Skip to main content
Log in

Laparoscopic Roux-en-Y gastric bypass in obese Korean patients: efficacy and potential adverse events

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to evaluate the medium-term efficacy and adverse events of laparoscopic Roux-en-Y gastric bypass (LRYGB) performed at a single center in Korea.

Methods

The records of 412 consecutive patients who underwent LRYGB between January 2011 and February 2014 were retrospectively reviewed. The preoperative demographics, surgical outcomes, and follow-up data including anthropometrics indices and late complications were analyzed.

Results

The mean preoperative body mass index was 38.0 ± 5.8 kg/m2 and 338 patients (82.0 %) had at least one obesity-related comorbidity. Seven patients (1.7 %) developed severe complications requiring invasive intervention or reoperation. The %EWL of the eligible patients was 63.1, 74.3, 79.2, 65.4, and 89.8 % at 6, 12, 18, 24, and 36 months, respectively. Diabetes was resolved in 63.5 % of the followed up patients. Twenty-two out of 256 patients (8.6 %) with available follow-up data failed to achieve  %EWL ≥50 % by 12 months after the surgery. The most frequent late complications were marginal ulcers (24.5 %) and anemia (18.0 %).

Conclusion

LRYGB achieves excellent weight loss and significant short- to medium-term comorbidity resolution in Korean obese patients with acceptable perioperative risks. However, late complications including marginal ulcers and nutritional deficiencies are not negligible. Therefore, regular and lifelong surveillance is mandatory in patients undergoing LRYGB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Withrow D, Alter D. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev. 2011;12(2):131–41.

    Article  CAS  PubMed  Google Scholar 

  3. Sjöström L. Review of the key results from the Swedish obese subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.

    Article  PubMed  Google Scholar 

  4. Karim MA, Ahmed J, Arneil C, Ali A. Utilization of hospital services by obese patients before and after bariatric surgery. Surg Today. 2013;43(10):1129–33.

    Article  PubMed  Google Scholar 

  5. Mason EE, Ito C. Gastric bypass in obesity. The Surg Clin N Am. 1967;47(6):1345.

    CAS  PubMed  Google Scholar 

  6. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    Article  PubMed  Google Scholar 

  7. Kang H-T, Shim J-Y, Lee H-R, Park B-J, Linton JA, Lee Y-J. Trends in prevalence of overweight and obesity in Korean adults, 1998–2009: the Korean National Health and Nutrition Examination Survey. J Epidemiol. 2014;24(2):109.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Park JY, Song D, Kim YJ. Causes and outcomes of revisional bariatric surgery: initial experience at a single center. Ann Surg Treat Res. 2014;86(6):295–301.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Huang CK, Lee YC, Hung CM, Chen YS, Tai CM. Laparoscopic Roux-en-Y gastric bypass for morbidly obese Chinese patients: learning curve, advocacy and complications. Obes Surg. 2008;18(7):776–81.

    Article  PubMed  Google Scholar 

  10. Tai CM, Lee YC, Wu MS, Chang CY, Lee CT, Huang CK, et al. The effect of Roux-en-Y gastric bypass on gastroesophageal reflux disease in morbidly obese Chinese patients. Obes Surg. 2009;19(5):565–70.

    Article  PubMed  Google Scholar 

  11. Lee H, Kim D, Lee S, Nam K, Kim E. Initial evaluation of laparoscopic Roux-en-Y gastric bypass and adjustable gastric banding in Korea: a single institution study. Obes Surg. 2010;20(8):1096–101.

    Article  PubMed  Google Scholar 

  12. Kasama K, Tagaya N, Kanahira E, Umezawa A, Kurosaki T, Oshiro T, et al. Has laparoscopic bariatric surgery been accepted in Japan? The experience of a single surgeon. Obes Surg. 2008;18(11):1473–8.

    Article  PubMed  Google Scholar 

  13. Lee WJ, Chong K, Lee YC, Ser KH, Chen SC, Chen JC, et al. Effects of obesity surgery on type 2 diabetes mellitus Asian patients. World J Surg. 2009;33(9):1895–903.

    Article  PubMed  Google Scholar 

  14. Kasama K, Mui W, Lee WJ, Lakdawala M, Naitoh T, Seki Y, et al. IFSO-APC consensus statements 2011. Obes Surg. 2012;22(5):677–84.

    Article  PubMed  Google Scholar 

  15. Dallal RM, Cottam D. Candy cane Roux syndrome—a possible complication after gastric bypass surgery. Surg Obes Relat Dis. 2007;3(3):408–10.

    Article  PubMed  Google Scholar 

  16. World Health Organization. Regional Office for the Western Pacific, International Association for the Study of Obesity. International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne: Health Communications Australia; 2000.

  17. Park JY, Kim YJ. Successful laparoscopic reversal of gastric bypass in a patient with malnutrition. Ann Surg Treat Res. 2014;87(4):217–21.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. The Am J Med. 2009;122(3):248–56.

    Article  PubMed  Google Scholar 

  19. Zhang Y, Ju W, Sun X, Cao Z, Xinsheng X, Daquan L, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-En-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Obes Surg. 2014;25(1):1–8.

