Mortality rate after open Roux-in-Y gastric bypass: a 10-year follow-up

The prevalence of obesity has increased to epidemic status worldwide. Thousands of morbidly obese individuals undergo bariatric surgery for sustained weight loss; however, mid- and long-term outcomes of this surgery are still uncertain. Our objective was to estimate the 10-year mortality rate, and determine risk factors associated with death in young morbidly obese adults who underwent bariatric surgery. All patients who underwent open Roux-in-Y gastric bypass surgery between 2001 and 2010, covered by an insurance company, were analyzed to determine possible associations between risk factors present at the time of surgery and deaths related and unrelated to the surgery. Among the 4344 patients included in the study, 79% were female with a median age of 34.9 years and median body mass index (BMI) of 42 kg/m2. The 30-day and 10-year mortality rates were 0.55 and 3.34%, respectively, and 53.7% of deaths were related to early or late complications following bariatric surgery. Among these, 42.7% of the deaths were due to sepsis and 24.3% to cardiovascular complications. Male gender, age ≥50 years, BMI ≥50 kg/m2, and hypertension significantly increased the hazard for all deaths (P<0.001). Age ≥50 years, BMI ≥50 kg/m2, and surgeon inexperience elevated the hazard of death from causes related to surgery. Male gender and age ≥50 years were the factors associated with increased mortality from death not related to surgery. The overall risk of death after bariatric surgery was quite low, and half of the deaths were related to the surgery. Older patients and superobese patients were at greater risk of surgery-related deaths, as were patients operated on by less experienced surgeons.

Hernias internas luego de bypass gástrico en Y de roux por laparoscopia / Internal hernias following laparoscopic roux en Y gastric bypass

Presentamos nuestra experiencia en el diagnóstico y tratamiento de los pacientes con hernias luego de bypass gástrico en Y de Roux por laparoscopia (BGYRL) debido a obesidad mórbida. Se revisaron las historias de una serie`prospectiva de pacientes sometidos a BGYRL, incluyéndose para el análisis a aquellos casos con diagnóstico de hernia interna posoperatoria. Se determinó el tiempo de presentación, síntomas hallazgos radiológicos, abordaje quirúrgico, tipo de hernía, técnica quirúrgica, y morbilidad. Desde enero de 2004 a diciembre de 2009 intervenimos 512 pacientes con obesidad mórbida mediante BGYRL, utilizando una posición antecólica del asa alimentaria, sin cerrar los defectos mesentéricos. Se reoperaron 30 pacientes (5.8%) debido a hernia interna, de los cuales 27 (90%) se pudieron resolver mediante un abordaje laparoscópico. El tiempo promedo de presentación fue de 20 meses, y el principal síntoma dolor abdominal postprandial. La radiología simple de abdomen fue positiva sólo en 8 casos (26.6%). Una`paciente falleció debido a infarto intestinal masivo y sepsis intraabdominal para una mortalidad de 3.3%. Se concluye que las hernias internas constituyen la complicación tardia con mayor potencial de letalidad luego de BGYRL, por lo que es necesario un alto índice de sospecha clínico para un diagnóstico y tratamiento tempranos.

We present our experience in the diagnosis and treatment of patients with internal hernias following laparoscopic Roux en Y gastric bypass (LRYGB) for morbid obesity. The records of a prospective series of patients submitted to LRYGB were reviewed, including for the analysis those with diagnosis of postoperative internal hernia. Time of onset, symptoms, radiologic findines, surgical approach, type of hernia, surgical technique, and morbidity were determined. From January 2004 to December 2009, 512 morbidity obese patients were submitted to LRYGB, using an antecolic alimentary limb, without closing the mesentetic defects. Thirty patients (5.8%) were reoerated because an internal hernia, 27 of them (90%) solved by laparoscopic approach. Mean time of onset was 20 months, and postprandial abdominal pain was the main symptom. Plain abdominal x-ray was positive only in 8 cases (26.6%) One patient died because intestinal infarction and abdominal sepsis for a 3.3% mortality rate. We concluded that internal hernias are the late complication with most lethality potential after a LRYGB, a high index of clinical suspición is necessary for an early diagnosis and treatment.

Hernias internas luego de bypass gástrico en Y de Roux por laparoscopia / Internal hernias after gastric bypass laparoscopic Roux en Y

Presentamos nuestra experiencia en el diagnóstico y tratamiento de los pacientes con hernias internas luego de bypass gástrico en Y de Roux por laparoscopia debido a obesidad mórbida. Se revisaron las historias de una serie de pacientes sometidos a bypass gástrico en Y de Roux por laparoscopia, incluyéndose para el análisis a aquellos casos con diagnóstico de hernia interna posoperatoria. Se determinó el tiempo de presentación, síntomas, hallazgos radiológicos, abordaje quirúrgico, tipo de hernia, técnica quirúrgica, y morbilidad. Desde enero de 2004 a diciembre de 2009 intervenimos 512 pacientes con obesidad mórbida mediante bypass gástrico en Y de Roux por laparoscopia, utilizando una posición antecólica del asa alimentaria, sin cerrar los defectos mesentéricos. Se reoperaron 30 pacientes (5,8%) debido a hernia interna, de los cuales 27 (90%) se pudieron resolver mediante un abordaje laparoscópico. El tiempo promedio de presentación fue de 20 meses, y el principal síntoma dolor abdominal posprandial. La radiología simple de abdomen fue positiva solo en 8 casos (26,6%). Una paciente falleció debido a infarto intestinal masivo y sepsis intraabdominal para una mortalidad de 3,3%. Se concluye que las hernias internas constituyen la complicación tardía con mayor potencial de letalidad luego de bypass gástrico en Y de Roux por laparoscopia, por lo que es necesario un alto índice de sospecha clínico para un diagnóstico y tratamiento tempranos.

We present our experience in the diagnosis and treatment of patients with internal hernias following laparoscopic Roux Y gastric bypass for morbid obesity. The records of a series of patients submitedd to laparoscopic Roux Y gastric bypass were reviewed, including for the analysis those cases with diagnosis of postoperative internal hernia. Time of onset, symptoms, radiologic findings, surgical approach, type of hernia, surgical technique, and morbidity were determined. From January 2004 to December 2009, 512 morbidly obese patientes were submitted to laparoscopic Roux Y gastric bypass, using an antecolic alimentary limb, without closing the mesenteric defects. Thirty patients (5,8%) were reoperated because an internal hernia, 27 ofthem (90%) solved by laparoscopic approach. Mean time of onset was 20 months, and postprandial abdominal pain was the main symptom. Plain abdominal x-ray was positive only in 8 cases (26,6%). One patient died because intestinal infarction and abdominal sepsis for a 3,3% mortality rate. We concluded that internal hernias are late complication with most lethality potential after a laparoscopic Roux Y gastric bypass, a high index of clinical suspicion is necessary for an early diagnosis and treatment.