Gastric bypass surgery for severe obesity: what can be achieved?

As severe obesity becomes an increasing problem, it is important that the role of surgery in the management of the condition becomes better understood and recognised. This study reports the outcome of a large series of gastric bypass operations performed for severe obesity by a single surgeon.

Between 1990-2002, 310 patients underwent gastric bypass surgery with all data being collected prospectively and recorded on a computerised database. Mean preoperative weight and percentage excess weight were 132 kg and 119%, respectively. There was no 30-day mortality and only one life threatening complication. Re-operations were required in 43 patients, most of which were related to ring removal or staple line disruption seen in the earlier form of gastric bypass. These problems are largely overcome with the currently performed technique. Percentage excess weight loss at 1, 2, 3, 4 and 5 years was 73%, 73%, 66%, 64%, and 59% respectively. Forty-nine of the 52 patients with type 2 diabetes were cured following surgery and 87% of those with hypertension resolved or improved their condition. Dyslipidaemia resolved or improved in 87% and asthma was cured or improved in 89% of those affected. 61 patients had symptoms of obstructive sleep apnoea prior to surgery and in 51 of these symptoms resolved following surgery.

This study confirms that gastric bypass is a very effective treatment for severe obesity and can be performed with a high level of safety. Gastric transection is an important component of the operation. The majority of important comorbidities seen before surgery either resolve or improve following surgery. Bariatric surgery is establishing itself as a very important and satisfying branch of upper gastrointestinal (GI) surgery.