    Google Scholar 

  20. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.

    Article  PubMed  Google Scholar 

  21. Attiah MA, Halpern CH, Balmuri U, Vinai P, Mehta S, Baltuch GH, et al. Durability of Roux-en-Y gastric bypass surgery: a meta-regression study. Ann Surg. 2012;256(2):251–4.

    Article  PubMed  Google Scholar 

  22. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  CAS  PubMed  Google Scholar 

  23. Chang S-H, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2014;149(3):275–87.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Panunzi S, De Gaetano A, Carnicelli A, Mingrone G. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: Do BMI or procedure choice matter? A meta-analysis. Ann Surg. 2015;261(3):459–67.

    PubMed  Google Scholar 

  25. Dixon JB, Chuang L-M, Chong K, Chen S-C, Lambert GW, Straznicky NE, et al. Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes. Diabetes Care. 2013;36(1):20–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Iacobellis G, Xu C, Campo RE, De La Cruz-Munoz NF. Predictors of short-term diabetes remission after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2015;25(5):782–7.

    Article  PubMed  Google Scholar 

  27. Boffetta P, McLerran D, Chen Y, Inoue M, Sinha R, He J, et al. Body mass index and diabetes in Asia: a cross-sectional pooled analysis of 900,000 individuals in the Asia cohort consortium. PLoS One. 2011;6(6):e19930.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Ma RC, Chan JC. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann NY Acad Sci. 2013;1281(1):64–91.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22(12):2554–63.

    Article  PubMed  Google Scholar 

  30. Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.

    Article  PubMed  Google Scholar 

  31. Stenberg E, Szabo E, Agren G, Naslund E, Boman L, Bylund A, et al. Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian obesity surgery registry. Ann Surg. 2013;260(6):1040–7.

    Article  Google Scholar 

  32. Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–61.

    Article  PubMed  Google Scholar 

  33. Dick A, Byrne TK, Baker M, Budak A, Morgan K. Gastrointestinal bleeding after gastric bypass surgery: nuisance or catastrophe? Surg Obes Relat Dis. 2010;6(6):643–7.

    Article  PubMed  Google Scholar 

  34. Rabl C, Peeva S, Prado K, James AW, Rogers SJ, Posselt A, et al. Early and late abdominal bleeding after Roux-en-Y gastric bypass: sources and tailored therapeutic strategies. Obes Surg. 2011;21(4):413–20.

    Article  PubMed  Google Scholar 

  35. Nguyen NT, Rivers R, Wolfe BM. Early gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2003;13(1):62–5.

    Article  PubMed  Google Scholar 

  36. Coblijn UK, Goucham AB, Lagarde SM, Kuiken SD, van Wagensveld BA. Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors, and patient presentation: a systematic review. Obes Surg. 2014;24(2):299–309.

    Article  PubMed  Google Scholar 

  37. Marinella MA. Anemia following Roux-en-Y surgery for morbid obesity: a review. South Med J. 2008;101(10):1024–31.

    Article  PubMed  Google Scholar 

  38. Brolin R, Gorman J, Gorman R, Petschenik A, Bradley L, Kenler H, et al. Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass? J Gastrointest Surg. 1998;2(5):436–42.

    Article  CAS  PubMed  Google Scholar 

  39. Obinwanne KM, Fredrickson KA, Mathiason MA, Kallies KJ, Farnen JP, Kothari SN. Incidence, treatment, and outcomes of iron deficiency after laparoscopic Roux-en-Y gastric bypass: a 10-year analysis. J Am Coll Surg. 2014;218(2):246–52.

    Article  PubMed  Google Scholar 

  40. Gesquiere I, Lannoo M, Augustijns P, Matthys C, Van der Schueren B, Foulon V. Iron deficiency after Roux-en-Y gastric bypass: insufficient iron absorption from oral iron supplements. Obes Surg. 2014;24(1):56–61.

    Article  PubMed  Google Scholar 

  41. von Drygalski A, Andris DA, Nuttleman PR, Jackson S, Klein J, Wallace JR. Anemia after bariatric surgery cannot be explained by iron deficiency alone: results of a large cohort study. Surg Obes Relat Dis. 2011;7(2):151–6.

    Article  Google Scholar 

  42. Love AL, Billett HH. Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol. 2008;83(5):403–9.

    Article  PubMed  Google Scholar 

  43. Park JY, Kim YJ. Laparoscopic resectional gastric bypass: initial experience in morbidly obese Korean patients. Surg Today. 2014 [Epub ahead of print].

Download references

Acknowledgments

Min Ju Soh contributed in this study as a research coordinator. This research was supported by the Soonchunhyang University Research Fund.

Conflict of interest

Drs. Ji Yeon Park and Yong Jin Kim have no financial disclosures.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yong Jin Kim.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, J.Y., Kim, Y.J. Laparoscopic Roux-en-Y gastric bypass in obese Korean patients: efficacy and potential adverse events. Surg Today 46, 348–355 (2016). https://doi.org/10.1007/s00595-015-1170-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-015-1170-y

Keywords

Navigation