar
  43. 43.
    Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.PubMedCrossRefGoogle Scholar
  44. 44.
    Di Giorgi M, Rosen DJ, Choi JJ, et al. Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. Surg Obes Relat Dis. 2010;6(3):249–53.CrossRefGoogle Scholar
  45. 45.
    Chikungowo SM, Wolfe LG, Doddson P, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6(3):254–9.CrossRefGoogle Scholar
  46. 46.
    Bonora E, Kiechl S, Willeit J, et al. Population-based incidence rates and risk factors for type 2 diabetes in white individuals. The Brüneck study. Diabetes. 2004;53(7):1782–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Lindström J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725–3.PubMedCrossRefGoogle Scholar
  48. 48.
    Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2001;289(1):76–9.CrossRefGoogle Scholar
  49. 49.
    Patti ME, Goldfine AB. Hypoglycemia following gastric bypass surgery: diabetes remission in the extreme? Diabetologia. 2010;53(11):2276–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Rabiee A, Magruder JT, Salas-Carillo R, et al. Hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass: unraveling the role of gut hormonal and pancreatic endocrine dysfunction. J Surg Res. 2011;177(2):199–205.CrossRefGoogle Scholar
  51. 51.
    Salehi M, Prigeon RL, D’Alessio DA. Gastric bypass surgery enhances glucagon-like peptide 1-stimulated postprandial insulin secretion in humans. Diabetes. 2011;60(9):2308–14.PubMedCrossRefGoogle Scholar
  52. 52.
    Roslin M, Damani T, Oren J, et al. Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia. Surg Endosc. 2011;25(6):1926–32.PubMedCrossRefGoogle Scholar
  53. 53.
    Cox DJ, Ford D, Gonder-Frederick L, et al. Driving mishaps among individuals with type 1 diabetes: a prospective study. Diabetes Care. 2009;32(12):2177–80.PubMedCrossRefGoogle Scholar
  54. 54.
    Ludwig D, Majzoub JA, Al-Zahrani A, et al. High glycemic foods, overeating, and obesity. Pediatrics. 1999;103(3):E26.PubMedCrossRefGoogle Scholar
  55. 55.
    Cui H, Elahi D, Andersen DK. Advances in the etiology and management of hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass. J Gastrointest Surg 2011 Jun 14.Google Scholar
  56. 56.
    Dapri G, Cadière GB, Himpens J. Laparoscopic placement of non-adjustable silicone ring for weight regain after Roux-en-Y gastric bypass. Obes Surg. 2009;19(5):650–4.PubMedCrossRefGoogle Scholar
  57. 57.
    Corsale I, Corsale C. Restoration of duodenal transit in the surgical treatment of postgastrectomy syndrome. The Soupault–Bucaille procedure. Minerva Chir. 2000;55(7–8):523–7.PubMedGoogle Scholar
  58. 58.
    Dapri G, Cadière GB, Himpens J. Laparoscopic reconversion of Roux-en-Y gastric bypass to original anatomy: technique and preliminary outcomes. Obes Surg. 2011;21(8):1289–95.PubMedCrossRefGoogle Scholar
  59. 59.
    Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353(3):249–54.PubMedCrossRefGoogle Scholar
  60. 60.
    Kim SH, Abbasi F, Lamendola C, et al. Glucose-stimulated insulin secretion in gastric bypass patients with hypoglycemic syndrome: no evidence for inappropriate pancreatic beta-cell function. Obes Surg. 2010;20(8):1110–6.PubMedCrossRefGoogle Scholar
  61. 61.
    Himpens J, Dapri G, Cadière GB. Laparoscopic conversion of the gastric bypass into a normal anatomy. Obes Surg. 2006;16(7):908–12.PubMedCrossRefGoogle Scholar
  62. 62.
    McLaughlin T, Peck M, Holst J, et al. Reversible hyperinsulinemic hypoglycemia after gastric bypass: a consequence of altered nutrient delivery. J Clin Endocrinol Metab. 2010;95(4):1851–5.PubMedCrossRefGoogle Scholar
  63. 63.
    Suter M, Donadini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011;254(2):267–73.PubMedCrossRefGoogle Scholar
  64. 64.
    Harbottle L. Audit of nutritional and dietary outcomes of bariatric surgery patients. Obes Rev. 2011;12(3):198–204.PubMedCrossRefGoogle Scholar
  65. 65.
    Shai I, Henkin Y, Weitzman S, et al. Determinants of long-term satisfaction after vertical banded gastroplasty. Obes Surg. 2003;133(2):269–74.CrossRefGoogle Scholar
  66. 66.
    Sullivan M, Karlsson J, Sjöström L, et al. Swedish obese subjects (SOS)—an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examinees. Int J Obes Relat Metab Disord. 1993;17(9):503–12.PubMedGoogle Scholar
  67. 67.
    Gentry K, Halverson JD, Heisler S. Psychologic assessment of morbidly obese patients undergoing gastric bypass: a comparison of preoperative and postoperative adjustment. Surgery. 1984;95:215–20.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2012

Authors and Affiliations

  • Jacques Himpens
    • 1
    • 2
    • 3
  • Anneleen Verbrugghe
    • 3
  • Guy-Bernard Cadière
    • 1
    • 2
  • Wouter Everaerts
    • 3
  • Jan-Willem Greve
    • 4
  1. 1.European School of Laparoscopic SurgeryBrusselsBelgium
  2. 2.Saint-Pierre University HospitalBrusselsBelgium
  3. 3.St. Blasius General HospitalDendermondeBelgium
  4. 4.Atrium Medical CenterHeerlenThe Netherlands

Personalised recommendations