Mid-term outcomes of Roux-en-Y Gastric Bypass on Vertical Banded Gastroplasty

Background Since 2002, we developed the Roux-en-Y Gastric Bypass on Vertical Banded Gastroplasty (RYGB-on-VBG) in open surgery. In the short-term the procedure has resulted to be effective; the weight loss curve was similar to standard RYGB, while allowing the traditional x-ray and endoscopy of the bypassed stomach: in this study mid-term outcomes were evaluated. Methods From June 2002 to June 2008, 232 patients, 173 female and 59 male, with age 42 ± 11.6 SD years, BMI 48.4 ± 8.5 SD kg/m² underwent RYGB-on-VBG via an open approach. The preoperative comorbidities were hypertension (45.7%) hyperlipidemia (35.0 %). OSAS (25 %), and type II DM (13.5 %). Follow-up was scheduled at 3, 6, and 12 months, and annually thereafter, and include: clinical control and blood examinations; x-ray study with barium; upper endoscopy if needed. Results The mean preoperative BMI decreased from 48.4 ± 8.4 kg/m² to 35.3 ± 6.3, 32.7 ± 5.8, 31.6 ± 5.9, 31.2 ± 6.1, 32.4 ± 6.8 and 32.2 ± 6.5 kg/m² after 6 months and 1, 2, 3, 4 and 5 years, respectively. The percentages resolution of comorbidities were: OSAS 89%; type II DM 83%, hypertension 45%; hyperlipidemia 30%. For every patient followed-up, the radiographic studies and/or a gastroscopy provided the details of the postoperative anatomy, including the bypassed stomach and duodenum. Conclusion Even at medium-term the outcomes of RYGB-on-VBG have been good: the weight loss curve and the resolution of comorbidities were comparable to standard RYGB; moreover this procedure enables traditional diagnostic evaluation of the stomach, which is only functionally excluded.