LONG TERM RESULTS AFTER ROUX-EN-Y GASTRIC BYPASS ON VERTICAL BANDED GASTROPLASTY WITH EXPLORABLE REMNANT: DOES THE PRESENCE OF A GASTRO-GASTRIC OUTLET IMPACT ON FINAL OUTCOMES IN TERM OF METABOLIC EFFICACY AND WEIGHT LOSS?

Background. Functional RYGB have been abandoned in 2004 since a great rate of complication had been observed. Roux-en-Y Gastric Bypass on Vertical Banded Gastroplasty is a functional RYGB procedure wich demonstrated a low long term complication rate. Aim of the study is to verify the remission rate of most common comorbidities observed in obese patients and theweight loss at long term follow-up. Methods. Since June 2002 to December 2011 363 patients (90 males, 273 females) with mean age 41.8±10.9 years and mean preoperative BMI 47.56±8.4 Kg/m2 (EBW% 99±36.2) underwent RYGB. A 1.1 cm gastro-gastric outlet ad the edge of gastric pouch was left in place and reinforced with a gore-tex band. Among them, Type II DM was reported in 88 (24.2 %) cases, antihypertensive medications were necessary in 178 (49.0%), hypercholesterolemia was observed in 88 cases (24.2 %). Sleep apnea (OSAS) was observed in 97 patients (26.7 %). Postoperative follow-up was assessed with specific laboratory test, upper gastrointestinal series, and medical examination at 3-6-12 months, then annually. Results. Long term weigh loss was good according with success criteria of Christou, with mean EWL% (±SD) 55.4(±16.8) after 6 months,67.4(±18.1) after 1 year,69.2±17.9 after 2 years, with few changes until 60.0(±20.5) after 10 years. Drop out rat was less than 10 %. Remission of diabetes was observed in 83 patients (94.3 %). Preoperative diabetic patients reached worse results than non-diabetics (5 years BMI 35.7±6.7 vs 31.6±5.9 Kg/m2). Remission of hypertension was observed in 156 patients (87.6 %). Preoperative blood glucose and Hb1Ac in diabetic patients were 157.0±44.3 mg/dl and 7.2±1.1%and dropped to 97.8±26.6 and 4.6±2.2 after 6months, and to 93.9±24.2 and 5.6±1.1 a 4 years (p<0.0001). Total cholesterol levels dropped from197.2±35.9 mg/dl preoperatively to 169.9±31.9 at 6 months, and assessed to 182.5± 31.3 after 4 years. Remission of OSAS was observed in 95 patients (98.9 %). Discussion. The outcomes of this series are similar to those obtained after standard RYGB. Even if not inflatable, the small size of gastro-gastric outlet didn’t allow the passage of big amount of chyme (confirmed at barium swallow) and didn‘t’ determine such complications due to pathologic gastro-gastric fistula. Nonetheless the traditional endoscopy of gastric remnant was always possible when performed. Conclusions. An outlet for endoscopic study of gastric remnant doesn’t compromise the metabolic effects of RYGB, neither in term of weight loss, or the impact on metabolic comorbidities.