Effect of elevated hemoglobin A1c in diabetic patients on complication rates after Roux-en-Y gastric bypass

Little is known regarding the effect of chronic hyperglycemia, expressed by glycated hemoglobin, on the healing-related complication rates in Roux-en-Y gastric bypass (RYGB).

We retrospectively examined the rate of complications in patients with type 2 diabetes mellitus undergoing RYGB according to the preoperative glycated hemoglobin (HbA1c) level, focusing specifically on the complications related to wound healing (i.e., anastomotic leak, stomal stenosis, and wound infection). Two groups were formed separating those with HbA1c values >7 and <7 g/dL. All patients were taking oral antiglycemic medications or insulin to control their blood glucose levels.

A total of 342 patients with type 2 diabetes mellitus underwent laparoscopic RYGB during a 3-year period (2008-2011). Of the 342 patients, 170 had elevated HbA1c values >7 g/dL (average 9.0) preoperatively, of which there were 4 superficial surgical site infections and 1 stomal stenosis, but no anastomotic leaks. Of the remaining 172 diabetic patients whose HbA1c level was <7 g/dL preoperatively (average 6.0 g/dL), 2 superficial surgical site infections, 2 stomal stenoses, and, again, no anastomotic leaks. No difference was seen in the combined complication rates between the 2 groups (2.9% versus 2.3%, P = .50).

In the present study, an elevated HbA1c >7 g/dL in patients with type 2 diabetes mellitus did not convey increased complication rates after RYGB.